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Bar N, Firestone RS, Usmani SZ. Aiming for the cure in myeloma: Putting our best foot forward. Blood Rev 2023; 62:101116. [PMID: 37596172 DOI: 10.1016/j.blre.2023.101116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/20/2023]
Abstract
Frontline therapy for multiple myeloma (MM) is evolving to include novel combinations that can achieve unprecedented deep response rates. Several treatment strategies exist, varying in induction regimen composition, use of transplant and or consolidation and maintenance. In this sea of different treatment permutations, the overarching theme is the powerful prognostic factors of disease risk and achievement of minimal residual disease (MRD) negativity. MM has significant inter-patient variability that requires treatment to be individualized. Risk-adapted and response-adapted strategies which are increasingly being explored to define the extent and duration of therapy, and eventually aim for functional curability. In addition, with T-cell redirection therapies rapidly revolutionizing myeloma treatments, the current standard of care for myeloma will change. This review analyzes the current relevant literature in upfront therapy for fit myeloma patients and provides suggestions for treatment approach while novel clinical trials are maturing.
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Affiliation(s)
- Noffar Bar
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine University, New Haven, CT, USA.
| | - Ross S Firestone
- Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Saad Z Usmani
- Multiple Myeloma Service, Department of medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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2
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Silberstein AE, Fiala MA, Loh KP, Cordner T, Mian H, Wildes TM. A pilot study of adherence to lenalidomide among older patients with multiple myeloma. J Geriatr Oncol 2023; 14:101560. [PMID: 37380519 PMCID: PMC10529650 DOI: 10.1016/j.jgo.2023.101560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Affiliation(s)
| | - Mark A Fiala
- Washington University School of Medicine, St. Louis, MO, USA; College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Theresa Cordner
- Washington University School of Medicine, St. Louis, MO, USA
| | - Hira Mian
- McMaster University, Hamilton, ON, Canada
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha, NE, USA.
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3
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Yang Y, Zhang Y, Wagner AK, Li H, Shi L, Guan X. The impact of government reimbursement negotiation on targeted anticancer medicines use and cost in China: A cohort study based on national health insurance data. J Glob Health 2023; 13:04083. [PMID: 37566690 PMCID: PMC10420358 DOI: 10.7189/jogh.13.04083] [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: 08/13/2023] Open
Abstract
Background High prices of targeted anticancer medicines (TAMs) result in financial toxicity for patients and the health insurance system. How national price negotiation and reimbursement policy affect the accessibility of TAMs for cancer patients remains unknown. Methods In this population-based cohort study, we used national health insurance claims data in 2017 and identified adult patients with cancer diagnoses for which price-negotiated TAMs were indicated. We estimated the half-month prevalence of price-negotiated TAMs use before and after the policy implementation in September 2017. We calculated direct medical costs, out-of-pocket (OOP) costs, and the proportion of OOP cost for each cancer patient to measure their financial burden attributable to TAMs use. We performed segmented linear and multivariable logistic regression to analyse the policy impact. Results We included 39 391 of a total 118 655 cancer beneficiaries. After September 2017, the prevalence of price-negotiated TAMs use increased from 1.4%-2.1% to 2.9%-3.1% (P = 0.005); TAMs users' daily medical costs increased from US$261.3 to US$292.5 (P < 0.001), while median daily OOP costs (US$68.2 vs US$65.7; P = 0.134) and OOP costs as a proportion of daily medical costs persisted (28.5% vs 28.5%; P = 0.995). Compared with resident beneficiaries, the relative probability of urban employee beneficiaries on TAMs uses decreased after the policy (adjusted odds ratio (aOR) = 2.4 vs aOR = 2.2). Conclusions The government price negotiation and reimbursement policy improved patient access to TAMs and narrowed disparities among insurance schemes. China's approach to promoting the affordability of expensive medicines provides valuable experience for health policy decision-makers.
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Affiliation(s)
- Yu Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yichen Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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4
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Wang T, Lu Q, Tang L. Assessment tools for patient-reported outcomes in multiple myeloma. Support Care Cancer 2023; 31:431. [PMID: 37389673 DOI: 10.1007/s00520-023-07902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Patients with multiple myeloma experience severe symptom burden. Patient participation in self-reporting is essential as medical staff's assessment of patient symptom severity is often lower than patient self-reporting. This article reviews patient-reported outcome (PRO) assessment tools and their application in the field of multiple myeloma. RESULTS The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) is the universal patient-reported outcome assessment tool most frequently used to evaluate the life quality in people with multiple myeloma. Among the specific patient-reported outcome assessment tools, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Multiple Myeloma Module (EORTC QLQ-MY20), the Functional Assessment of Cancer Therapy-Multiple Myeloma (FACT-MM), and the M.D. Anderson Symptom Inventory-Multiple Myeloma Module (MDASI-MM) are the most widely used, with some scholars using the EORTC QLQ-MY20 as a calibration correlate for scale development. Most current assessment instruments were developed using classical measurement theory methods; future researchers could combine classic theory tests and item response theory to create scientific assessment instruments. In addition, researchers select the appropriate assessment tool based on the purpose of the study. They can translate high-quality assessment tools into different languages and consider applying them more often to assessing multiple myeloma patients. Finally, most existing PROs focus on measuring life quality and symptoms in people with multiple myeloma, with less research on outcomes such as adherence and satisfaction, thus failing to comprehensively evaluate the patient treatment and disease management. CONCLUSIONS Research has shown that the field of PROs in multiple myeloma is in an exploratory phase. There is still a need to enrich the content of PROs and develop more high-quality PRO scales for multiple myeloma based on the strengths and weaknesses of existing tools. With the successful advancement of information technology, PROs for people with multiple myeloma could be integrated with electronic information systems, allowing patients to report their health status in real time and doctors to track their condition and adjust their treatment, thereby improving patient outcomes.
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Affiliation(s)
- Ting Wang
- Department of Haematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Qin Lu
- Department of Haematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - LeiWen Tang
- Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
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5
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Jiang H, Lyu J, Mou W, Jiang Q, Du J. Association between financial toxicity and health‐related quality of life in cancer survivors: A systematic review. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/19/2022] [Accepted: 10/30/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Hua Jiang
- School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Jianxia Lyu
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Wenxuan Mou
- School of Nursing Chengdu Medical College Chengdu China
| | - Qinghua Jiang
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China
| | - Jiali Du
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center School of Medicine University of Electronic Science and Technology of China Chengdu China
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6
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Naser AY, Ofori-Asenso R, Awawdeh SA, Qadus S, Alwafi H, Liew D. Real World Adherence to and Persistence With Oral Oncolytics in Multiple Myeloma: A Systematic Review and Meta-analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:760-773. [PMID: 35764491 DOI: 10.1016/j.clml.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Oral oncolytic treatments (OOTs) have improved the prognosis of patients with multiple myeloma (MM). However, the effectiveness of these therapies is undermined by poor adherence. We aimed to characterize the real-world adherence to, and persistence with, OOTs for MM. MATERIALS AND METHODS MEDLINE, EMBASE, and the International Pharmaceutical abstracts databases were searched for relevant observational studies published in English up to November 21, 2021. This was supplemented by manual searches of abstracts from the annual meetings of the American Society of Hematology, the American Society for Clinical Oncology, and the European Hematology Association as well as screening the references of included articles. Random-effects meta-analysis was performed. RESULTS Following screening of 11,557 articles, 19 studies involving 27,129 patients in 8 countries (France, the US, Germany, Italy, the UK, Brazil, South Korea, and Belgium) prescribed OOTs (lenalidomide, thalidomide, pomalidomide, panobinostat, ixazomib, and melphalan) for MM were included. The overall pooled proportion of adherent patients was 67.9% (95% confidence interval [CI]: 57.1%-77.8%). The pooled proportion of adherent patients was higher in self-reported questionnaire-based studies compared to those using prescription/dispensing data (81.6% vs. 61.0%; P-value for difference = .08). Across 5 studies involving 15,363 patients, a pooled proportion of 35.8% (95% CI: 22.0-50.9) discontinued treatment. Factors reported to be associated with nonadherence included increasing age, higher comorbidity, polypharmacy, and a lack of social support. CONCLUSION In patients with MM, adherence to and persistence with OOTs remains suboptimal. To achieve desired clinical outcomes, interventions to improve adherence and minimize discontinuation may be warranted.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Real World Data Enabling Platform, Roche Products Ltd, Welwyn Garden City, UK.
| | - Safaa Al Awawdeh
- Department of Basic Pharmaceutical Sciences, Isra University, Amman, Jordan
| | - Sami Qadus
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Alqura University, Saudi Arabia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Adelaide Medical School, University of Adelaide, Adelaide, Australia
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7
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Parker C, Berkovic D, Ayton D, Zomer E, Liew D, Wei A. Patient Perceived Financial Burden in Haematological Malignancies: A Systematic Review. Curr Oncol 2022; 29:3807-3824. [PMID: 35735414 PMCID: PMC9221876 DOI: 10.3390/curroncol29060305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/19/2022] Open
Abstract
Advances in scientific understanding have led to novel therapies and improved supportive care for many patients with haematological malignancies. However, these new drugs are often costly, only available at centralised health care facilities, require regular specialist reviews and lengthy treatment regimens. This leads to a significant financial burden. Understanding the impact of financial burden on haematological patients is important to appreciate the urgency of alleviating this systemic issue. Method: Eligible studies were identified by systematically searching Medline, PsycINFO, CINAHL and Embase. Self-reported data reported in both quantitative and qualitative studies that described the financial burden for patients with haematological malignancies were included. Quality appraisal of the included studies was undertaken using the Joanna Briggs Institute tools. A narrative synthesis was employed. For quantitative studies, outcomes were extracted, tabulated and categorised to find similarities and differences between the studies. For qualitative studies, quotations, codes and themes were extracted and then clustered. An inductive approach derived qualitative themes. Results: Twenty studies were identified for inclusion. Of the quantitative studies most (83%) employed un-validated researcher-generated measures to assess financial burden. Between 15–59% of patients experienced a financial burden. Out-of-pocket expenditure was frequent for clinical appointments, prescription and non-prescription medication, and travel. Financial burden was associated with a worsening quality of life and living in metropolitan areas, but there was no evidence for impact on survival. Patient-centred experiences from the qualitative inquiry complemented the quantitative findings and five themes were determined: familial or household impact; reliance on others; barriers to care due to cost; and barriers to accessing financial assistance and sources of out-of-pocket expenses. Conclusion: The impacts of financial burden are yet to be fully appreciated in haematological malignancies, exacerbated by the heterogeneous methods employed by researchers. Future work should focus on identifying the long-term ramifications of financial burden for patients and should trial interventions to reduce its prevalence and patient impacts.
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Affiliation(s)
- Catriona Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
- Department of Haematology, Alfred Health, Melbourne 3004, Australia;
- Correspondence:
| | - Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (D.B.); (D.A.); (E.Z.); (D.L.)
| | - Andrew Wei
- Department of Haematology, Alfred Health, Melbourne 3004, Australia;
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8
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Ouchveridze E, Banerjee R, Desai A, Aziz M, Lee-Smith W, Mian H, Berger K, McClune B, Sborov D, Qazilbash M, Kumar S, Mohyuddin GR. Financial toxicity in hematological malignancies: a systematic review. Blood Cancer J 2022; 12:74. [PMID: 35459862 PMCID: PMC9033803 DOI: 10.1038/s41408-022-00671-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 02/06/2023] Open
Abstract
Hematologic malignancy outcomes have remarkably improved in the past decade with further advancement expected in future years. However, the detrimental effects of financial toxicity (FT) on patients with hematologic malignancies, because of both diagnoses and subsequent treatments, have not been studied comprehensively. We performed a systematic review of all studies reporting FT as a primary or secondary outcome among adult or pediatric patients with hematological malignancies. A total of 55 studies met the inclusion criteria for analysis. Across studies, 20-50% of patients reported some form of FT, including loss of work productivity, food and transportation costs, and depletion of savings. Younger age, lower-income level, unemployment, and rural residence were the most commonly identified risk factors for FT. Two studies looked at survival outcomes, with one reporting improvement in survival with a decrease in financial toxicity. However, significant heterogeneity in FT definitions was found between countries and payor systems. Only half of the studies (51%, n = 28) used validated survey instruments such as the COST assessment. The present systematic review identified that FT is common in patients with hematological malignancies and may be associated with poorer outcomes. However, studies of FT generally use non-standardized methods with cross-sectional analyses rather than longitudinal, prospective assessments. Further work is needed to standardize FT reporting and investigate measures to alleviate FT among patients with hematologic malignancies.
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Affiliation(s)
- Evguenia Ouchveridze
- Department of Hematological Malignancies and Cellular Therapeutics, Kansas University Medical Center, Kansas, KS, USA
| | - Rahul Banerjee
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aakash Desai
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Aziz
- Mulford Health Science Library, University of Toledo, Toledo, OH, USA
| | - Wade Lee-Smith
- Mulford Health Science Library, University of Toledo, Toledo, OH, USA
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Katherine Berger
- Patient Advocate, University of Hartford, West Hartford, CT, USA
| | - Brian McClune
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Douglas Sborov
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Muzaffar Qazilbash
- Division of Transplant, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ghulam Rehman Mohyuddin
- Division of Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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9
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Lasala R, Santoleri F. Association between adherence to oral therapies in cancer patients and clinical outcome: A systematic review of the literature. Br J Clin Pharmacol 2021; 88:1999-2018. [PMID: 34784654 DOI: 10.1111/bcp.15147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/23/2023] Open
Abstract
AIMS Adherence to therapy is a key factor in successful treatment. The aim of this systematic review is to assess the extent to which patients with better adherence to oral therapy have better clinical outcomes among cancer patients. METHODS All studies published in PubMed up to 20 October 2020, which considered the use of oral anticancer drugs for cancer patients and which correlated treatment adherence with a clinical outcome, were considered. RESULTS From the 42 studies considered in the systematic review, 14 were for oncological indications and 28 for haematological indications. There was considerable variance in calculation methods, outcomes considered, and in the definitions of adherence. However, it emerged that most studies reported a significant correlation between adherence to therapy and clinical outcome. CONCLUSION As adherence to therapy is a key factor in achieving a better clinical outcome, future studies with large samples, robust endpoints and the use of at least two methods of assessing adherence would be desirable in order to produce more robust evidence.
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10
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Whitney RL, White AEC, Rosenberg AS, Kravitz RL, Kim KK. Trust and shared decision-making among individuals with multiple myeloma: A qualitative study. Cancer Med 2021; 10:8040-8057. [PMID: 34608770 PMCID: PMC8607252 DOI: 10.1002/cam4.4322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/02/2021] [Accepted: 09/18/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Multiple myeloma (MM) is an incurable cancer with complex treatment options. Trusting patient-clinician relationships are essential to promote effective shared decision-making that aligns best clinical practices with patient values and preferences. This study sought to shed light on the development of trust between MM patients and clinicians. METHODS Nineteen individual semi-structured interviews were conducted with MM patients within 2 years of initial diagnosis or relapse for this qualitative study. Interviews were recorded and transcripts were coded thematically. RESULTS We identified three main themes: (1) externally validated trust describes patients' predisposition to trust or distrust clinicians based on factors outside of patient-clinician interactions; (2) internally validated trust describes how patients develop trust based on interactions with specific clinicians. Internally validated trust is driven primarily by clinician communication practices that demonstrate competence, responsiveness, listening, honesty, and empathy; and (3) trust in relation to shared decision-making describes how patients relate the feeling of trust, or lack thereof, to the process of shared decision-making. CONCLUSION Many factors contribute to the development of trust between MM patients and clinicians. While some are outside of clinicians' control, others derive from clinician behaviors and interpersonal communication skills. These findings suggest the possibility that trust can be enhanced through communication training or shared decision-making tools that emphasize relational communication. Given the important role trust plays in shared decision-making, clinicians working with MM patients should prioritize establishing positive, trusting relationships.
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Affiliation(s)
- Robin L Whitney
- The Valley Foundation School of Nursing, San Jose State University, San Jose, California, USA
| | | | - Aaron S Rosenberg
- UC Davis Comprehensive Cancer Center, Sacramento, California, USA.,Department of Internal Medicine, University of California, Davis, Davis, California, USA
| | - Richard L Kravitz
- Department of Internal Medicine, University of California, Davis, Davis, California, USA.,Center for Health Policy and Research, University of California, Davis, Davis, California, USA
| | - Katherine K Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California, USA
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11
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Silveira LP, Menezes de Pádua CA, Drummond PLDM, Malta JS, Marques dos Santos RM, Costa NL, Machado TRL, Reis AMM. Validation of an Instrument for Measuring Adherence to Treatment With Immunomodulators in Patients With Multiple Myeloma. Front Pharmacol 2021; 12:651523. [PMID: 34045961 PMCID: PMC8146909 DOI: 10.3389/fphar.2021.651523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Validate the Treatment Adherence Measure (TAM) instrument in outpatients with MM concerning construct validity, reliability and the ceiling and floor effects. Methods: This cross-sectional study included patients diagnosed with MM previously treated with an immunomodulator for at least one month, aged 18 or over, and followed-up in the investigated outpatient clinics. Adherence to immunomodulators was measured by TAM. The TAM's reliability was assessed using Cronbach's alpha; The association between adherence and health-related quality of life was investigated to analyze the divergent and convergent construct, measured by the Quality of Life Questionnaire core (QLQ-C30) and the Quality of Life Questionnaire Multiple Myeloma module (QLQ-MY20). The presence of a ceiling or floor effect in the TAM was also analyzed. Results: Eighty-four patients were included in the study, achieving 97.6% adherence. Cronbach's alpha was 0.41, and the hypothesis of convergent construct validity was confirmed, with statistical significance, in contrast to the hypothesis of divergent construct validity. The presence of the ceiling effect in TAM suggested that this instrument does not allow changes to be detected in individuals concerning adherence to IMiDs. Conclusion: TAM instrument did not show satisfactory validity and reliability to measure MM's adherence. MM patients treated at oncohematological outpatient clinics in a metropolitan region of southeastern Brazil showed high adherence to IMiDs.
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Affiliation(s)
- Lívia Pena Silveira
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Paula Lana de Miranda Drummond
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Jéssica Soares Malta
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Naiane Lima Costa
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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12
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Solano M, Daguindau E, Faure C, Loriod P, Pain C, Maes AC, Marguet P, Kroemer M, Rumpler A, Fontan J, Deconinck E, Limat S, Clairet AL. Oral therapy adherence and satisfaction in patients with multiple myeloma. Ann Hematol 2021; 100:1803-1813. [PMID: 33938996 DOI: 10.1007/s00277-021-04543-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
The transition to oral therapies in patients with multiple myeloma (MM) offers potential benefits to patients; however, they must self-manage their medication and adherence plays an important role in patient care. It has been shown that patient satisfaction with their medication has a strong positive correlation with adherence in chronic diseases. The aim of this study was to estimate adherence rate of oral antimyeloma therapies and to identify risk factors for medication non-adherence. This observational, prospective, and multicentre survey based on a self-report questionnaire enrolled MM patients with at least 3 months of oral therapy. The 6-item Girerd scale and the medication possession ratio (MPR) were used for measuring medication adherence and the SATMED-Q® questionnaire was used for measuring satisfaction. An analysis of risk factors for non-adherence to oral therapy was performed using univariate analysis. A total of 101 patients participated in the survey, yielding a response rate of 87%. The prevalence of adherence to oral antimyeloma therapy was estimated at 51.5% using the Girerd questionnaire. According to the MPR, adherence was evaluated at 96% (i.e. MPR ≥ 0.80). Both methods combined, adherence was estimated at 50.5%. One risk factor for medication non-adherence was identified: Eastern Cooperative Oncology Group Performance Status > 2 (p = 0.007). One predictive factor for high medication adherence was identified: high satisfaction with treatment (p = 0.01). Identifying patients at higher risk for non-adherence allows clinical pharmacists to personalise therapeutic information and education and to improve the quality of healthcare overall.
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Affiliation(s)
- Marine Solano
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.
| | - Etienne Daguindau
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Cyril Faure
- Internal Medicine Department, Groupe Hospitalier de La Haute-Saône, Hospital of Haute Saone, Vesoul, France
| | - Pierre Loriod
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Coline Pain
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Anne-Cécile Maes
- Internal Medicine Department, Groupe Hospitalier de La Haute-Saône, Hospital of Haute Saone, Vesoul, France
| | - Pauline Marguet
- Pharmacy Department, Centre Hospitalier Général Louis Pasteur, Hospital of Dole, Dole, France
| | - Marie Kroemer
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Anne Rumpler
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Jean Fontan
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France
| | - Eric Deconinck
- Hematology Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Samuel Limat
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
| | - Anne-Laure Clairet
- Pharmacy Department, Centre Hospitalier Universitaire de Besançon, University Hospital of Besançon, Besançon, France.,Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, University of Bourgogne Franche-Comté (UBFC), INSERM, EFS BFC, UMR 1098, Besançon, France
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13
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Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol 2021; 28:1216-1248. [PMID: 33804288 PMCID: PMC8025828 DOI: 10.3390/curroncol28020117] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. METHODS A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. RESULTS Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. CONCLUSIONS We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
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Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Claire de Oliveira
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M6J 1H4, Canada
| | | | - Beverley Essue
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
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14
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Terpos E, Mikhael J, Hajek R, Chari A, Zweegman S, Lee HC, Mateos MV, Larocca A, Ramasamy K, Kaiser M, Cook G, Weisel KC, Costello CL, Elliott J, Palumbo A, Usmani SZ. Management of patients with multiple myeloma beyond the clinical-trial setting: understanding the balance between efficacy, safety and tolerability, and quality of life. Blood Cancer J 2021; 11:40. [PMID: 33602913 PMCID: PMC7891472 DOI: 10.1038/s41408-021-00432-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Treatment options in multiple myeloma (MM) are increasing with the introduction of complex multi-novel-agent-based regimens investigated in randomized clinical trials. However, application in the real-world setting, including feasibility of and adherence to these regimens, may be limited due to varying patient-, treatment-, and disease-related factors. Furthermore, approximately 40% of real-world MM patients do not meet the criteria for phase 3 studies on which approvals are based, resulting in a lack of representative phase 3 data for these patients. Therefore, treatment decisions must be tailored based on additional considerations beyond clinical trial efficacy and safety, such as treatment feasibility (including frequency of clinic/hospital attendance), tolerability, effects on quality of life (QoL), and impact of comorbidities. There are multiple factors of importance to real-world MM patients, including disease symptoms, treatment burden and toxicities, ability to participate in daily activities, financial burden, access to treatment and treatment centers, and convenience of treatment. All of these factors are drivers of QoL and treatment satisfaction/compliance. Importantly, given the heterogeneity of MM, individual patients may have different perspectives regarding the most relevant considerations and goals of their treatment. Patient perspectives/goals may also change as they move through their treatment course. Thus, the 'efficacy' of treatment means different things to different patients, and treatment decision-making in the context of personalized medicine must be guided by an individual's composite definition of what constitutes the best treatment choice. This review summarizes the various factors of importance and practical issues that must be considered when determining real-world treatment choices. It assesses the current instruments, methodologies, and recent initiatives for analyzing the MM patient experience. Finally, it suggests options for enhancing data collection on patients and treatments to provide a more holistic definition of the effectiveness of a regimen in the real-world setting.
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Affiliation(s)
- Evangelos Terpos
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ajai Chari
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
| | - Hans C Lee
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - María-Victoria Mateos
- Department of Hematology, University Hospital of Salamanca, IBSAL, CIC, IBMCC (USAL-CSIC), Salamanca, Spain
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Karthik Ramasamy
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, RDM, Oxford University, NIHR BRC Blood Theme, Oxford, UK
| | - Martin Kaiser
- Department of Haematology, The Royal Marsden Hospital, and Division of Molecular Pathology, The Institute of Cancer Research (ICR), London, UK
| | - Gordon Cook
- Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Katja C Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caitlin L Costello
- Department of Medicine, Division of Blood and Marrow Transplantation, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Jennifer Elliott
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Antonio Palumbo
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Saad Z Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Charlotte, NC, USA
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15
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Xavier FD, Ferreira FSB, Abreu RM. Treatment of elderly patients with refractory/relapsed multiple myeloma: oral drugs adherence and the COVID-19 outbreak. Oncotarget 2020; 11:4371-4386. [PMID: 33316011 PMCID: PMC7720774 DOI: 10.18632/oncotarget.27819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/17/2020] [Indexed: 01/10/2023] Open
Abstract
Once the treatment of refractory/relapsed multiple myeloma in the elderly is greatly influenced by the adherence of patients and family members, clinicians should be aware of patients’ behavior and lifestyle, as it may influence the individual treatment plan for each patient. Furthermore, treatment with oral chemotherapy is of special value during the COVID-19 outbreak. Multidisciplinary healthcare involvement is crucial in the management of polypharmacy, adverse events and dose adjustment due to comorbidities and natural loss of renal function with age. Oral drugs simplify intake, reduce hospital visits, and improve autonomy and quality of life. However, although oral drugs have advantages, they also transfer control and responsibility from the healthcare professional to the patient, who must be able to understand and follow the directions given. Therefore, patient education and communication with healthcare professionals are critical for adherence.
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Affiliation(s)
- Flávia Dias Xavier
- Department of Hematology, Hospital Universitario de Brasilia-UNB/Ebserh, Brasilia, DF, Brazil.,Hospital Sirio Libanes, Centro de Oncologia, Unidade Brasilia, Brasilia, DF, Brazil
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16
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Rifkin RM, Bell JA, DasMahapatra P, Hoole M, Lowe M, Curran C, Campbell S, Hou P, Romanus D. Treatment Satisfaction and Burden of Illness in Patients with Newly Diagnosed Multiple Myeloma. PHARMACOECONOMICS - OPEN 2020; 4:473-483. [PMID: 31605300 PMCID: PMC7426337 DOI: 10.1007/s41669-019-00184-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This observational study identified attributes of patient-reported satisfaction with therapy for multiple myeloma (MM), described the treatment-related time burden and indirect costs, and investigated the effect of administration route (oral vs. injectable) on these outcomes among patients with newly diagnosed MM (NDMM) and among caregivers. METHODS Patients residing in the USA with a self-reported diagnosis of NDMM were recruited from PatientsLikeMe, MyelomaCrowd, and Facebook (16 December 2016 and 6 July 2017) to complete an electronic survey including questions on treatment experience, economic burden, and standardized patient-reported outcome measures, including the Treatment Satisfaction Questionnaire for Medication with three domains (global satisfaction, effectiveness, and convenience) and the Work Productivity and Activity Impairment Questionnaire. Univariate and multivariate analyses identified predictors of patient-perceived treatment satisfaction. RESULTS Among 188 patients, worse Eastern Cooperative Oncology Group performance status (ECOG PS) was correlated with lower patient-perceived effectiveness and convenience of their current treatment. White race and oral administration route were independently correlated with higher patient-perceived convenience of treatment. Injectable therapy use was associated with a trend towards increased activity impairment (43 vs. 34%; p = 0.05) and significantly higher time burden of treatment administration, with threefold higher adjusted indirect costs of MM therapy compared with solely orally administered therapies (monthly mean $US482 vs. 153; 2016 values; p < 0.0001). CONCLUSIONS Factors associated with patient-perceived satisfaction with NDMM treatment-ECOG PS, race, administration route-warrant increased attention in shared treatment decision making to help identify patient needs and improve the patient's treatment experience. The use of orally administered therapies could improve patients' activity impairment and reduce the time burden associated with therapy.
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Affiliation(s)
| | - Jill A Bell
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
| | | | | | | | | | - Scott Campbell
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Peijie Hou
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Dorothy Romanus
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, 40 Landsdowne Street, Cambridge, MA, 02139, USA.
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17
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Mauro J, Mathews KB, Sredzinski ES. Effect of a Smart Pill Bottle and Pharmacist Intervention on Medication Adherence in Patients with Multiple Myeloma New to Lenalidomide Therapy. J Manag Care Spec Pharm 2019; 25:1244-1254. [PMID: 31663462 PMCID: PMC10398191 DOI: 10.18553/jmcp.2019.25.11.1244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND U.S. specialty drug spend is expected to reach $400 billion by 2020, with significant growth in oncology. New oral oncology approvals have allowed for more convenient outpatient administration compared with physician-administered chemotherapies; however, patients may encounter challenges with adherence when taking medications at home. Emerging medication adherence technology (MAT) attempts to provide at-home adherence support, and while one such technology, smart pill bottles (SPB), claims to improve medication adherence, few studies have formally assessed their effects. OBJECTIVES To assess the effect of an SPB with pharmacist intervention on medication adherence in adult patients with multiple myeloma (MM) new to lenalidomide therapy (≤ 5 cycle dispenses). Secondary objectives were to evaluate treatment cycles completed, evaluate the significance of real-time pharmacist engagement (intervention group only), determine the incremental cost-effectiveness ratio (ICER), and evaluate patient satisfaction and likelihood to use an SPB. METHODS This prospective, random assignment, single-site, and single-blinded study recruited 40 adult patients diagnosed with MM new to lenalidomide at a specialty pharmacy. Recruitment was completed January-February 2016, and the length of study was 6 months. Participants were randomized 1:1 between the intervention and control groups. The intervention group received lenalidomide in activated SPBs with light, chimes, text message reminders, and pharmacist follow-up if weekly SPB adherence rates dropped below 80%. The control group received lenalidomide in identical SPBs with all alerts deactivated. SBPs contained cellular capabilities, enabling around-the-clock data transmission and captured data upon bottle-uncapping events. Patient adherence was calculated by dividing the number of bottle-uncapping events by the total number of doses supplied for each dosing cycle. Lenalidomide cycles completed and pharmacist outreach to the same patient were counted to determine pharmacist intervention. The ICER was calculated to determine SPB cost-effectiveness, and a Likert scale survey was given to the intervention group to evaluate patient satisfaction with the full-service SPB. RESULTS Sixteen participants in each arm completed the study; 4 patients in each arm were lost to follow-up. Median adherence was improved for the intervention group compared with the control group (median = 100% vs. 87.4%; P = 0.001). The ICER per patient percentage adherence increase was found to be $96.03. Sixty percent of patients in the intervention group who responded to the post-satisfaction survey rated the full SPB service very positively. CONCLUSIONS In this study, SPB interventions were associated with increased medication adherence and patient satisfaction. This pilot also provides empirical data on the cost-effectiveness of adherence technology used in a specialty pharmacy oncology setting. DISCLOSURES This study was supported by Avella Specialty Pharmacy and AdhereTech. All authors are employees of Avella; Eric Sredzinski was an option holder of Avella; and none of the Avella authors had a financial interest in AdhereTech. AdhereTech provided the SPBs and data services for the duration of this study. The authors report no other potential conflicts of interest. Interim study data were presented at the 2016 Southwestern States Residency Conference (SSRC) on June 20, 2016, in Phoenix, AZ.
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18
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Chari A, Romanus D, DasMahapatra P, Hoole M, Lowe M, Curran C, Campbell S, Bell JA. Patient-Reported Factors in Treatment Satisfaction in Patients with Relapsed/Refractory Multiple Myeloma (RRMM). Oncologist 2019; 24:1479-1487. [PMID: 31371520 PMCID: PMC6853123 DOI: 10.1634/theoncologist.2018-0724] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/07/2019] [Indexed: 02/07/2023] Open
Abstract
This article identifies factors associated with patient‐reported satisfaction with multiple myeloma therapy and the treatment‐related time burden and indirect costs among patients with relapsed or refractory multiple myeloma and their caregivers. Improved understanding of these variables will inform treatment decisions across this complex treatment landscape. Background. Therapy choices in relapsed/refractory multiple myeloma (RRMM) should consider patient satisfaction with treatment, because it is associated with adherence to therapy, health outcomes, and medical safety. The primary objective of this pilot cross‐sectional observational study was to ascertain factors associated with patient‐reported treatment satisfaction in RRMM. Patients and Methods. Patients with a self‐reported diagnosis of RRMM recruited from PatientsLikeMe, MyelomaCrowd, and Facebook were administered an electronic survey that included questions on demographics and clinical history, treatment experience, economic burden, and standardized patient‐reported outcome measures, including the Treatment Satisfaction Questionnaire for Medication, Eastern Cooperative Oncology Group performance status (ECOG PS) measure, and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem V2.0. Univariable and multivariable analyses were used to identify predictors of patient‐perceived treatment satisfaction. Results. One hundred sixty patients with RRMM participated in the study, with a median of two prior relapses and 66.3% reporting the most recent relapse within the last 12 months. ECOG PS ≥2 was associated with lower patient‐reported global satisfaction and perceived effectiveness of current treatment. In addition to shorter time spent receiving therapy, orally administered treatment was the strongest predictor of higher satisfaction with treatment convenience. For patients receiving an injectable drug‐containing regimen versus an all‐oral regimen, respectively, time spent receiving multiple myeloma‐directed therapy was higher (12.6 vs. 4.0 hours per month), and total monthly indirect costs were $1,033 and $241. Conclusion. Poor ECOG PS was linked to reduced treatment satisfaction and perceived effectiveness of current therapy, whereas an all‐oral regimen was associated with increased treatment convenience satisfaction. Implications for Practice. This study suggests that attributes including better Eastern Cooperative Oncology Group performance status, less time spent receiving treatment, and oral route of treatment administration lead to higher patient‐perceived satisfaction with relapsed/refractory multiple myeloma (RRMM) treatment. Oral route of administration was also associated with less time spent receiving treatment and reduced economic burden for patients. Increased attention to these factors in shared treatment decision making is warranted to help identify individual patient needs, preferences, and expectations for RRMM treatments, to resolve dissatisfaction issues, and to improve the experience of patients with RRMM.
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Affiliation(s)
- Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York New York, USA
| | - Dorothy Romanus
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | | | | | - Maria Lowe
- PatientsLikeMe, Cambridge, Massachusetts, USA
| | | | - Scott Campbell
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Jill A Bell
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
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19
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Martino M, Rossi M, Ferreri A, Loteta B, Morabito A, Moscato T, Console G, Innao V, Naso V, Provenzano PF, Recchia AG, Gentile M. Quality of life outcomes in multiple myeloma patients: a summary of recent clinical trials. Expert Rev Hematol 2019; 12:665-684. [PMID: 31251688 DOI: 10.1080/17474086.2019.1634541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Management of multiple myeloma (MM) has improved over recent years. Health-related quality of life (HRQoL) data is becoming increasingly important, owing to improved survival outcomes. Areas covered: The authors performed an expert review of the literature to identify evidence-based data available on HRQoL in frontline and relapsed/refractory MM (RRMM) patients. Expert opinion: De-novo patients should be informed that the HRQoL is expected to improve during first-line treatment with different degrees of possible deterioration during the first cycles. Achievement of a maximal response should be strongly considered, particularly in the frontline setting, but must also be balanced with tolerability, HRQoL, and patient preferences. The same degree of improvement in HRQoL cannot be expected during conventional relapse treatments, where patients should be prepared only for stabilization of HRQoL. However, focusing attention only on measures such as toxicity may provide just a partial view of overall treatment effectiveness. Nonetheless, the authors believe the added value of taking into consideration the patient's perspectives and the importance of patient-reported outcomes in the evaluation of treatment effects should be considered mandatory. The incorporation of quality of life assessment into clinical and research practice has the potential of improving treatment outcomes.
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Affiliation(s)
- Massimo Martino
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Marco Rossi
- b Department of Experimental and Clinical Medicine, Magna Græcia University , Catanzaro , Italy
| | - Anna Ferreri
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Barbara Loteta
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Antonella Morabito
- c Pharmacy Unit, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Tiziana Moscato
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Giuseppe Console
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Vanessa Innao
- d Division of Hematology, Department of Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina , Messina , Italy
| | - Virginia Naso
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Pasquale Fabio Provenzano
- a Stem Cell Transplant Program, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli , Reggio Calabria , Italy
| | - Anna Grazia Recchia
- e Department of Hematology, Unità di Ricerca Biotecnologica (URB) , Cosenza , Italy
| | - Massimo Gentile
- f Hematology Unit, Department of Hemato-Oncology, Ospedale Annunziata , Cosenza , Italy
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20
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Seitzler S, Finley-Oliver E, Simonelli C, Baz R. Quality of life in multiple myeloma: considerations and recommendations. Expert Rev Hematol 2019; 12:419-424. [DOI: 10.1080/17474086.2019.1613886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Samantha Seitzler
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Elizabeth Finley-Oliver
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christine Simonelli
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rachid Baz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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21
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Lea CS, Bohra S, Moore T, Passwater C, Liles D. Exploring behaviors, treatment beliefs, and barriers to oral chemotherapy adherence among adult leukemia patients in a rural outpatient setting. BMC Res Notes 2018; 11:843. [PMID: 30497510 PMCID: PMC6267791 DOI: 10.1186/s13104-018-3935-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023] Open
Abstract
Objective Adherence to oral chemotherapy is essential for patients with chronic myeloid leukemia (CML) and multiple myeloma (MM) to remain in remission. Few studies have used a Likert-type scale to measure medication adherence in CML and MM patients. We applied a validated treatment adherence tool, the ASK-12 (Adherence Starts with Knowledge®) survey, which assessed inconvenience and forgetfulness, treatment beliefs, and medication-taking behaviors recorded on a five-point Likert-type scale at two visits. Results A medication adherence survey was administered to 42 newly diagnosed or pre-existing CML or MM patients at two outpatient oncology clinics affiliated with an academic medical center in rural eastern North Carolina. Thirty-one patients completed surveys at visit 1 and visit 2 (median 4.5 months apart). Most patients were treated for MM (65%), were non-Hispanic black (68%) and female (58%). Within subscales, mean adherence scores decreased between visits, signaling better adherence. Overall, visit scores were correlated (0.63, p = 0.001). Forgetting to take medication sometimes was the most common reason for non-adherence. Medication costs were not a barrier for MM patients. Greater patient–provider informed decision-making was identified as an opportunity for quality improvement among CML patients. The ASK-12 survey provided a strategy to obtain robust information on medication adherence. Electronic supplementary material The online version of this article (10.1186/s13104-018-3935-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Suzanne Lea
- Department of Public Health, Brody School of Medicine, East Carolina University, Mailstop 660, Greenville, NC, 27834, USA.
| | - Sulochana Bohra
- Department of Public Health, Brody School of Medicine, East Carolina University, Mailstop 660, Greenville, NC, 27834, USA.,, 3900 Paramount Parkway, Morrisville, NC, USA
| | - Tiffanie Moore
- Division of Hematology/Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Chelsea Passwater
- Vidant Cancer Services, Vidant Medical Center, Greenville, NC, 27834, USA
| | - Darla Liles
- Division of Hematology/Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
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