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Walsh LE, Polacek LC, Panageas K, Reiner A, Walbert T, Thomas AA, Buthorn J, Sigler A, Prigerson HG, Applebaum AJ, Diamond EL. Coping with glioblastoma: prognostic communication and prognostic understanding among patients with recurrent glioblastoma, caregivers, and oncologists. J Neurooncol 2022; 158:69-79. [PMID: 35437688 PMCID: PMC10022487 DOI: 10.1007/s11060-022-04010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/07/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Glioblastoma (GBM) is a devastating neuro-oncologic disease with invariably poor prognosis. Despite this, research shows patients have unrealistic perceptions of their prognosis, which may relate in part to communication patterns between patients, caregivers and oncologists. The purpose of this study was to examine communication processes and goals among patients, caregivers, and oncologists to elucidate drivers of prognostic understanding (PU) in the context of recurrent GBM. METHODS This was a prospective, multi-center study enrolling adult patients with GBM, caregivers, and oncologists, who independently reported the content of a specific discussion involving the disclosure of GBM recurrence. Communication processes and goals were characterized for each participant, and concordance between all dyads and patient-caregiver-oncologist triads were calculated. RESULTS Seventeen patient, caregiver, and oncologist triads were analyzed. At the individual level, three (17.6%) patients and 8 (47.1%) caregivers reported having discussed prognosis during the clinical encounter, as compared to ten oncologists (58.8%). Seven patients (41.2%) and 5 caregivers (29.4%), versus thirteen oncologists (76.5%) reported ever discussing prognosis or life expectancy at previous appointments. Generally, patient-caregiver concordance (i.e., both answered the same) regarding communication goals and processes was low. Triads showed limited concordant responses in discussing curability (n = 5), prognosis (n = 4), end-of-life treatment goals (n = 4), and ever discussing prognosis (n = 3). CONCLUSION Patients, caregivers and oncologists had discordant views regarding communication processes and prognostic goals, even when recalling a single discussion. This study highlights the importance of clear and frequent communication about prognosis, and the need for further research on communication and PU in the neuro-oncology setting.
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Affiliation(s)
- Leah E Walsh
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura C Polacek
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System and Department of Neurology Wayne State University, Detroit, MI, USA
| | - Alissa A Thomas
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allison Sigler
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Holly G Prigerson
- Department of Medicine, Center for Research on End of Life Care, Weill Cornell Medicine, New York, NY, USA
| | - Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Applebaum AJ, Polacek LC, Walsh L, Reiner AS, Lynch K, Benvengo S, Buthorn J, Atkinson TM, Mao JJ, Panageas KS, Diamond EL. The unique burden of rare cancer caregiving: caregivers of patients with Erdheim-Chester disease. Leuk Lymphoma 2020; 61:1406-1417. [PMID: 32090658 DOI: 10.1080/10428194.2020.1719090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Research examining the experience of informal caregivers (ICs) for patients with rare cancers is limited. This was a mixed-methods pilot study of 14 ICs for patients with Erdheim-Chester disease (ECD), an ultra-rare neoplasm. Participants were predominantly female and over half provided at least 60% of their loved one's care. Participants completed measures of the impact of caregiving, caregiver burden, unmet needs, quality of life, anxiety, and depression. Participants reported substantial impact of caregiving, including limiting (50%) or discontinuing (21%) paid employment, and exhausting financial savings (43%). ICs reported a moderate level of burden with five (38%) reporting risk for burnout. While participants reported anxiety (64%) and depression (14%), their overall quality of life was favorable. Semi-structured interviews highlighted factors related to the distress and isolation of navigating a rare cancer. ECD ICs report burden and distress shaped by the experience of providing care for a patient with a rare cancer.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Laura C Polacek
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leah Walsh
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie Benvengo
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Weill Cornell Medical College, New York, NY, USA.,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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3
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Umemura Y, Weill B, Khan B, Buthorn J, Ridder A, Nevel K, Panageas K, Boire A. HOUT-08. PATIENT AND PHYSICIAN PERSPECTIVES ON LUMBAR PUNCTURE. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVE
To investigate patients’ and physicians’ perceptions of lumbar puncture (LP) and tolerability.
METHODS
Adult patients were surveyed prior to and after the procedure regarding patient perceptions and actual experience of LP. Presence of symptoms pre- and post-LP were compared by McNemar test; symptom severity score was rated 0–10, compared by Wilcoxon test; and relative risks were compared by Fisher’s exact test. In addition to patient surveys, email requests to complete an eight-question survey regarding LP tolerability was sent to faculty physicians at two academic centers.
RESULTS
A total of 154 patients and 302 physicians completed the surveys during 1/2017-5/2019. Ninety-one patients (59%) reported anxiety prior to-LP compared to 52 (34%) who reported anxiety after the LP (p< 0.0001). Whereas 74% of patients predicted LP to be painful prior to LP, only 48% reported that LP was painful after the procedure (p< 0.0001). On an 11-point scale, patients anticipated significantly greater pain from LP than they reported after the procedure (mean 3.4 and 2.0 respectively, p< 0.0001). Patients who anticipated pain were more likely to experience pain (RR=1.65, 95% CI 1.07–2.73). There was no significant difference in symptoms such as headache, nausea, generalized pain, vision or gait disturbance before and after the procedure. After the LP, 117 patients (77%) answered they would repeat LP if recommended by their doctors. Out of 302 physicians (40% women), the majority (81%) felt that the LP induces anxiety or worry in patients, and 50% answered that the LP is painful for patients in general.
CONCLUSION
We observed that although anticipation of pain contributed to pre-procedure anxiety, LP was generally well-tolerated. The majority of patients experienced minimal pain. The results of this study suggest that measures to reduce pre-procedure anxiety may improve the tolerability of LP, an important diagnostic tool in neuro-oncology.
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Affiliation(s)
| | - Benjamin Weill
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Baber Khan
- University of Michigan, Ann Arbor, MI, USA
| | - Justin Buthorn
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Adrienne Boire
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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4
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Diamond EL, Durham BH, Ulaner GA, Drill E, Buthorn J, Ki M, Bitner L, Cho H, Young RJ, Francis JH, Rampal R, Lacouture M, Brody LA, Ozkaya N, Dogan A, Rosen N, Iasonos A, Abdel-Wahab O, Hyman DM. Efficacy of MEK inhibition in patients with histiocytic neoplasms. Nature 2019; 567:521-524. [PMID: 30867592 PMCID: PMC6438729 DOI: 10.1038/s41586-019-1012-y] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022]
Abstract
Histiocytic neoplasms are a heterogeneous group of clonal hematopoietic disorders marked by diverse mutations in the mitogen-activated protein kinase (MAPK) pathway.1,2 For the 50% of histiocytosis patients with BRAFV600-mutations3–5, RAF inhibition is highly efficacious and has dramatically altered the natural history of the disease.6,7 Conversely, no standard therapy exists for the remaining 50% of patients lacking BRAFV600-mutations. While ERK dependence has been hypothesized to be a consistent feature across histiocytic neoplasms, this remains clinically unproven and many kinase mutations found in these patients have not been biologically characterized. We set out to evaluate ERK dependence in histiocytoses through a proof-of-concept clinical trial of the oral MEK1/2 inhibitor cobimetinib in patients with histiocytoses. Patients were enrolled regardless of tumor genotype. In parallel, novel MAPK alterations identified in treated patients were characterized for their ability to activate ERK. In 18 treated patients, the overall response rate (ORR) was 89% (90% CI: 73–100). Responses were durable, with no acquired resistance to date. At one year, 100% of responses were ongoing, and 94% of patients remained progression-free. Efficacy was observed regardless of genotype with responses achieved in patients with ARAF, BRAF, RAF1, NRAS, KRAS, MEK1, and MEK2 mutations. Consistent with observed responses, characterization of the novel mutations identified in treated patients confirmed them to be activating. Collectively, these data demonstrate that histiocytic neoplasms are characterized by remarkable dependence on MAPK signaling and, consequently, responsiveness to MEK inhibition. These results extend the benefits of molecularly targeted therapy to the entire spectrum of patients with histiocytosis.
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Affiliation(s)
- Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Benjamin H Durham
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary A Ulaner
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther Drill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Ki
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillian Bitner
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hana Cho
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Young
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raajit Rampal
- Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario Lacouture
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lynn A Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neval Ozkaya
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neal Rosen
- Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Weill Cornell Medical College, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Omar Abdel-Wahab
- Weill Cornell Medical College, New York, NY, USA. .,Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - David M Hyman
- Weill Cornell Medical College, New York, NY, USA. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Diamond EL, Prigerson HG, Correa DC, Reiner A, Panageas K, Kryza-Lacombe M, Buthorn J, Neil EC, Miller AM, DeAngelis LM, Applebaum AJ. Prognostic awareness, prognostic communication, and cognitive function in patients with malignant glioma. Neuro Oncol 2018. [PMID: 28645200 DOI: 10.1093/neuonc/nox117] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Malignant glioma (MG) is a devastating neuro-oncologic disease with almost invariably poor prognosis. Prognostic awareness (PA) is the awareness of incurable disease and shortened life expectancy (LE). Accurate PA is associated with favorable psychological outcomes at the end of life (EoL) for patients with cancer; however, little is known about PA or prognostic communication in MG. Moreover, research has yet to evaluate the impact of cognitive impairment on PA and preferred forms of communication. Methods Fifty MG patients and 32 paired caregivers were evaluated in this exploratory study with a semi-structured PA assessment aimed to measure their awareness of MG incurability and LE. Full PA was defined as awareness of MG incurability and accurate estimate of LE. The assessment included a survey about preferences for prognostic communication (items from the Prognosis and Treatment Perceptions Questionnaire), neurocognitive assessment (Hopkins Verbal Learning Test-Revised, Trail Making Test Parts A and B, and the Controlled Oral Word Association Test), and measurements of mood (Hospital Anxiety and Depression Scale) and quality of life (Functional Assessment of Cancer Therapy-Brain [FACT-Br]). Results Twenty (40%) patients and 22 (69%) caregivers had full PA. Thirty (60%) patients and 23 (72%) caregivers reported that prognostic information was extremely or very important, and 21 (42%) patients and 16 (50%) caregivers desired more prognostic information. Patients with memory impairment more frequently believed that prognostic information was important (P = 0.04, P = 0.03) and desired more information (P = 0.05, P = 0.003) as compared with those without impairment. Conclusions Most MG patients were unaware of their LE. Memory impairment may influence preferences for prognostic information.
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Affiliation(s)
- Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Holly G Prigerson
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Denise C Correa
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Reiner
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine Panageas
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Kryza-Lacombe
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth C Neil
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alex M Miller
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Allison J Applebaum
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Research on End of Life Care, Weill Cornell Medical College, New York, New York; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
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6
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Sousa A, Gomar JJ, Ragland JD, Conejero-Goldberg C, Buthorn J, Keehlisen L, Huey TE, Koppel J, Gordon ML, Christen E, Goldberg TE. The Relational and Item-Specific Encoding Task in Mild Cognitive Impairment and Alzheimer Disease. Dement Geriatr Cogn Disord 2018; 42:265-277. [PMID: 27723653 DOI: 10.1159/000448170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Relational and Item-Specific Encoding task (RISE) measures episodic memory subcomponents, including item-specific and relational encoding of to-be-remembered stimuli. These memory components are neurobiologically relevant because they may engage distinct subregions of the medial temporal lobe, perirhinal and entorhinal cortices, parahippocampus, and hippocampus. METHODS A total of 125 participants, including 84 healthy controls (HC), 22 mild cognitive impairment-diagnosed and 19 Alzheimer disease (AD)-diagnosed participants, were administered the RISE and neuropsychological measures. Stepwise linear regressions assessed prediction of functional ability from RISE d' measures. ANOVAs and logistic regressions determined the ability of the RISE to discriminate between the diagnostic groups. In addition, the psychometric properties of the RISE were examined. RESULTS RISE measures predicted diagnosis with pseudo R2 values in the range of 0.25-0.30. Receiver operating characteristic curves demonstrated adequate sensitivity and specificity with areas under the curve in the range of 0.78-0.98. Memory following relational encoding was a significant predictor of everyday functional competence. The RISE had acceptable psychometric properties, with the exception of floor effects in the AD group. CONCLUSION The RISE measures significantly predicted diagnosis and predicted everyday functional competence. The RISE offers unique advantages in the assessment of HC and individuals with preclinical AD.
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Affiliation(s)
- Amber Sousa
- The Litwin-Zucker Research Center, The Feinstein Institute for Medical Research, Manhasset, N.Y., USA
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7
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Umemura Y, Weill B, Buthorn J, Boire A. NTOX-15. PATIENT PERSPECTIVES ON LUMBAR PUNCTURE. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Applebaum AJ, Kryza-Lacombe M, Buthorn J, DeRosa A, Corner G, Diamond EL. Existential distress among caregivers of patients with brain tumors: a review of the literature. Neurooncol Pract 2015; 3:232-244. [PMID: 31385976 DOI: 10.1093/nop/npv060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Indexed: 11/14/2022] Open
Abstract
Background Attention to existential needs is a component of comprehensive oncologic care, and understanding these needs among informal caregivers of patients with brain tumors is necessary to provide them with comprehensive psychosocial care. The purpose of this systematic review was to synthesize the literature on existential distress experienced by these informal caregivers to inform the development of psychotherapeutic interventions for this population. Methods A systematic review was conducted using electronic medical databases. Studies that examined any element of existential distress among informal caregivers of patients with brain tumors were included. A final sample of 35 articles was reviewed. Results Six existential themes emerged: identity; isolation; responsibility and guilt; death anxiety; deriving meaning and personal growth; and spirituality and religion. The unique existential experience of parenting a patient with a brain tumor also emerged. Existential distress in all areas was identified as experienced early in the cancer trajectory and as a critical, unmet need. Conclusions Existential distress is well documented among informal caregivers of patients with brain tumors and is a significant driving force of burden. Awareness and acknowledgement of this distress, as well as interventions to ameliorate this suffering, are needed. More candid communication between health care providers and caregivers about brain tumor prognosis and caregivers' existential distress may improve their psychosocial outcomes.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (A.J.A.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (M.K.L., J.B., E.L.D.); Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (A.D.); Department of Psychology, University of Southern California, Los Angeles, California (G.C.)
| | - Maria Kryza-Lacombe
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (A.J.A.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (M.K.L., J.B., E.L.D.); Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (A.D.); Department of Psychology, University of Southern California, Los Angeles, California (G.C.)
| | - Justin Buthorn
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (A.J.A.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (M.K.L., J.B., E.L.D.); Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (A.D.); Department of Psychology, University of Southern California, Los Angeles, California (G.C.)
| | - Antonio DeRosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (A.J.A.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (M.K.L., J.B., E.L.D.); Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (A.D.); Department of Psychology, University of Southern California, Los Angeles, California (G.C.)
| | - Geoff Corner
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (A.J.A.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (M.K.L., J.B., E.L.D.); Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (A.D.); Department of Psychology, University of Southern California, Los Angeles, California (G.C.)
| | - Eli L Diamond
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York (A.J.A.); Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (M.K.L., J.B., E.L.D.); Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York (A.D.); Department of Psychology, University of Southern California, Los Angeles, California (G.C.)
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9
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Diamond E, Prigerson H, Panageas K, Correa D, Kryza-Lacombe M, Neil E, Reiner A, Buthorn J, Breitbart W, DeAngelis L, Applebaum A. HCP-08PROGNOSTIC AWARENESS AND PROGNOSTIC COMMUNICATION IN MALIGNANT GLIOMA. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov216.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Koppel J, Jimenez H, Azose M, D'Abramo C, Acker C, Buthorn J, Greenwald BS, Lewis J, Lesser M, Liu Z, Davies P. Pathogenic tau species drive a psychosis-like phenotype in a mouse model of Alzheimer's disease. Behav Brain Res 2014; 275:27-33. [PMID: 25151619 DOI: 10.1016/j.bbr.2014.08.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 01/30/2023]
Abstract
Psychotic Alzheimer's disease (AD+P) is a rapidly progressive variant of AD associated with an increased burden of frontal tau pathology that affects up to 50% of those with AD, and is observed more commonly in females. To date, there are no safe and effective medication interventions with an indication for treatment in this condition, and there has been only very limited exploration of potential animal models for pre-clinical drug development. Pathogenic tau is over represented in the frontal cortex in AD+P, especially in females. In order to develop a candidate animal model of AD+P, we employed a tau mouse model with a heavy burden of frontal tau pathology, the rTg(tauP301L)4510 mouse, hereafter termed rTg4510. We explored deficits of prepulse inhibition of acoustic startle (PPI), a model of psychosis in rodents, and the correlation between pathogenic phospho-tau species associated with AD+P and PPI deficits in female mice. We found that female rTg4510 mice exhibit increasing PPI deficits relative to littermate controls from 4.5 to 5.5 months of age, and that these deficits are driven by insoluble fractions of the phospho-tau species pSer396/404, pSer202, and pThr231 found to be associated with human AD+P. This preliminary data suggests the utility of the rTg4510 mouse as a candidate disease model of human female AD+P. Further work expanded to include both genders and other behavioral outcome measures relevant to AD+P is necessary.
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Affiliation(s)
- J Koppel
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA.
| | - H Jimenez
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - M Azose
- Touro College, Brooklyn, NY, USA
| | - C D'Abramo
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - C Acker
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - J Buthorn
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - B S Greenwald
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - J Lewis
- Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Lesser
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Z Liu
- Hofstra University, Hempstead, LI, USA
| | - P Davies
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
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