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White LL, Kupzyk KA, Berger AM, Cohen MZ, Bierman PJ. Self-efficacy for symptom management in the acute phase of hematopoietic stem cell transplant: A pilot study. Eur J Oncol Nurs 2019; 42:21-27. [PMID: 31446260 DOI: 10.1016/j.ejon.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Hematopoietic stem cell transplant (HSCT) is an intensive treatment associated with distressing treatment and disease-related symptoms that affect patient outcomes such as functional status and quality of life. Self-efficacy for symptom management (SESM) is a person's belief in their ability to perform behaviors to prevent and relieve symptoms. Presence of SESM can impact symptom distress and functional status. This study describes the changes over time and relationships among SESM, symptom distress, and physical functional status in adults during the acute phase of HSCT. METHODS Patients (n = 40) completed measures of symptom distress, SESM, and physical function at time points prior to and at days 7, 15 and 30 post-transplant. Clinical outcomes were length of stay and number of readmissions. RESULTS Symptom distress, physical function, and SESM changed significantly over time. There was a significant negative relationship between symptom distress and physical function and between symptom distress and SESM at all points. The lowest levels of SESM and physical function were at day 7 when symptom distress was highest. Symptom distress was a moderator for the relationship between physical function and SESM at day 15. CONCLUSION This was the first study to examine SESM in the acute phase of HSCT. Higher SESM was associated with fewer symptoms and increased physical function. Less symptom distress was associated with higher physical function and confidence to manage symptoms. These findings provide the basis for development of patient-centered interventions to enhance SESM when symptoms are at their highest immediately after HSCT.
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Affiliation(s)
- Lynn L White
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, USA; Avera McKennan Hospital and University Health Center, 1325 S Cliff Ave, Sioux Falls, SD, 57105, USA; Augustana University, 2001 S Summit Ave, Sioux Falls, SD, 57197, USA.
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Ann M Berger
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Marlene Z Cohen
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Ave, Omaha, NE, 68105, USA.
| | - Philip J Bierman
- College of Medicine, University of Nebraska Medical Center, Department of Internal Medicine, Division of Oncology & Hematology, 983332 Nebraska Medical Center, Omaha, NE, 68198, USA.
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Taher AT, Origa R, Perrotta S, Kouraklis A, Ruffo GB, Kattamis A, Goh AS, Huang V, Zia A, Herranz RM, Porter JB. Patient-reported outcomes from a randomized phase II study of the deferasirox film-coated tablet in patients with transfusion-dependent anemias. Health Qual Life Outcomes 2018; 16:216. [PMID: 30453981 PMCID: PMC6245526 DOI: 10.1186/s12955-018-1041-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/31/2018] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Adherence to long-term chelation therapy in transfusion-dependent patients is critical to prevent iron overload-related complications. Once-daily deferasirox dispersible tablets (DT) have proven long-term efficacy and safety in patients ≥2 years old with chronic transfusional iron overload. However, barriers to optimal adherence remain, including palatability, preparation time, and requirements for fasting state. A new film-coated tablet (FCT) formulation was developed, swallowed once daily (whole/crushed) with/without a light meal. METHODS The open-label, Phase II ECLIPSE study evaluated patient-reported outcomes (PROs) in transfusion-dependent thalassemia or lower-risk myelodysplastic syndromes patients randomized 1:1 to receive deferasirox DT or FCT over 24 weeks as a secondary outcome of the study. Three PRO questionnaires were developed to evaluate both deferasirox formulations: 1) Modified Satisfaction with Iron Chelation Therapy Questionnaire; 2) Palatability Questionnaire; 3) Gastrointestinal (GI) Symptom Diary. RESULTS One hundred seventy three patients were enrolled; 87 received the FCT and 86 the DT formulation. FCT recipients consistently reported better adherence (easier to take medication, less bothered by time to prepare medication and waiting time before eating), greater satisfaction/preference (general satisfaction and with administration of medicine), and fewer concerns (less worry about not swallowing enough medication, fewer limitations in daily activities, less concern about side effects). FCT recipients reported no taste or aftertaste and could swallow all their medicine with an acceptable amount of liquid. GI summary scores were low for both formulations. CONCLUSIONS These findings suggest a preference in favor of the deferasirox FCT formulation regardless of underlying disease or age group. Better patient satisfaction and adherence to chelation therapy may reduce iron overload-related complications. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02125877; registered April 26, 2014.
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Affiliation(s)
- Ali T Taher
- Department of Internal Medicine, Director - Fellowship and Residents Research Program, Faculty of Medicine American University of Beirut Medical Center, Beirut, Lebanon.
- Emory School of Medicine, Atlanta, USA.
| | - Raffaella Origa
- Ospedale Pediatrico Microcitemico 'A.Cao', A.O. 'G. Brotzu', Cagliari, Italy
| | | | - Alexandra Kouraklis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Giovan Battista Ruffo
- U.O.C. Ematolog. Con Talassemia, A.O. Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Antonis Kattamis
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Ai-Sim Goh
- Department of Medicine, Hospital Pulau Pinang, Georgetown, Penang, Malaysia
| | - Vicky Huang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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El-Jawahri A, Vandusen H, Traeger L, Fishbein JN, Keenan T, Gallagher ER, Greer JA, Pirl WF, Jackson VA, Spitzer TR, Chen YBA, Temel JS. Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer 2016; 122:806-12. [PMID: 26650840 PMCID: PMC4788001 DOI: 10.1002/cncr.29818] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [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: 09/08/2015] [Revised: 10/27/2015] [Accepted: 11/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND During hospitalization for hematopoietic stem cell transplantation (HCT), patients experience a steep deterioration in quality of life (QOL) and mood. To our knowledge, the impact of this deterioration on patients' QOL and posttraumatic stress disorder (PTSD) symptoms after HCT is unknown. METHODS We conducted a prospective longitudinal study of patients hospitalized for HCT. They assessed QOL using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at the time of admission for HCT, during hospitalization, and 6 months after HCT. We also used the Hospital Anxiety and Depression Scale (HADS) to measure patients' anxiety and depression symptoms at baseline and during HCT hospitalization. The PTSD Checklist was used to assess for PTSD symptoms. Multivariable linear regression models were used to identify predictors of QOL and PTSD symptoms at 6 months. RESULTS We enrolled 90 of 93 consecutively eligible patients (97%) undergoing autologous and allogeneic HCT. Data at 6 months were available for 67 participants. At 6 months, 28.4% of participants met the criteria for PTSD and 43.3% had clinically significant depression. On multivariable regression analyses adjusting for significant covariates, changes in QOL and depression scores from week 2 of HCT hospitalization to baseline predicted worse QOL (changes in scores between week 2 and baseline [Δ] QOL: β, 0.94 [P<.0001] and Δ PHQ-9: β, -2.59 [P = 0.001]) and PTSD symptoms (Δ QOL: β, -0.40 [P<.0001] and Δ PHQ-9: β, 1.26 [P<.0001]) at 6 months after HCT. CONCLUSIONS Six months after HCT, a significant percentage of patients met the criteria for PTSD and depression. A decline in QOL and an increase in depressive symptoms during hospitalization for HCT were found to be the most important predictors of 6-month QOL impairment and PTSD symptoms. Therefore, managing symptoms of depression and QOL deterioration during HCT hospitalization may be critical to improving QOL at 6 months and reducing the risk of PTSD. Cancer 2016;122:806-812. © 2015 American Cancer Society.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Harry Vandusen
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Lara Traeger
- Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston MA
| | - Joel N. Fishbein
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Tanya Keenan
- Massachusetts General Hospital, Department of Internal Medicine, 55 Fruit Street, Boston MA
| | - Emily R. Gallagher
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Joseph A. Greer
- Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston MA
| | - William F. Pirl
- Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston MA
| | - Vicki A. Jackson
- Massachusetts General Hospital, Palliative Care Department, 55 Fruit Street, Boston MA
| | - Thomas R. Spitzer
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Yi-Bin A. Chen
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Jennifer S. Temel
- Massachusetts General Hospital, Department of Hematology-Oncology, 55 Fruit Street, Boston MA
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Meadows ME, Chang G, Jones JA, Antin JR, Orav EJ. Predictors of neuropsychological change in patients with chronic myelogenous leukemia and myelodysplastic syndrome. Arch Clin Neuropsychol 2013; 28:363-74. [PMID: 23391504 PMCID: PMC3656510 DOI: 10.1093/arclin/acs141] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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] [Accepted: 12/16/2012] [Indexed: 11/14/2022] Open
Abstract
This study examined the course of neuropsychological functioning in patients with chronic myelogeous leukemia (n = 91) or myelodysplastic syndrome (n = 15) who underwent standard treatment for their disease or allogeneic hematopoietic stem cell transplantation (HSCT) at baseline, 12 months, and 18 months post-treatment. At baseline, 23% of the participants (n = 75) in the longitudinal sample had Z-scores on at least one of the neuropsychological tests that were <1.4. Participants in the study showed improvement over baseline at the 12 and 18 months assessments. The average Z-scores for the six cognitive domains in the longitudinal data set over the course of the study ranged from -0.89 to 0.59. Significant predictors of change in neuropsychological test scores included age, with older participants showing less improvement over time. Other predictors included baseline cognitive domains (language, memory, and attention), previous cocaine use, disease status, intelligence quotient, and quality of life measures. Findings support previous studies in patients with hematological malignancies who showed cognitive impairments at baseline prior to HSCT. However, there was little evidence for further cognitive decline over the course of 18 months.
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Affiliation(s)
- Mary-Ellen Meadows
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Pinchon DJ, Stanworth SJ, Dorée C, Brunskill S, Norfolk DR. Quality of life and use of red cell transfusion in patients with myelodysplastic syndromes. A systematic review. Am J Hematol 2009; 84:671-7. [PMID: 19705430 DOI: 10.1002/ajh.21503] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The main treatment for many patients with Myelodysplastic Syndromes (MDS) remains red cell transfusion to attenuate the symptoms of chronic anemia. Fatigue can reduce a patient's health related quality of life (HRQoL), but there is little understanding of the optimal use of transfusions to improve this. A systematic review was performed to identify and appraise publications reporting the use of HRQoL instruments in patients with MDS. A total of 17 separate studies were identified that used 14 HRQoL instruments, but only one MDS disease specific HRQoL instrument (QOL-E) was reported. Two well established HRQoL instruments were most often used in MDS research (variants of the Functional Assessment of Cancer Therapy (FACT) and the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30)). Several common problems were identified in the published literature including a lack of power calculations to detect clinically relevant changes, small sample sizes and significant attrition rates for completion of HRQoL assessments, all of which limit the strength of any conclusions. There is no consensus on the optimal transfusion regimen to improve HRQoL in transfusion-dependent MDS. Future research into HRQoL within MDS is a pressing requirement. Studies should focus on the domains that are of most clinical importance to the patient as well as traditional quantitative changes of hemoglobin concentration.
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Heptinstall K. Quality of life in myelodysplastic syndromes. A special report from the Myelodysplastic Syndromes Foundation, Inc. Oncology (Williston Park) 2008; 22:13-19. [PMID: 18434977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Patients diagnosed with myelodysplastic syndromes (MDS) typically report that they have no idea what MDS is. The heavy physical toll of MDS and its management, such as the need for frequent blood work, blood transfusions, red cells or platelets, and physician visits, as well as the debilitating fatigue experienced by some patients, often leads to a diminished quality of life (QoL). The impact of MDS on QoL is much greater than is generally appreciated, and though difficult to quantify, data that document the wide-ranging effects of MDS on patients' lives-both negative and positive--are accumulating. A broadened understanding of QoL aspects of MDS by physicians and nurses--the impact of an MDS diagnosis, of living with MDS every day, and of MDS-specific management approaches and treatments-can only improve clinicians' communication with, and care of, these patients. This special report highlights QoL findings from patient and caregiver forums conducted by The MDS Foundation, Inc. in the United States and in Europe.
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Thomas ML. Strategies for achieving transfusion independence in myelodysplastic syndromes. Eur J Oncol Nurs 2007; 11:151-8. [PMID: 16935559 DOI: 10.1016/j.ejon.2006.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 06/23/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
Myelodysplastic syndromes (MDS) are a group of complex diseases of the myeloid stem cell that result in chronic cytopenias. In some instances, these disorders may progress to acute myeloid leukemia. Patients with MDS frequently experience chronic, symptomatic anemia, and many become dependent on chronic transfusions of packed red blood cells. However, long-term transfusion dependence has clinical and economic consequences, including a potentially negative impact on patients' quality of life (QOL). Recently, studies have investigated various strategies to reduce or eliminate transfusion needs in MDS patients. Supportive measures with hematopoietic growth factors such as erythropoietin are often less effective in MDS-associated anemia than in anemia from other causes, but some patients may benefit from this approach. Treatment with other agents, such as antithymocyte globulin, azacitidine, decitabine, thalidomide, and lenalidomide, has resulted in transfusion independence in some subsets of MDS patients. Nurses who care for patients with MDS should be aware of the impact of transfusion dependence on the patient's QOL, as well as the benefits and risks of the various other treatment options available to these patients. Such knowledge will enable the nurse to provide accurate, relevant information, so that patients can make informed choices regarding treatment options for MDS.
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Affiliation(s)
- Mary Laudon Thomas
- VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
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Molnár I, Stark N, Lovato J, Powell BL, Cruz J, Hurd DD, Mathieu JS, Chen TC, Holick MF, Cambra S, McQuellon RP, Schwartz GG. Treatment of low-risk myelodysplastic syndromes with high-dose daily oral cholecalciferol (2000-4000 IU vitamin D(3)). Leukemia 2007; 21:1089-92. [PMID: 17344922 DOI: 10.1038/sj.leu.2404601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Becze E. Clinical, communication, and coping knowledge: the keys to helping MDS patients on their journey to hope. ONS Connect 2007; 22:59-60. [PMID: 17824568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Sekeres MA, Stone RM, Zahrieh D, Neuberg D, Morrison V, De Angelo DJ, Galinsky I, Lee SJ. Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome. Leukemia 2004; 18:809-16. [PMID: 14762444 DOI: 10.1038/sj.leu.2403289] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Older patients with acute myeloid leukemia (AML) and advanced myelodysplastic syndrome (aMDS) must decide between receiving intensive induction chemotherapy (IC) or nonintensive chemotherapy/best supportive care (NIC). Little information exists about what factors influence treatment decisions and what quality of life (QOL) is associated with treatment choices. We prospectively examined 43 patients 60 years or older who were interviewed at diagnosis and periodically over 1 year. IC choice was associated with younger age (66 vs 76 years, P=0.01) and AML diagnosis, but not with performance status, comorbidities, or QOL. In total, 63% of all patients reported not being offered other treatment options despite physician documentation of alternatives. Patient and physician estimates of cure differed significantly: 74% of patients estimated their chance of cure to be 50% or greater, yet for 89% of patients physician estimates of cure were 10% or less. IC patients experienced decreased QOL at 2 weeks, but rebounded to baseline and to NIC levels by 6 weeks. Initial QOL is not associated with treatment choice in older AML and aMDS patients. Regardless of treatment choice, patients report not being offered treatment options and overestimate their chances of cure. In IC patients, QOL decreases during hospitalization but rebounds after discharge.
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Affiliation(s)
- M A Sekeres
- Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Clavio M, Nobili F, Balleari E, Girtler N, Ballerini F, Vitali P, Rosati P, Venturino C, Varaldo R, Gobbi M, Ghio R, Rodriguez G. Quality of life and brain function following high-dose recombinant human erythropoietin in low-risk myelodysplastic syndromes: a preliminary report. Eur J Haematol 2004; 72:113-20. [PMID: 14962248 DOI: 10.1046/j.0902-4441.2003.00183.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In this prospective study we evaluate the effects of high-dose recombinant human erythropoietin (rHuEPO) on quality of life (QOL) and brain function in patients with low-risk myelodysplastic syndromes (MDS) (<10% marrow blasts). Preliminary data are reported. METHODS Eleven consecutive patients were given rHuEPO (40,000 IU two times a week) for 12 wk. Responsive patients continued with 40,000 IU/wk for further 12 wk. Changes in QOL were assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) self-report. Neurophysiological evaluation at the start of the therapy (t0) included duplex scanning of neck vessels, transcranial Doppler sonography (TCD), a complex neuropsychological evaluation, and quantitative electroencephalography (qEEG). Eight patients completed the neurophysiological evaluation after 24 wk (t1). RESULTS Six patients (55%) achieved an erythroid response after 12 wk, which was maintained after 24 wk of treatment. FACT-An score showed a relevant improvement between t0 and t1 in these patients. At baseline, TCD showed a mean cerebral blood flow (CBF) velocity in the upper normal range. Abnormalities in brain function were observed in five patients. In the eight patients who were re-evaluated at t1, improvement was observed in three responding patients, two of them with abnormal values at t0. A strict correlation between QOL and neurophysiological improvements was not observed. CONCLUSIONS A high-dose induction phase with rHuEPO followed by maintenance therapy may be an effective therapeutic schedule for low-risk MDS patients. The erythroid response was associated with positive changes in the QOL. Neurophysiological improvements occurred only in a part (50%) of responding patients, mainly those who showed altered results at baseline.
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Affiliation(s)
- Marino Clavio
- Department of Haematology and Oncology, Azienda Ospedale S. Martino e Cliniche Universitaire Convenzionate, Genova, Italy
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Jansen AJG, Essink-Bot ML, Beckers EAM, Hop WCJ, Schipperus MR, Van Rhenen DJ. Quality of life measurement in patients with transfusion-dependent myelodysplastic syndromes. Br J Haematol 2003; 121:270-4. [PMID: 12694248 DOI: 10.1046/j.1365-2141.2003.04272.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The myelodysplastic syndromes (MDS) are clonal disorders characterized by dysplasia in at least two myeloid cell lines. Fatigue is one of the most significant symptoms. MDS patients are treated with blood transfusions to improve their health-related quality of life (HRQoL). A cross-sectional pilot study was performed for psychometric evaluation of three internationally established HRQoL measures in MDS patients, and for investigation of the association between the severity of chronic anaemia and HRQoL. Fifty consecutive MDS patients completed the Short Form 36, the Multidimensional Fatigue Inventory and the EuroQoL-5D Visual Analogue Scale. Hb level was measured during the same visit. Psychometric analysis focused on feasibility, construct validity and reliability. The questionnaires showed a high feasibility, reliability and validity. MDS patients had worse HRQoL scores than the age- and sex-matched general population. We found a positive correlation between haemoglobin (Hb) level and HRQoL. This study provides insights into the suitability of established HRQoL measures for the evaluation of interventions in MDS patients. Hb value and HRQoL are complementary variables for evaluation of the severity of chronic anaemia in patients with MDS.
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Affiliation(s)
- A J G Jansen
- Sanquin Blood Bank South West Region, Department of Public Health, and Department of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
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Kornblith AB, Herndon JE, Silverman LR, Demakos EP, Odchimar-Reissig R, Holland JF, Powell BL, DeCastro C, Ellerton J, Larson RA, Schiffer CA, Holland JC. Impact of azacytidine on the quality of life of patients with myelodysplastic syndrome treated in a randomized phase III trial: a Cancer and Leukemia Group B study. J Clin Oncol 2002; 20:2441-52. [PMID: 12011121 DOI: 10.1200/jco.2002.04.044] [Citation(s) in RCA: 311] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The impact of azacytidine (Aza C) on the quality of life of 191 patients with myelodysplastic syndrome was assessed in a phase III Cancer and Leukemia Group B trial (9221). PATIENTS AND METHODS One hundred ninety-one patients (mean age, 67.5 years; 69% male) were randomized to receive either Aza C (75 mg/m(2) subcutaneous for 7 days every 4 weeks) or supportive care, with supportive care patients crossing over to Aza C upon disease progression. Quality of life was assessed by centrally conducted telephone interviews at baseline and days 50, 106, and 182. Overall quality of life, psychological state, and social functioning were assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and the Mental Health Inventory (MHI). RESULTS Patients on the Aza C arm experienced significantly greater improvement in fatigue (EORTC, P =.001), dyspnea (EORTC, P =.0014), physical functioning (EORTC, P =.0002), positive affect (MHI, P =.0077), and psychological distress (MHI, P =.015) over the course of the study period than those in the supportive care arm. Particularly striking were improvements in fatigue and psychological state (MHI) in patients treated with Aza C compared with those receiving supportive care for patients who remained on study through at least day 106, corresponding to four cycles of Aza C. Significant differences between the two groups in quality of life were maintained even after controlling for the number of RBC transfusions. CONCLUSION Improved quality of life for patients treated with Aza C coupled with significantly greater treatment response and delayed time to transformation to acute myeloid leukemia or death compared with patients on supportive care (P <.001) establishes Aza C as an important treatment option for myelodysplastic syndrome.
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Affiliation(s)
- Alice B Kornblith
- Women's Cancers Program, Dana-Farber Cancer Institute, Rm. D1210, 44 Binney Street, Boston, MA 02115, USA.
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Weihrauch MR, Rabe K, Kochanek M, Tesch H, Diehl V, Wolf J. [Factitious disorders. Hematologic, neurologic and dermatologic symptoms in a physician with factitious disorder]. Med Klin (Munich) 2001; 96:555-60. [PMID: 11603120 DOI: 10.1007/pl00002241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HISTORY AND FINDINGS A 38-year-old female physician was admitted with the suspected diagnosis of a myelodysplastic syndrome. The self-reported history was inconsistent and incoherent. On physical examination neurological and dermatological disorders could be found. EXAMINATIONS A bone marrow puncture revealed a toxicity-induced bone marrow damage. Extensive examinations to evaluate the neurological symptoms did not show any pathological findings. A toxicological screening identified opioids, benzodiazepines and promethazine. TREATMENT AND COURSE Because of the inconsistent history and the contradictory results of our clinical tests, we asked in other hospitals for past admissions and were thus able to have insight into a hospital career that grasped numerous different admission diagnoses. All presented symptoms, especially the bone marrow damage, were self-induced by the patient. CONCLUSIONS For the first time in this patient's history, a factitious disorder was diagnosed after a hospital career of almost 10 years. In this publication, the case is thoroughly presented. Additionally, the current literature is reviewed with latest recommendations for therapeutic strategies about this poorly understood disorder.
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Abstract
Health-related quality of life (QOL) is a dynamic, subjective, multidimensional concept. In chronic illnesses such as myelodysplastic syndromes (MDS), management typically focuses on control of the disease and its symptoms. Yet an equally important consideration is maintaining the patient's QOL. Much research remains to be done on the subject of QOL in the MDS population. MDS patients have unique problems that can affect QOL: they tend to be elderly and to have comorbid conditions; they develop complications resulting from cytopenias such as infection and bleeding; they experience fatigue; they run the risk of converting to a form of acute leukemia typically resistant to therapy; and they face uncertainty. This paper will address the above problems using a conceptual approach to QOL that has been useful for patients with cancer and various chronic illnesses. The approach, based on the work of Ferrell and Cella, concentrates on five areas of the patient's life: the physical, functional, emotional, social, and spiritual. Actual testing of this conceptual framework in the MDS patient population has begun. Here methods of systematically testing and assessing QOL are discussed in order to help clinicians meet the primary purpose of therapy in the setting of chronic illness: improving or preserving the individual's QOL.
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Affiliation(s)
- M L Thomas
- Veterans Affairs Palo Alto Health Care System, CA 94304, USA
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Weis J, Köchlin G. [Experience in psychosocial management of cancer patients undergoing bone marrow transplantation]. Psychother Psychosom Med Psychol 1993; 43:159-65. [PMID: 8327628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Psychosocial care of cancer patients undergoing bone marrow transplantation. During the last years bone marrow transplantation (BMT) has emerged as a treatment of choice especially for cancer diseases of the haemopoietic system as well as for certain solid tumours. BMT is a very invasive treatment with high dose chemotherapy and total body irradiation, which is accompanied by special psychosocial strains for the patient. Therefore psychosocial care during the acute treatment is needed. In this paper a psychosocial liaison service in a BMT unit as part of a comprehensive psychosocial care on different oncology wards of an acute clinic is presented. Based on a systematic clinical documentation of the psychosocial interventions the practice and problems of the psychosocial care are described. Apart of common problems of psychosocial liaison services known from the literature the experiences show special demands reflecting the special environment of the treatment setting. These problems are discussed with regard to the different target groups (patients, relatives, medical staff). Following the reported experiences some proposals concerning structure and integration of psychosocial care in an BMT unit are given.
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Affiliation(s)
- J Weis
- Abteilung Rehabilitationspsychologie, Psychologisches Institut, Universität Freiburg
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Abstract
The transition of a medical or surgical procedure from impossible to standard therapy requires a stage of experimentation, during which research priorities must be balanced with the interests of the patient. This paper examines such a "first case," and the interpersonal and group dynamics that play a part in the choice of a specific patient to be the first to receive that procedure.
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Affiliation(s)
- M L Stuber
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles 90024-1759
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Larson RA, Wernli M, Le Beau MM, Daly KM, Pape LH, Rowley JD, Vardiman JW. Short remission durations in therapy-related leukemia despite cytogenetic complete responses to high-dose cytarabine. Blood 1988; 72:1333-9. [PMID: 3167210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Seventeen patients with therapy-related myelodysplastic syndrome (t-MDS) or therapy-related acute nonlymphocytic leukemia (t-ANLL) were treated with single-agent high-dose cytarabine (HDAC; 1 to 3 g/m2 every 12 hours for 12 doses). The initial neoplasm was still present in eight patients when t-MDS/t-ANLL developed. Fifteen of the 16 patients with chromosomal abnormalities in bone marrow cells had loss or rearrangement of chromosomes 5 and/or 7. One patient had a t(15;17), and one had inadequate material for cytogenetic analysis. Twelve patients had normal metaphase cells (3% to 71%). Indications for HDAC therapy were progressive pancytopenia in 13 patients or rising blast count in four. Five patients died of marrow hypoplasia following therapy. Four others had refractory t-ANLL and died within the subsequent 5 months. Only one of ten patients with a poor performance status (PS greater than or equal to 2 using the ECOG scale) achieved a complete remission, but all seven patients with a good performance status (PS less than or equal to 1) had a complete remission. Hematologic remissions were achieved in 8 patients (47%) after one (6 patients) or two (2 patients) induction courses and were confirmed by recovery of a 100% normal marrow karyotype in six of the seven patients who were retested. Patients in remission received one to four consolidation courses with HDAC alternating with cytarabine/doxorubicin, but seven relapsed within 8 months (median remission duration, 5 months). In every case, the original chromosomal abnormality reappeared at relapse. HDAC has a high response rate for good-performance patients with t-MDS/t-ANLL, but complete remissions are short even when confirmed cytogenetically and consolidated intensively.
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Affiliation(s)
- R A Larson
- Department of Medicine, University of Chicago, IL 60637
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