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Lorca LA, Sacomori C, Peña C, Barrera C, Salazar M, Leão I, Valladares X, Rojas C. Psychometric properties of the Chilean version of the quality of life questionnaire for multiple myeloma. Rev Bras Enferm 2024; 77:e20230100. [PMID: 38716906 PMCID: PMC11067932 DOI: 10.1590/0034-7167-2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/25/2023] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To evaluate the internal consistency and construct validity of the QLQ-MY20 for assessing the quality of life in multiple myeloma survivors in Chile. METHODS This was a cross-sectional study conducted between March 2020 and December 2022. It involved 118 individuals from two public hospitals. The QLQ-C30 and QLQ-MY20 questionnaires were used. Internal consistency was assessed using Cronbach's alpha(α), and construct validity was evaluated through hypothesis testing (Mann-Whitney and Spearman correlation). RESULTS The average age of participants was 67.2 years (SD=9.2). Internal consistency for the complete scale was α=0.779, for the "disease symptoms" dimension α=0.671, for the "side effects of treatments" dimension α=0.538, and for the "future perspective" dimension α=0.670. Four of the five construct validity hypotheses were confirmed: women, individuals with worse performance status, those with pain, and those with worse fatigue showed more symptoms. CONCLUSIONS The Chilean version of the QLQ-MY20 demonstrates adequate internal consistency and construct validity.
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Affiliation(s)
| | - Cinara Sacomori
- Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana. Santiago, Chile
| | | | | | | | - Ivana Leão
- Universidad Católica del Maule. Talca, Chile
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Seefat MR, Cucchi DGJ, Groen K, Donker ML, van der Hem KG, Westerman M, Gerrits AM, Beeker A, van de Donk NWCJ, Blommestein HM, Zweegman S. Treatment sequences and drug costs from diagnosis to death in multiple myeloma. Eur J Haematol 2024; 112:360-366. [PMID: 37821211 DOI: 10.1111/ejh.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023]
Abstract
Novel therapies for multiple myeloma (MM) have improved patient survival, but their high costs strain healthcare budgets. End-of-life phases of treatment are generally the most expensive, however, these high costs may be less justifiable in the context of a less pronounced clinical benefit. To manage drug expenses effectively, detailed information on end-of-life drug administration and costs are crucial. In this retrospective study, we analysed treatment sequences and drug costs from 96 MM patients in the Netherlands who died between January 2017 and July 2019. Patients received up to 16 lines of therapy (median overall survival: 56.5 months), with average lifetime costs of €209 871 (€3111/month; range: €3942-€776 185) for anti-MM drugs. About 85% of patients received anti-MM treatment in the last 3 months before death, incurring costs of €20 761 (range: €70-€50 122; 10% of total). Half of the patients received anti-MM treatment in the last 14 days, mainly fully oral regimens (66%). End-of-life treatment costs are substantial despite limited survival benefits. The use of expensive treatment options is expected to increase costs further. These data serve as a reference point for future cost studies, and further research is needed to identify factors predicting the efficacy and clinical benefit of continuing end-of-life therapy.
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Affiliation(s)
- M R Seefat
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - D G J Cucchi
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - K Groen
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M L Donker
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - K G van der Hem
- Department of Internal Medicine, Zaandam Medical Center, Zaandam, The Netherlands
| | - M Westerman
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - A M Gerrits
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - A Beeker
- Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - N W C J van de Donk
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - S Zweegman
- Department of Hematology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Delforge M, Patel K, Eliason L, Dhanda D, Shi L, Guo S, Marshall TS, Arnulf B, Cavo M, Nooka A, Manier S, Callander N, Giralt S, Einsele H, Ailawadhi S, Popa McKiver M, Cook M, Rodríguez-Otero P. Health-related quality of life in patients with triple-class exposed relapsed and refractory multiple myeloma treated with idecabtagene vicleucel or standard regimens: patient-reported outcomes from the phase 3, randomised, open-label KarMMa-3 clinical trial. Lancet Haematol 2024; 11:e216-e227. [PMID: 38423700 DOI: 10.1016/s2352-3026(24)00005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Chimeric antigen receptor T-cell therapy idecabtagene vicleucel (ide-cel) showed significantly improved progression-free survival compared with standard regimens in adults with relapsed and refractory multiple myeloma who had received two to four previous regimens in the ongoing phase 3 KarMMa-3 trial (NCT03651128). This study analysed patient-reported outcomes (PROs), a KarMMa-3 secondary endpoint. METHODS In the randomised, open-label, phase 3 KarMMa-3 trial, 386 patients in hospitals (≥18 years of age, with measurable disease and an Eastern Cooperative Oncology Group performance status score of 0 or 1, who had received two to four previous regimens-including an immunomodulatory agent, a proteasome inhibitor, and daratumumab-and had documented disease progression after receiving their last dose of the last therapy) were randomly assigned to ide-cel (n=254) or standard regimens (daratumumab, pomalidomide, and dexamethasone; daratumumab, bortezomib, and dexamethasone; ixazomib, lenalidomide, and dexamethasone; carfilzomib and dexamethasone; or elotuzumab, pomalidomide, and dexamethasone; n=132). Patients were expected to complete the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life C30 Questionnaire (QLQ-C30), Multiple Myeloma Module (QLQ-MY20), EQ 5 dimensions (EQ-5D), and EQ-5D visual analogue scale (VAS) at baseline and follow-up timepoints (data cutoff April 18, 2022). PROs included nine prespecified primary domains: EORTC QLQ-C30 GHS-quality of life (QoL), physical functioning, cognitive functioning, fatigue, and pain; QLQ-MY20 disease symptoms and side effects of treatment; and five-level EQ-5D (EQ-5D-5L) index score and EQ-5D visual VAS. Differences in overall least-squares mean changes from baseline to month 20 were analysed using post-hoc constrained longitudinal data analysis. Time to confirmed improvement or deterioration from baseline was analysed using Cox proportional hazard models. FINDINGS Patients were randomly assigned between May 6, 2019, and April 8, 2022. Overall, the median age was 63 years (IQR 55-68); 151 (39%) patients were female; and 250 (65%) patients were White, 36 (9%) Black or African American, 19 (5%) Hispanic or Latino, 12 (3%) Asian, and seven (2%) of other race. The median follow-up was 18·6 months (IQR 14·0-26·4). PRO compliance was higher than 75% throughout. Overall least-squares mean changes from baseline favoured ide-cel with Hedges' g effect sizes from 0·3 to 0·7 for most domains. Patients in the ide-cel group showed statistically significant and clinically meaningful improvements across the primary PRO domains of interest, with the exception of QLQ-MY20 disease symptoms, side effects of treatment, and EQ-5D-5L index score, which showed improvement across assessment visits but did not exceed the within-group minimally important difference thresholds. The ide-cel group had shorter times to clinically meaningful improvement than the standard regimens group in QLQ-C30 domains except in role functioning, diarrhoea, and financial difficulties; in QLQ-MY20 domains except body image; and in EQ-5D-VAS. INTERPRETATION Ide-cel offers improved health-related quality of life compared with standard regimens for patients with relapsed and refractory multiple myeloma after previous lines of therapy. The PRO data highlight the extended QoL benefits of a one-time infusion with ide-cel compared with continuous treatment with standard regimens in the treatment of triple-class exposed patients with relapsed and refractory multiple myeloma. FUNDING 2seventy bio and Celgene, a Bristol Myers Squibb Company.
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Affiliation(s)
- Michel Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium.
| | - Krina Patel
- Department of Lymphoma Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | - Bertrand Arnulf
- Department of Immuno-Hematology, Hôpital Saint-Louis, Paris, France
| | - Michele Cavo
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Seràgnoli Institute of Hematology, University of Bologna, Bologna, Italy
| | - Ajay Nooka
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Salomon Manier
- Department of Hematology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Natalie Callander
- Division of Hematology, Oncology and Palliative Care, University of Wisconsin Health, Madison, WI, USA
| | - Sergio Giralt
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Sikander Ailawadhi
- Division of Hematology-Oncology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Mark Cook
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
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Dachs LR, Gaisán CM, Bustamante G, López SG, García EG, Persona EP, González-Calle V, Auzmendi MS, Pérez JMA, González Montes Y, Ríos Tamayo R, de Miguel Llorente D, Bernal LP, Mayol AS, Caro CC, Grande M, Fernández-Nistal A, Naves A, Miguel EMOS. Assessment of the psychometric properties of the Spanish version of EORTC QLQ-MY20 and evaluation of health-related quality of Life outcomes in patients with relapsed and/or refractory multiple myeloma in the real-world setting in Spain: results from the CharisMMa study. Leuk Lymphoma 2023; 64:1847-1856. [PMID: 37539698 DOI: 10.1080/10428194.2023.2240922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
We evaluated the psychometric properties of the Spanish version of the European Organization for Research and Treatment of Multiple Myeloma (MM) specific quality-of-life (QoL) questionnaire module (QLQ-MY20) in relapsed/refractory MM (RRMM) patients. This was an observational, cross-sectional, multicenter study using EORTC QLQ-C30 and QLQ-MY20 in RRMM patients (ClinicalTrials.gov ID NCT03188536). We assessed the non-response rate, ceiling/floor effects, internal consistency, test-retest reliability, and validity. The study included 276 patients (53.3% males, mean [SD] age of 67.4 [10.5] years). The EORTC QLQ-MY20 showed a low non-response rate, very low ceiling and floor effects, and good internal consistency. The test-retest reliability assessment revealed good temporary stability, the construct validity analysis stated four main factors similar to the ones of the original version, and the criterion validity assessment showed no differences between groups. In conclusion, the Spanish version of EORTC QLQ-MY20 is a reliable and valid tool for assessing QoL in RRMM patients.
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Affiliation(s)
| | - Carmen Montes Gaisán
- Hospital Universitario Marqués de Valdecilla (IDIVAL). Universidad de Cantabria. Santander, Spain
| | | | | | | | - Ernesto Pérez Persona
- Instituto de Investigación Sanitaria Bioaraba, Vitoria-Gasteiz, Spain
- Osakidetza. Hospital Universitario de Álava. Vitoria-Gasteiz, Spain
| | - Verónica González-Calle
- Hospital Universitario de Salamanca (HUS/IBSAL), Salamanca, Spain
- Centro de Investigación Biomédica en Red (CIBERONC), Spain
- Instituto Universitario de Biología Molecular y Celular del Cáncer - IBMCC (USAL-CSIC), Salamanca, Spain
| | | | | | | | | | | | | | | | | | - Marta Grande
- Takeda Farmacéutica España, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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Boquoi A, Giagounidis A, Goldschmidt H, Heinsch M, Rummel MJ, Kröger N, Mai EK, Strapatsas J, Haas R, Kobbe G. Health-Related Quality of Life in Multiple Myeloma Patients Treated with High- or Low-Dose Lenalidomide Maintenance Therapy after Autologous Stem Cell Transplantation-Results from the LenaMain Trial (NCT00891384). Cancers (Basel) 2023; 15:5157. [PMID: 37958331 PMCID: PMC10650513 DOI: 10.3390/cancers15215157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/02/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION The LenaMain trial (NCT00891384) reported increased progression-free survival with 25 mg of lenalidomide maintenance compared to 5 mg. Here, we report the patient-reported outcomes. MATERIALS AND METHODS Scores obtained from the EORTC Quality of Life Questionnaire C30 were analyzed for longitudinal changes from baseline within the groups as well as cross-sectional scores. RESULTS Compliance rates were high, with 95.7% at baseline and 70% during maintenance. At study entry, scores were high for functioning and low for symptoms. During maintenance, the median global health status/quality of life (GHS/QoL) was constant, without significant differences over time (median GHS/QoL: 68 at baseline and 58 for Len high and 68 for Len low at 2 years) and between treatment arms (mean change < 2). Similarly, most functional scale domains were constant. Notably, diarrhea increased consistently for both treatment arms (baseline: -1.905 (range: -5.78-1.97); end of year 2: 16.071 (range: 5.72-26.42); p < 0.05). The subgroup analysis showed that neither disease activity, duration of treatment, nor adverse events affected the health-related quality of life (HR-QoL) or utility. CONCLUSION High baseline scores were maintained throughout the trial without significant differences between the Len dosages, which supports continuous treatment with a dose tailored to patients' HR-QoL.
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Affiliation(s)
- Amelie Boquoi
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
| | - Aristoteles Giagounidis
- Klinik für Onkologie, Hämatologie und Palliativmedizin, Marien Hospital Düsseldorf, Rochusstr. 2, 40479 Düsseldorf, Germany;
| | - Hartmut Goldschmidt
- National Center for Tumor Diseases Heidelberg (NCT), 69120 Heidelberg, Germany;
- Department of Internal Medicine V, University of Heidelberg, 69120 Heidelberg, Germany
| | | | - Mathias J. Rummel
- Medizinische Klinik IV, University Hospital, 35392 Giessen, Germany;
| | | | - Elias K. Mai
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Judith Strapatsas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
| | - Rainer Haas
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
| | - Guido Kobbe
- Department of Hematology, Oncology and Clinical Immunology, University Hospital Duesseldorf, 40225 Duesseldorf, Germany; (J.S.); (R.H.); (G.K.)
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McGarvey N, Ung B, Carattini T, Imanak K, Lee A, Campbell TB, Patwardhan P. Post-infusion Costs Associated with Idecabtagene Vicleucel Treatment for Patients with Relapsed/Refractory Multiple Myeloma in the KarMMa Trial. Adv Ther 2023; 40:4626-4638. [PMID: 37597153 PMCID: PMC10499666 DOI: 10.1007/s12325-023-02623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Patients with triple-class exposed relapsed/refractory multiple myeloma (RRMM) have poor outcomes with substantial healthcare costs. Idecabtagene vicleucel (ide-cel), a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T cell therapy, showed deep, durable responses in patients with RRMM in the pivotal phase 2 KarMMa trial (NCT03361748). Healthcare resource utilization (HCRU) and costs were estimated for ide-cel-treated patients in the KarMMa trial. METHODS Post-infusion costs were estimated based on HCRU data, including facility care, diagnostics, medications, and procedures. Length of stay (LOS) was extracted for inpatient and intensive care unit (ICU) care. All patients had a 14-day post-infusion inpatient stay per trial protocol. Analyses were conducted for patients treated in the United States (US), who received the ide-cel target dose of 450 × 106 CAR + T cells and assuming a 7-day inpatient stay. RESULTS Overall, 128 patients received ide-cel and were included in this analysis. Mean age was 60 years, 59% were men, and 81% were white. Mean total LOS was 23.9 days. Total estimated costs over 24 months post-infusion were US$115,614 per patient, driven by facility costs (75%; $86,385). Most costs were incurred in the first month (58%; $67,259). The scenario analysis assuming a 7-day inpatient stay showed estimated 24-month costs of $92,294. For the 54 (42%) patients who received ide-cel high dose, total costs over 24 months were $113,298 per patient. CONCLUSIONS Extrapolation of costs based on HCRU data from patients receiving single-infusion of ide-cel in the KarMMa trial showed substantially reduced HCRU and costs over 2 years after initial treatment. Most costs were incurred during the first month after ide-cel infusion, likely attributable to the 14-day inpatient stay required by the trial protocol. These findings suggest a nominal, incremental monthly cost of care immediately after treatment, which may be lower in routine clinical practice.
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Affiliation(s)
| | - Brian Ung
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | - Ken Imanak
- BluePath Solutions, Los Angeles, CA, USA
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Tervonen T, Duenas A, Collacott H, Lam A, Gries KS, Carson R, Trevor N, Krucien N, He J. Current Health State Affected Patient Preferences More Than Disease Status: A Discrete Choice Experiment in Multiple Myeloma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:909-917. [PMID: 36738785 DOI: 10.1016/j.jval.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 11/30/2022] [Accepted: 01/18/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To examine how disease status and current health state influence treatment preferences of patients with multiple myeloma (MM). METHODS Participants with MM from France, Germany, and the United Kingdom completed a web-based survey that included a discrete choice experiment (DCE) and EQ-5D assessment. The DCE elicited preferences for 8 attributes: increased life expectancy, increased time to relapse, pain, fatigue, risk of infection, administration (route and duration), frequency of administration, and monitoring. Multinomial logit models were used to analyze DCE preference data and to calculate life expectancy trade-offs. RESULTS Three hundred participants with MM (newly diagnosed, transplant eligible, n = 108; newly diagnosed, transplant ineligible, n = 105; relapsed-refractory, n = 87) completed the survey. The most valued attributes were pain, fatigue, and increased life expectancy. Participants would want an additional 2.7 years of life expectancy (95% confidence interval [CI] 2.4-3.1 years) to tolerate extreme pain and an additional 2.0 years of life expectancy (95% CI 1.6-2.3 years) to tolerate constant fatigue. Participants in a better health state (third EQ-5D score quartile [0.897]) required less additional life expectancy than participants with a worse health state (first EQ-5D score quartile [0.662]) to tolerate extreme pain (2.3 years [95% CI 1.9-2.6 years] vs 3.0 years [95% CI 2.6-3.4 years]; P = .007). There was little difference in treatment preferences between newly diagnosed and relapsed-refractory patients for pain, fatigue, and increased life expectancy. CONCLUSIONS Current health state influenced treatment preferences of patients with MM more than disease status and should be considered when making treatment decisions.
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Affiliation(s)
| | | | | | - Annette Lam
- Janssen Global Services LLC, Raritan, NJ, USA
| | | | - Robin Carson
- Janssen Research & Development LLC, Spring House, PA, USA
| | | | | | - Jianming He
- Janssen Global Services LLC, Raritan, NJ, USA.
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Metin T, Uğur Ö, Özdemir SÇ, Gönderen A, Sunu C. The unknown impact of multiple myeloma: assessing the impact of financial well-being on quality of life of caregivers. Support Care Cancer 2023; 31:288. [PMID: 37079098 DOI: 10.1007/s00520-023-07751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Patients with multiple myeloma and their caregivers are financially burdened, and their quality of life is significantly affected by treatment costs and care expenses. The aim of our study is to examine the impact of financial well-being of the caregiver on the life quality of patients with multiple myeloma. METHODS The study included 113 patients with multiple myeloma and 113 caregivers in two hospitals located in Western Turkey. This study evaluated the demographic characteristics of patients and their caregivers, financial status, financial well-being, and quality of life of caregivers. Simple linear regression analyses were used to examine the impact of financial well-being on caregiver quality of life. RESULTS The average age of multiple myeloma patients and caregivers is 64.00 ± 11.05 and 48.02 ± 11.4, respectively. Of patients, 50.4% and 62.8% of their caregivers were female. It is determined that 51.3% of the patients were diagnosed in 1-5 years, 85% received chemotherapy, and 80.5% had an ECOG performance status between 0 and 1. Caregivers' quality of life and financial well-being were found to be low. On one hand, while caregivers' financial well-being (β = - 1.003; t = - 3.831; p = .000) negatively affected the quality of their lives, their financial satisfaction (β = 2.507; t = 3.820; p = .000) positively affected the quality of their lives, on the other hand. CONCLUSIONS Caregivers' quality of life declined as their financial well-being got worse. Decreased quality of life of caregivers may affect the quality of care they provide to patients with MM. Hence, this study recommends the following. First, nurses who care for patients with MM should always assess the financial situation of patients and caregivers. Second, patient navigators, hospital billing specialists, and social workers should provide financial guidance to multiple myeloma patients and caregivers and provide help in solving their financial problems. Finally, policies that support the financial situation of patients and caregivers should be developed.
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Affiliation(s)
- Tuba Metin
- Simav Vocational School of Health Services, Kutahya Health Sciences University, Kutahya, Turkey.
| | - Özlem Uğur
- Department of Oncology Nursing, Faculty of Nursing, Dokuz Eylül University, İzmir, Turkey
| | | | - Aysun Gönderen
- Department of Hematology, Kutahya Health Sciences University Evliya Çelebi Training and Research Hospital, Kutahya, Turkey
| | - Cenk Sunu
- Department of Hematology, Faculty of Medicine, Sakarya University, Adapazarı, Sakarya, Turkey
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Delforge M, Otero PR, Shah N, Moshkovich O, Braverman J, Dhanda DS, Lanar S, Devlen J, Miera M, Gerould H, Campbell TB, Munshi NC. Analysis of patient-reported experiences up to 2 years after receiving idecabtagene vicleucel (ide-cel, bb2121) for relapsed or refractory multiple myeloma: longitudinal findings from the phase 2 KarMMa trial. Leuk Res 2023; 129:107074. [PMID: 37087950 DOI: 10.1016/j.leukres.2023.107074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/20/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To understand the long-term experience of patients receiving ide-cel chimeric antigen receptor T (CAR T) cell therapy for relapsed or refractory multiple myeloma in the pivotal phase 2 KarMMa trial. METHODS This qualitative study analyzed semi-structured patient interviews 6-24 months after ide-cel infusion. Thematic analysis with quantitative and longitudinal analyses explored patient perceptions of ide-cel treatment experience, advantages and disadvantages, and long-term health-related quality of life impact. Patient journeys were developed from narrative analysis of perceived treatment benefits with known remission length. RESULTS Interviews with 45 patients 6-24 months postinfusion were analyzed; all reported ≥ 1 ide-cel treatment advantage, most often related to efficacy (n = 42/45, 93%), few or no side effects (n = 35/45, 78%), and avoidance of other treatments (n = 34/45, 76%). Patients generally reported 6-month improvements in physical health, functioning, emotional well-being, social life, and outlook on the future; these improvements mostly remained "stable" through 18 and 24 months. The most common patient journeys comprised physical, functioning, or emotional benefit with remission < 2 years. CONCLUSIONS Longitudinal analysis of patient experiences showed sustained benefits and preference for ide-cel up to 24 months after treatment. Trial Registration Number and Date: NCT03361748. December 5, 2017.
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10
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Fonseca R, Tran D, Laidlaw A, Rosta E, Rai M, Duran J, Ammann EM. Impact of Disease Progression, Line of Therapy, and Response on Health-Related Quality of Life in Multiple Myeloma: A Systematic Literature Review. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023; 23:426-437.e11. [PMID: 37061416 DOI: 10.1016/j.clml.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
This systematic literature review (SLR) was conducted to better understand the impact of disease progression, line of therapy, and clinical response on health-related quality of life (HRQoL) in patients with multiple myeloma (MM). Multiple databases were searched to identify records relating to HRQoL in adult patients with MM. Titles and abstracts were independently screened by 2 reviewers for inclusion based on pre-defined criteria. Records flagged for inclusion had full texts subsequently screened using the same method. A third round of screening was then conducted to identify studies that assessed the relationship of HRQoL to disease progression, line of therapy, or clinical response. Quality assessment was conducted on utility studies using the National Institute for Health and Care Excellence Quality Assessment Checklist for Health State Utility Values. After all rounds of screening were complete, 44 records (representing 41 studies) were included in the SLR. Thirty records reported data relating HRQoL to disease progression, 5 reported data relating HRQoL to line of therapy, and 19 reported data relating HRQoL to response. Despite a lack of homogeneity and small number of studies, the data show overall that progressive disease and increasing lines of therapy were associated with worsened patient HRQoL and increasing depth of response was associated with improved patient HRQoL. The findings from this SLR support that desirable treatment outcomes such as delayed progression, fewer lines of therapy, and achieving the deepest possible clinical response result in improved HRQoL in patients with MM.
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Affiliation(s)
| | - Diana Tran
- EVERSANA(TM), Burlington, Ontario, Canada
| | | | | | - Manvir Rai
- EVERSANA(TM), Burlington, Ontario, Canada
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Lee HC, Ramasamy K, Weisel K, Abonour R, Hardin JW, Rifkin RM, Ailawadhi S, Terebelo HR, Durie BGM, Tang D, Joshi P, Liu L, Jou YM, Che M, Hernandez G, Narang M, Toomey K, Gasparetto C, Wagner LI, Jagannath S. Treatment Patterns, Survival, Quality of Life, and Healthcare Resource Use Among Patients With Triple-Class Refractory Multiple Myeloma in US Clinical Practice: Findings From the Connect MM Disease Registry. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:112-122. [PMID: 36567211 DOI: 10.1016/j.clml.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adults with triple-class refractory (TCR) multiple myeloma (MM) have limited treatment options and poor prognosis, but the burden of TCR MM has not been well characterized. This study evaluated treatment patterns, overall survival (OS), health-related quality of life (HRQoL), and healthcare resource use (HCRU) among patients with TCR MM in US clinical practice. PATIENTS AND METHODS Patients with TCR MM in the Connect MM Registry (NCT01081028; a large, US, multicenter, prospective observational cohort study of patients with newly diagnosed MM) were included. Patient characteristics, treatment patterns, HRQoL, and HCRU were analyzed using descriptive statistics. OS was calculated using Kaplan-Meier methodology for the overall cohort and for patients with/without ≥1 post-TCR line of therapy (LOT). RESULTS A total of 232 patients with TCR MM were included; 155 (67%) had ≥1 post-TCR LOT (post-TCR-Treated subgroup; median 9.9 months of follow-up). Most common post-TCR treatments were carfilzomib (47%), pomalidomide (40%), and daratumumab (26%); median treatment duration was 3.3 months. Median OS was 9.9 months in the overall population, 10.8 months in post-TCR-Treated patients, and 2.6 months for those with no new post-TCR LOT. HRQoL deteriorated and pain increased over 1 year of follow-up, with clinically meaningfully changes in EQ-5D (mean, -0.06 points) and FACT-G (mean, -9.9 points). 124 (53%) patients had ≥1 all-cause hospitalization and 58 (25%) had ≥1 MM-related hospitalization; median annualized length of stay was 35.3 and 42.9 days, respectively. CONCLUSION The burden of TCR MM is substantial, emphasizing the need for more effective treatment options in the TCR setting.
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Affiliation(s)
- Hans C Lee
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karthik Ramasamy
- Department of Haematology, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Katja Weisel
- Department of Oncology, Hematology and Bone Marrow Transplantation, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Rafat Abonour
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Robert M Rifkin
- Rocky Mountain Cancer Centers/US Oncology Research, Denver, CO
| | | | | | | | | | | | | | | | - Min Che
- Bristol Myers Squibb, Princeton, NJ
| | - Gabriela Hernandez
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
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Salek S, Ionova T, Oliva EN, Andreas M, Skoetz N, Kreuzberger N, Laane E. The Reporting, Use, and Validity of Patient-Reported Outcomes in Multiple Myeloma in Clinical Trials: A Systematic Literature Review. Cancers (Basel) 2022; 14:cancers14236007. [PMID: 36497488 PMCID: PMC9741479 DOI: 10.3390/cancers14236007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are becoming increasingly important in supporting clinical outcomes in clinical trials. In multiple myeloma (MM), PRO measurement is useful to reveal how treatment affects physical, psychosocial, and functional behaviour as well as symptoms and treatment-related adverse events to evaluate the benefit-risk ratio of a particular drug or drug combination. We report the types of PRO instruments used in MM, the frequency in which they are utilised in randomised controlled trials (RCTs), and the consistency of their reporting. METHODS The European Hematology Association (EHA) supports the development of guidelines for the use of PROs in adult patients with haematological malignancies. The first step is the present systematic review of the literature. MEDLINE and CENTRAL were searched for RCTs in MM between 2015 and 2020. Study design, characteristics of MM and its treatment, the primary outcomes, and the types of PRO instrument(s) were extracted using a predefined template. Additionally, in a stepwise approach, it was assessed whether the identified instruments had been validated for multiple myeloma patients, patients with haematological malignancies, or cancer patients. RESULTS Following screening for RCTs, 283 studies were included for review from 10,707 records retrieved, and 118 of these planned the use of PRO measures. Thirty-eight PRO instruments were reported. The most frequently used instrument (92 studies) was the EORTC QLQ-30. The EORTC-MY20 MM-specific questionnaire was the second most frequently used (50 studies), together with the EQ-5D (50 studies). Only 19 PRO instruments reported were consistent with the trial registry. Furthermore, in 58 publications, the information on PRO instruments differed between the publication and the trial registry. Further, information on PRO in HTA reports was available for 26 studies, of which 18 reports were consistent with the trial registries. Out of the 38 instruments used, six had been validated for patients with multiple myeloma (the most frequently used), six for patients with haematological malignancies, and 10 for cancer patients in general. CONCLUSIONS The findings indicate that the measurement of PROs in RCTs for MM is underutilised, underreported, and often inconsistent. Guidelines for the appropriate use of PROs in MM are needed to ensure standardisation in selection and reporting. Furthermore, not all PRO instruments identified have been validated for myeloma patients or patients with haematological malignancies. Thus, guidelines for the appropriate use and reporting of PROs are needed in MM to ensure standardisation in the selection and reporting of PROs.
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Affiliation(s)
- Sam Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
- Correspondence:
| | - Tatiana Ionova
- Quality of Life Monitoring Department, Saint-Petersburg State University Hospital, 190103 Saint-Petersburg, Russia
| | - Esther Natalie Oliva
- Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy
| | - Marike Andreas
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Nina Kreuzberger
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Edward Laane
- Hematology-Oncology Clinic, Tartu University, 50406 Tartu, Estonia
- Kuressaare Hospital, 93815 Kuressaare, Estonia
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Janssens R, Lang T, Vallejo A, Galinsky J, Morgan K, Plate A, De Ronne C, Verschueren M, Schoefs E, Vanhellemont A, Delforge M, Schjesvold F, Cabezudo E, Vandebroek M, Stevens H, Simoens S, Huys I. What matters most to patients with multiple myeloma? A Pan-European patient preference study. Front Oncol 2022; 12:1027353. [PMID: 36523996 PMCID: PMC9745810 DOI: 10.3389/fonc.2022.1027353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/26/2022] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Given the rapid increase in novel treatments for patients with multiple myeloma (MM), this patient preference study aimed to establish which treatment attributes matter most to MM patients and evaluate discrete choice experiment (DCE) and swing weighting (SW) as two elicitation methods for quantifying patients' preferences. METHODS A survey incorporating DCE and SW was disseminated among European MM patients. The survey included attributes and levels informed by a previous qualitative study with 24 MM patients. Latent class and mixed logit models were used to estimate the DCE attribute weights and descriptive analyses were performed to derive SW weights. MM patients and patient organisations provided extensive feedback during survey development. RESULTS 393 MM patients across 21 countries completed the survey (M years since diagnosis=6; M previous therapies=3). Significant differences (p<.01) between participants' attribute weights were revealed depending on participants' prior therapy experience, and their experience with side-effects and symptoms. Multivariate analyses showed that participants across the three MM patient classes identified via the latent class model differed regarding their past number of therapies (F=4.772, p=.009). Patients with the most treatments (class 1) and those with the least treatments (class 3) attached more value to life expectancy versus quality of life-related attributes such as pain, mobility and thinking problems. Conversely, patients with intermediary treatment experience (class 2) attached more value to quality of life-related attributes versus life expectancy. Participants highlighted the difficulty of trading-off between life expectancy and quality of life and between physical and mental health. Participants expressed a need for greater psychological support to cope with their symptoms, treatment side-effects, and uncertainties. With respect to patients' preferences for the DCE or SW questions, 42% had no preference, 32% preferred DCE, and 25% preferred SW. CONCLUSIONS Quality of life-related attributes affecting MM patients' physical, mental and psychological health such as pain, mobility and thinking problems were considered very important to MM patients, next to life expectancy. This underscores a need to include such attributes in decision-making by healthcare stakeholders involved in MM drug development, evidence generation, evaluation, and clinical practice. This study highlights DCE as the preferred methodology for understanding relative attribute weights from a patient's perspective.
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Affiliation(s)
- Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | | - Elise Schoefs
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Michel Delforge
- Department of Oncology, University Hospital Leuven, Leuven, Belgium
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Haematology, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for B cell Malignancies, University of Oslo, Oslo, Norway
| | - Elena Cabezudo
- Department of Haematology, H. Moises Broggi/ICO-Hospitalet, Barcelona, Spain
| | | | - Hilde Stevens
- Institute for Interdisciplinary Innovation in Healthcare (I3h), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Iida S, Nakakoji M, Spanopoulos D, Okazuka K, Parulekar V, Ishida T. Practice patterns and outcomes for triple-class exposed patients with relapsed/refractory multiple myeloma in Japan. Future Oncol 2022; 18:3839-3852. [PMID: 36331578 DOI: 10.2217/fon-2022-0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim: Treatment options for triple-class exposed (TCE) patients with multiple myeloma (MM) in Japan are limited. Materials & methods: Retrospective observational study using the Medical Data Vision database (April 2008-April 2021). Eligible adults with MM received a new post-TCE treatment. Treatments, healthcare resource utilization (HCRU) and costs (per patient per month [PPPM]) were analyzed with subgroup analyses by prior stem cell transplantation (SCT vs No SCT). Results: Of 459 TCE patients, 216 (47%) had post-TCE treatment of whom 194 (90%) had no prior SCT. Median duration of the first post-TCE line of therapy (LOT) was 2 months; 49% of No SCT patients received a subsequent LOT. Total healthcare costs were comparable between No SCT and SCT groups (¥1.3 million PPPM each; US$12,328 and $12,391, respectively), driven by treatment costs. Median post-index overall survival (n = 216) was 15.8 months (95% CI: 10.5, 22.3). Conclusion: New treatments with better effectiveness are needed for patients with TCE MM in Japan.
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Affiliation(s)
- Shinsuke Iida
- Department of Hematology & Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | | - Tadao Ishida
- Department of Hematology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
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Fischer J, Knop S, Danhof S, Einsele H, Keller D, Löffler C. The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: a prospective observational study. BMC Cancer 2022; 22:1032. [PMID: 36192719 PMCID: PMC9528097 DOI: 10.1186/s12885-022-10101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/13/2022] [Indexed: 12/09/2022] Open
Abstract
Background Multiple myeloma (MM) is the third most common hematologic malignancy with increasing importance due to improving treatment strategies and long-term outcomes in an aging population. This study aims to analyse influencing factors on health-related quality of life (HRQoL), such as treatment strategies, participation in a clinical trial and patient characteristics like anxiety, depression, gender, and age. A better understanding of the individual factors in context with HRQoL could provide a helpful instrument for clinical decisions. Methods In this prospective observational study, the HRQoL of MM patients with different therapies (first-line and relapse) was quantified by standardized questionnaires (EORTC QLQ-C30 and -MY20) in the context of sociodemographic data, individual anxiety and depressiveness (PHQ-4), and a selected number of clinical parameters and symptoms at defined time-points before, during, and after therapy. Results In total, 70 patients were included in the study. The median age of the study cohort was 62 years. 44% were female and 56% were male patients. More than half of the patients were fully active with an ECOG 0. Global health status was significantly higher in patients with first-line treatment and even increased after start of therapy, while the pain level decreased. In contrast, patients with relapsed MM reported a decreasing global health status and increasing pain. Additionally, there was a higher global health status in less anxious/depressive patients. HRQoL decreased significantly after start of chemotherapy in the parameters body image, side effects of treatment, and cognitive functioning. Tandem stem-cell transplantation was not found to be a risk factor for higher impairment of HRQoL. Participation in a clinical study led to an improvement of most aspects of HRQoL. Among others, increased anxiety and depression, female gender, older age, impaired performance status, and recurrent disease can be early indicators for a reduced HRQoL. Conclusion This study showed the importance of regular longitudinal assessments of patient reported outcomes (PROs) in routine clinical care. For the first time, to our knowledge, we were able to demonstrate a potential impact between participation in clinical trials and HRQoL. However, due to frequently restrictive inclusion criteria for clinical trials, these MM patients might not be directly comparable with patients treated within standard therapy concepts. Further studies are needed to clarify the relevance of this preliminary data in order to develop an individualized, patient-centred, therapy concept. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10101-9.
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Affiliation(s)
- Julia Fischer
- Department of Pediatrics, Wuerzburg University Medical Center, Josef-Schneider-Straße 2, 97080, Würzburg, Germany.
| | - Stefan Knop
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Sophia Danhof
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Hermann Einsele
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Daniela Keller
- "Daniela Keller - Statistik und Beratung", Prosselsheimer Straße 4, 97273, Kuernach, Germany
| | - Claudia Löffler
- Department of Haematology and Oncology, Wuerzburg University Medical Center, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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Patient experience before and after treatment with idecabtagene vicleucel (ide-cel, bb2121): qualitative analysis of patient interviews in the KarMMa trial. Leuk Res 2022; 120:106921. [DOI: 10.1016/j.leukres.2022.106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
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Malta JS, Drummond PLDM, Silveira LP, Costa NL, Santos RMMD, Machado CJ, Reis AMM, de Pádua CAM. Effect of therapeutic regimens and polypharmacy on health-related quality of life of people with multiple myeloma: a cross-sectional study in Belo Horizonte, Brazil. Curr Med Res Opin 2022; 38:1275-1283. [PMID: 35083943 DOI: 10.1080/03007995.2022.2034387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multiple myeloma (MM) is an incurable hematological cancer and its treatment is geared to promote better Health-Related Quality of Life (HRQoL). We aimed to assess HRQoL and compare scores between variables on therapeutic regimens and polypharmacy in MM patients. METHODS This cross-sectional study was performed from April/2019 to February/2020 in Belo Horizonte, Brazil. HRQoL scores were obtained by the QLQ-C30 and QLQ-MY20 instruments. Data were retrieved from interviews and medical records. Therapeutic regimens were grouped into thalidomide-containing regimens; bortezomib-containing regimens; bortezomib and thalidomide-containing regimens; other therapeutic regimens, and remission group. We performed univariate analyses by the Mann-Whitney method and adopted the Kruskal-Wallis test for multiple comparisons. Robust multiple linear regression was used to determine the association between independent variables and the HRQoL scores. RESULTS The sample included 225 participants and most patients (65.3%) were on active treatment and had worse scores concerning future perspective. Polypharmacy was associated with worse scores on all scales in the univariate analyses. We observed a difference in the global health and body image (p < .05) scales in the multiple comparisons with therapeutic regimens. The global health scale difference was found between groups with other regimens and the remission group (p < .05). The difference between the bortezomib and thalidomide-containing regimens and remission group was not statistically significant (p = .077) in the body image scale. The multiple linear regression maintained the association of polypharmacy with worse HRQoL scores. CONCLUSION We identified an independent association between HRQoL and polypharmacy in MM patients. However, there was no difference between the evaluated regimens, suggesting they are equivalent in Brazil about HRQoL.
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Affiliation(s)
- Jéssica Soares Malta
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
| | - Paula Lana de Miranda Drummond
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
- Fundação Ezequiel Dias - Funed, Belo Horizonte, Brasil
| | - Lívia Pena Silveira
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
- Hospital das Clínicas da UFMG, Belo Horizonte, Brasil
| | - Naiane Lima Costa
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brasil
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Steinmetz HT, Singh M, Milce J, Haidar M, Rieth A, Lebioda A, Kohnke J. Management of Patients with Relapsed and/or Refractory Multiple Myeloma Treated with Novel Combination Therapies in Routine Clinical Practice in Germany. Adv Ther 2022; 39:1247-1266. [PMID: 35034310 PMCID: PMC8918129 DOI: 10.1007/s12325-021-02022-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Multiple myeloma remains an incurable plasma cell malignancy which, despite improvements in overall survival over the last decade, is characterized by recurrent relapse and is associated with a poor prognosis. This study investigates the use of novel agents in current real-world clinical practice in the management of relapsed and/or refractory multiple myeloma (RRMM) in Germany over different lines of therapy. METHODS A retrospective chart review was conducted for patients with RRMM treated at multiple centers across Germany between May 2017 and June 2018. Variables included patient demographics and clinical characteristics, current and prior treatment regimens, treatment response, cytogenetic abnormalities, testing methodology, and resource utilization. RESULTS Data were analyzed from 484 patients from 47 centers across Germany (60% male; average age over 70 years; majority at International Staging System stage 2 or 3). Bone pain and anemia were the most common symptoms at diagnosis, with 63% of patients receiving osteoprotective drugs. Approximately one-third (32%) of patients had received autologous stem cell transplantation and approximately 70% underwent cytogenetic testing. After failure to respond to first-line treatment, most patients received regimens containing second-generation proteasome inhibitors and monoclonal antibodies, with overall response rates greater than 90% in second line (95% and 90% for daratumumab-based and carfilzomib-based therapies, respectively). The incidence of unplanned hospitalization ranged from 11% to 16% across all treatment lines, with longer hospital stays required for treatment administration than for treatment-related toxicity. CONCLUSION Although treatment patterns for RRMM in Germany differ by line of therapy and are adapted as disease progresses, patients mostly receive combination regimens with carfilzomib or daratumumab in second and third lines, with high overall response rates achieved in all lines.
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Affiliation(s)
- H Tilman Steinmetz
- Center for Hematology and Oncology, Oncology Cologne, Sachsenring 69, 50677, Cologne, Germany.
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Delforge M, Shah N, Miguel JSF, Braverman J, Dhanda DS, Shi L, Guo S, Yu P, Liao W, Campbell TB, Munshi NC. Health-related quality of life with idecabtagene vicleucel in relapsed and refractory multiple myeloma. Blood Adv 2022; 6:1309-1318. [PMID: 34933328 PMCID: PMC8864645 DOI: 10.1182/bloodadvances.2021005913] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022] Open
Abstract
Idecabtagene vicleucel (ide-cel), a B-cell maturation antigen-directed chimeric antigen receptor T cell therapy, showed deep, durable responses in patients with triple-class exposed, relapsed and refractory multiple myeloma (RRMM) in the phase 2 KarMMa (Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma) trial. We assessed health-related quality of life (HRQoL) among KarMMa patients. The European Organization for Research and Treatment of Cancer Quality of Life C30 Questionnaire and its supplementary 20-item multiple myeloma module, as well as the EuroQol 5-dimension 5-level instrument, were administered at screening, baseline (≤72 hours before or same day as lymphodepletion), day of ide-cel treatment, and after ide-cel treatment. Mean changes from baseline that exceeded the predetermined threshold of minimally important difference were deemed clinically meaningful. The proportions of patients experiencing clinically meaningful changes in HRQoL were assessed using within-patient change thresholds. Time to stable improvement (≥2 consecutive visits with clinically meaningful HRQoL improvements) was analyzed by using the Kaplan-Meier method. A total of 126 (98%) of 128 patients treated with ide-cel were included in the HRQoL analysis. Pretreatment baseline RRMM burden was high and meaningfully worse than that in the age- and sex-weighted general population. Statistically significant and clinically meaningful improvements from baseline were observed by month 1 for pain (-8.9) and disease symptoms (-10.2), and by month 2 for fatigue (-7.2), physical functioning (6.1), cognitive functioning (6.7), and global health status/QoL (8.0). Clinically meaningful improvements in fatigue, pain, and physical functioning were most prominent at months 9, 12, and 18, respectively, and were sustained through 15 to 18 months after ide-cel treatment. For triple-class exposed patients with RRMM with a poor prognosis and few treatment options, a single ide-cel infusion provides early, sustained, statistically significant, and clinically meaningful improvements in HRQoL. This study was registered at Clinicaltrials.gov as #NCT03361748.
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Affiliation(s)
| | - Nina Shah
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Nikhil C. Munshi
- The LeBow Institute for Myeloma Therapeutics and Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Patient-reported outcome measures are associated with health care utilization in patients with transplant ineligible multiple myeloma: a population-based study. Blood Cancer J 2022; 12:17. [PMID: 35087029 PMCID: PMC8795114 DOI: 10.1038/s41408-021-00602-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
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Jensen CE, Vohra SN, Nyrop KA, Deal AM, LeBlanc MR, Grant SJ, Muss HB, Lichtman EI, Rubinstein SM, Wood WA, Mangieri NJ, Jamison L, Tuchman SA. OUP accepted manuscript. Oncologist 2022; 27:694-702. [PMID: 35511734 PMCID: PMC9355823 DOI: 10.1093/oncolo/oyac079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christopher E Jensen
- Corresponding author: Christopher E. Jensen, MD, 170 Manning Drive, Houpt Building, CB# 7305, 3rd Floor, Chapel Hill, NC 27599, USA. Tel: +1 252 908 1739; Fax: +1 919 966 6735;
| | - Sanah N Vohra
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew R LeBlanc
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shakira J Grant
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eben I Lichtman
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel M Rubinstein
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William A Wood
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nicholas J Mangieri
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lee Jamison
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sascha A Tuchman
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Dolph M, Tremblay G, Gilligan AM, Leong H. Network Meta-Analysis of Once Weekly Selinexor-Bortezomib-Dexamethasone in Previously Treated Multiple Myeloma. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:26-35. [PMID: 34616855 PMCID: PMC8460427 DOI: 10.36469/001c.27080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/30/2021] [Indexed: 06/13/2023]
Abstract
Background: Despite the availability of new treatments, multiple myeloma (MM) is an incurable cancer with nearly all patients relapsing and undergoing multiple lines of treatment. Performing head-to-head comparisons of all treatment options is not feasible. Thus, network meta-analyses play an important role in allowing health-care decision makers to compare the effectiveness of treatment options. Objectives: A Bayesian network meta-analysis (NMA) was developed from studies identified from a systematic literature review (SLR) to evaluate the efficacy of once weekly oral selinexor with once weekly bortezomib and low-dose dexamethasone (XVd) relative to other therapies in previously treated MM. Methods: Ovid was systematically searched for phase 2-3 randomized clinical trials (RCTs) in MM that assessed progression-free survival (PFS), overall survival (OS) and overall response rates (ORR). Two population subsets were assessed: second-line patients (2L) and third-line or greater patients (3L+). Base case results compared all regimens against twice weekly bortezomib and dexamethasone (Vd) as the anchored comparator regimen. Results: Forty-seven RCTs met inclusion. For 2L PFS, OS and ORR, XVd had, on average, out of all iterations, the 6th (out of 21), 4th (out of 15), and 5th (out of 20) best result, respectively, versus Vd. For 3L+ PFS, OS and ORR, XVd had the 12th (out of 24), 11th (out of 22), and 8th (out of 25) best result, respectively, versus Vd. There was no statistically significant difference between XVd and other top-ranking therapies for PFS, OS, and ORR in either 2L and 3L+ except for daratumumab/bortezomib/dexamethasone [DVd], which was favorable versus XVd (2L PFS only). Discussion: Results for XVd were more favorable in 2L, having a higher probability of being a top 5 regimen, compared with 3L+ therapies based on the reported clinical trial results. However, in typical clinical practice, most triplet regimens have been modified using weekly bortezomib dosing, raising questions about the actual efficacy of these regimens versus the reported results using twice weekly bortezomib dosing. Conclusions: The addition of XVd, which was designed with once weekly bortezomib dosing, to the treatment landscape for previously treated MM provides a regimen that may potentially be noninferior to the other top 5 regimens in both 2L and 3L+ settings and is associated with less peripheral neuropathy.
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23
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Lepretre S, Touboul C, Flinois A, Kutikova L, Giannopoulou C, Makhloufi K, Chauny JV, Désaméricq G. Quality of life in adults with acute lymphoblastic leukemia in France: results from a French cross-sectional study. Leuk Lymphoma 2021; 62:2957-2967. [PMID: 34162314 DOI: 10.1080/10428194.2021.1941924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In recent years, treatment of acute lymphoblastic leukemia (ALL) has improved substantially, leading to longer survival. This has necessitated a greater focus on health-related quality of life (HRQoL), but data are lacking. In a part-prospective, part-retrospective study, we enrolled 219 adults with ALL in France to assess the impact of key disease and treatment characteristics on HRQoL. Overall HRQoL and most specific QoL domain scores were consistently better among patients receiving front-line therapy, those currently in complete remission, and those who had previously received hematopoietic stem-cell transplantation. Furthermore, HRQoL was consistently impaired in patients with minimal residual disease present (MRD+). In multivariate analyses, multiple lines of therapy, MRD+, leukopenia, comorbidities, and anemia were significantly associated with impaired HRQoL. This study provides real-world data on HRQoL in adults with ALL in France and shows the positive impact of MRD-negative status on HRQoL.
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Affiliation(s)
| | - Chantal Touboul
- Real World Evidence, Epidemiology and Observational Research, Kantar Health, Paris, France
| | - Alain Flinois
- Department of Oncology, Kantar Health, Paris, France
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24
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Ebraheem MS, Seow H, Balitsky AK, Pond GR, Wildes TM, Sivapathasundaram B, Sussman J, Mian H. Trajectory of Symptoms in Patients Undergoing Autologous Stem Cell Transplant for Multiple Myeloma: A Population-Based Cohort Study of Patient-Reported Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e714-e721. [PMID: 34099429 DOI: 10.1016/j.clml.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Autologous stem cell transplant (ASCT) is an established treatment for patients with newly diagnosed multiple myeloma (NDMM). Understanding the symptom burden associated with ASCT may be an important consideration for patients with NDMM when selecting treatment options. PATIENTS AND METHODS We conducted a population-based study of patients who underwent an ASCT for NDMM in Ontario, Canada, between 2007 and 2018. The patient-reported outcome, Edmonton Symptom Assessment System (ESAS) score, which captures nine common cancer-associated symptoms and is routinely collected at all outpatient visits, was linked to provincial administrative healthcare data. The monthly prevalence of moderate or severe symptoms (ESAS ≥ 4) each month in the first year following ASCT was analyzed. A multivariable logistic regression model was used to identify factors associated with moderate to severe symptoms. RESULTS In our final cohort of 1969 patients who had undergone an ASCT, a total of 12,820 unique assessments were captured. Symptom burden was highest at 1 month post-ASCT, with moderate to severe tiredness and impaired well-being being the two most common symptoms. Symptom burden substantially improved by 3 months post-ASCT, reaching a new baseline for the year following. On multivariable analysis, female sex, increased co-morbidities, earlier year of diagnosis, and myeloma-related end-organ damage (specifically, bone and kidney disease) were associated with a higher odds of reporting moderate to severe symptoms. CONCLUSION In this large population-based study using patient-reported outcomes, there was a substantial burden of symptoms noted among NDMM patients 1 month post-ASCT, which improved over time. Tailored supportive care interventions should focus on strategies to optimize management of identified symptoms.
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Affiliation(s)
- Mohammed S Ebraheem
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Hsien Seow
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Amaris K Balitsky
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Gregory R Pond
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | | | | | - Jonathan Sussman
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Hira Mian
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON.
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25
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Borgsten F, Gatopoulou X, Pisini M, Tambour M, Schain F, Jones CV, Kwok KHM, Batyrbekova N, Björkholm M. Healthcare resource utilisation and sickness absence in newly diagnosed multiple myeloma patients who did not undergo autologous stem cell transplantation: Trends in Sweden with the changing treatment landscape. Eur J Haematol 2021; 107:92-103. [PMID: 33728732 DOI: 10.1111/ejh.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The introduction of novel drugs has significantly improved outcomes for multiple myeloma (MM) patients. This study describes survival, healthcare resource utilisation and sickness absence in association with the changing MM treatment landscape over time, focussing on patients who did not undergo autologous stem cell transplantation (ASCT). METHODS Population-based, retrospective registry study in Sweden, where 7012 non-ASCT patients diagnosed between 2001 and 2015 were stratified into diagnosis periods 2001-2005 (n = 2053), 2006-2010 (n = 2372) and 2011-2015 (n = 2587). RESULTS Median survival increased from 2.5 to 3.4 years from 2001-2005 to 2011-2015. During the first 3 years of follow-up, patients diagnosed during 2011-2015 spent 29% and 12% less time in health care (55 days; inpatient admissions and outpatient visits) than patients diagnosed during 2001-2005 (78 days) and 2006-2010 (63 days), respectively. This was associated with less inpatient and more outpatient healthcare usage. Average 3-year sickness absence (362 days) was 31% and 12% less than for patients diagnosed during 2001-2005 (522 days) and 2006-2010 (410 days), respectively. CONCLUSIONS These findings of improved survival, reduced healthcare needs and greater productivity in non-ASCT MM patients with access to improved treatment practices and novel drugs provide important real-world cost-benefit insights for the continued development and introduction of treatments for MM.
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Affiliation(s)
| | | | | | | | - Frida Schain
- Schain Research AB, Bromma, Sweden.,Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - Christina V Jones
- Schain Research AB, Bromma, Sweden.,Department of Cell and Molecular Biology, Karolinska Institutet, Solna, Sweden
| | - Kelvin Ho Man Kwok
- Schain Research AB, Bromma, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Nurgul Batyrbekova
- SDS Life Science, Danderyd, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Magnus Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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26
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Selvy M, Kerckhove N, Pereira B, Barreau F, Nguyen D, Busserolles J, Giraudet F, Cabrespine A, Chaleteix C, Soubrier M, Bay JO, Lemal R, Balayssac D. Prevalence of Chemotherapy-Induced Peripheral Neuropathy in Multiple Myeloma Patients and its Impact on Quality of Life: A Single Center Cross-Sectional Study. Front Pharmacol 2021; 12:637593. [PMID: 33967771 PMCID: PMC8101543 DOI: 10.3389/fphar.2021.637593] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Bortezomib is a pivotal drug for the management of multiple myeloma. However, bortezomib is a neurotoxic anticancer drug responsible for chemotherapy-induced peripheral neuropathy (CIPN). CIPN is associated with psychological distress and a decrease of health-related quality of life (HRQoL), but little is known regarding bortezomib-related CIPN. This single center, cross-sectional study assessed the prevalence and severity of sensory/motor CIPN, neuropathic pain and ongoing pain medications, anxiety, depression, and HRQoL, in multiple myeloma patients after the end of bortezomib treatment. Paper questionnaires were sent to patients to record the scores of sensory and motor CIPNs (QLQ-CIPN20), neuropathic pain (visual analogue scale and DN4 interview), anxiety and depression (HADS), the scores of HRQoL (QLQ-C30 and QLQ-MY20) and ongoing pain medications. Oncological data were recorded using chemotherapy prescription software and patient medical records. The prevalence of sensory CIPN was 26.9% (95% CI 16.7; 39.1) among the 67 patients analyzed and for a mean time of 2.9 ± 2.8 years since the last bortezomib administration. The proportion of sensory CIPN was higher among patients treated by intravenous and subcutaneous routes than intravenous or subcutaneous routes (p = 0.003). QLQ-CIPN20 motor scores were higher for patients with a sensory CIPN than those without (p < 0.001) and were correlated with the duration of treatment and the cumulative dose of bortezomib (coefficient: 0.31 and 0.24, p = 0.01 and 0.0475, respectively), but not sensory scores. Neuropathic pain was screened in 44.4% of patients with sensory CIPN and 66.7% of them had ongoing pain medications, but none were treated with duloxetine (recommended drug). Multivariable analysis revealed that thalidomide treatment (odds-ratio: 6.7, 95% CI 1.3; 35.5, p = 0.03) and both routes of bortezomib administration (odds-ratio: 13.4, 95% CI 1.3; 139.1, p = 0.03) were associated with sensory CIPN. Sensory and motor CIPNs were associated with anxiety, depression, and deterioration of HRQoL. Sensory CIPN was identified in a quarter of patients after bortezomib treatment and associated with psychological distress that was far from being treated optimally. There is a need to improve the management of patients with CIPN, which may include better training of oncologists regarding its diagnosis and pharmacological treatment.
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Affiliation(s)
- Marie Selvy
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France.,Service de Chirurgie digestive, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France.,Service de Pharmacologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Direction de La Recherche Clinique et de l'Innovation, Clermont-Ferrand, France
| | - Fantine Barreau
- Service d'Hématologie clinique adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Daniel Nguyen
- College of Pharmacy, University of Oklahoma, Oklahoma City, OK, United States
| | - Jérôme Busserolles
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Fabrice Giraudet
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Aurélie Cabrespine
- Service d'Hématologie clinique adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Carine Chaleteix
- Service d'Hématologie clinique adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Martin Soubrier
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France.,UNH-UMR 1019, INRA, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jacques-Olivier Bay
- Service d'Hématologie clinique adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France.,EA 7453 CHELTER, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Richard Lemal
- Service d'Hématologie clinique adulte, CHU Clermont-Ferrand, Clermont-Ferrand, France.,EA 7453 CHELTER, Université Clermont Auvergne, Clermont-Ferrand, France
| | - David Balayssac
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Direction de La Recherche Clinique et de l'Innovation, Clermont-Ferrand, France
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27
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Engelhardt M, Ihorst G, Singh M, Rieth A, Saba G, Pellan M, Lebioda A. Real-World Evaluation of Health-Related Quality of Life in Patients With Multiple Myeloma From Germany. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e160-e175. [DOI: 10.1016/j.clml.2020.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023]
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28
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Steinmetz TH, Singh M, Lebioda A, Fink L, Schoehl M, Rieth A, Gonzalez-McQuire S, Engelhardt M. Healthcare resource utilization and costs among patients with relapsed and/or refractory multiple myeloma treated with proteasome inhibitors in real-world clinical practice in Germany. J Med Econ 2021; 24:114-122. [PMID: 33390079 DOI: 10.1080/13696998.2020.1867469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To assess the real-world healthcare resource utilization (HRU) and costs associated with different proteasome inhibitors (PIs) for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) in Germany. METHODS We conducted a retrospective medical chart review of treatment patterns, outcomes, and HRU for patients with RRMM treated with bortezomib, carfilzomib, or ixazomib in second- or third-line (2L or 3L) therapy in Germany. Data were collected between 1 January 2017 and 30 June 2017. Costs were calculated based on drug prices and unit costs in Germany. RESULTS Physicians provided data on 302 patients. Mean monthly total direct costs per patient receiving PI-based therapy were €7,925 and €10,693 for 2L and 3L, respectively, of which approximately 90% was anti-myeloma drug costs. Overall, the highest costs were associated with patients receiving 3L therapy. Regardless of treatment line, costs were higher for patients who had received a stem cell transplant (SCT) in a previous treatment line than for those who had not; the data suggest that this reflects the use of triplet regimens following a SCT. Patients with a complete response (CR) experienced no unplanned hospitalizations during the study period, whereas patients with progressive disease experienced the highest number of unplanned and planned hospitalizations. In 2L therapy, the highest proportion of patients with a CR was observed in those receiving carfilzomib (12% carfilzomib; 4% bortezomib; 0% ixazomib). LIMITATIONS Patients with missing or incomplete follow-up data were included in the study and were accounted for using monthly cost estimates. CONCLUSIONS Anti-myeloma drugs were the main contributor to total HRU costs associated with RRMM in Germany. Improved treatment response was associated with lower costs and reduced hospitalizations.
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Affiliation(s)
| | | | | | - Leah Fink
- Kantar, Health Division, Paris, France
| | | | | | | | - Monika Engelhardt
- Faculty of Freiburg, University Hospital of Freiburg, Freiburg, Germany
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29
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Fonseca R, Usmani SZ, Mehra M, Slavcev M, He J, Cote S, Lam A, Ukropec J, Maiese EM, Nair S, Potluri R, Voorhees PM. Frontline treatment patterns and attrition rates by subsequent lines of therapy in patients with newly diagnosed multiple myeloma. BMC Cancer 2020; 20:1087. [PMID: 33172403 PMCID: PMC7656738 DOI: 10.1186/s12885-020-07503-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/06/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND For patients with multiple myeloma (MM), each additional line of therapy (LOT) is associated with lower response rates, shorter treatment duration and treatment-free intervals, and increased rates of toxicities and comorbidities. Here, we examine frontline treatment patterns, and attrition rates by LOT among newly diagnosed MM (NDMM) patients in the United States who were eligible or ineligible for autologous stem cell transplant (ASCT). METHODS Data were identified from three US patient-level databases collectively covering the period January 2000 to September 2018. Patients had an index diagnosis of MM on or after January 1, 2007, medical and prescription insurance coverage at diagnosis, a 1-year look-back period prior to the index diagnosis, no prior malignancies in the 1-year period before index diagnosis, and had received ≥1 LOT. RESULTS Among patients who did not receive ASCT (non-transplant; n = 22,062), 12,557 (57%) received only 1 LOT and 9505 (43%) received > 1 LOT. Patients receiving only 1 LOT were significantly older, had higher mean Charlson Comorbidity Index (CCI) scores, and higher incidences of comorbidities. Among the 2763 patients receiving ASCT, 2184 received > 1 LOT, and 579 (21%) received only 1 LOT (ie, ASCT was the last treatment). 1682 (61%) patients received induction therapy as frontline treatment, of whom 187 (11%) also received consolidation therapy. The latter group was younger than those who received only induction therapy, had lower mean CCI scores, and comparable or lower incidences of selected comorbidities. The most common frontline therapy for non-transplant and transplant-eligible patients was bortezomib/dexamethasone and bortezomib/lenalidomide/dexamethasone, respectively. Attrition rates across all LOTs were high for non-transplant patients (range, 43-57%) and transplant patients (range, 21-37%). Treatment duration decreased by LOT for non-transplant patients and was consistent across LOTs for transplant patients. CONCLUSIONS In this analysis, a substantial proportion of patients with NDMM who received frontline therapy did not appear to receive a subsequent LOT. These high attrition rates underscore the need to use the most optimal treatment regimens upfront rather than reserving them for later LOTs in which the clinical benefit may decrease.
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Affiliation(s)
- Rafael Fonseca
- Division of Hematology and Oncology, Mayo Clinic, 13400 E. Shea Blvd., MCCRB 3-001, Phoenix, AZ, 85259, USA.
| | - Saad Z Usmani
- Levine Cancer Institute/Atrium Health, Charlotte, NC, USA
| | | | | | - Jianming He
- Janssen Global Services, LLC, Raritan, NJ, USA
| | - Sarah Cote
- Janssen Global Services, LLC, Raritan, NJ, USA
| | - Annette Lam
- Janssen Global Services, LLC, Raritan, NJ, USA
| | - Jon Ukropec
- Janssen Global Medical Affairs, Horsham, PA, USA
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30
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Weisel K, Dimopoulos M, Moreau P, Yagci M, Larocca A, Kanate AS, Vural F, Cascavilla N, Basu S, Johnson P, Byeff P, Hus M, Rodríguez-Otero P, Muelduer E, Anttila P, Hayden PJ, Krauth MT, Lucio P, Ben-Yehuda D, Mendeleeva L, Guo S, Yu X, Grote L, Biyukov T, Dhanasiri S, Richardson P. Health-related quality-of-life results from the phase 3 OPTIMISMM study: pomalidomide, bortezomib, and low-dose dexamethasone versus bortezomib and low-dose dexamethasone in relapsed or refractory multiple myeloma. Leuk Lymphoma 2020; 61:1850-1859. [DOI: 10.1080/10428194.2020.1747066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg, Germany and University Hospital of Tuebingen, Tuebingen, Germany
| | | | | | - Munci Yagci
- Gazi Universitesi Tip Fakultesi Hastanesi, Besevler, Turkey
| | - Alessandra Larocca
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Abraham S. Kanate
- Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV, USA
| | | | - Nicola Cascavilla
- Fondazione IRCSS Casa Sollievo Della Sofferenza, San Giovanni Rotundo, Italy
| | - Supratik Basu
- New Cross Hospital, Wolverhampton, University Of Wolverhampton, United Kingdom
| | - Peter Johnson
- Department of Haematology, Western General Hospital, Edinburgh, United Kingdom
| | - Peter Byeff
- Cancer Center of Central Connecticut, Southington, CT, USA
| | - Marek Hus
- Samodzielny Publiczny Szpital Nr 1 W Lublinie, Lublin, Poland
| | | | | | - Pekka Anttila
- Division of Hematology, Helsinki University and Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | - Maria-Theresa Krauth
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Paulo Lucio
- Champalimaud Center for the Unknown, Lisbon, Portugal
| | | | - Larisa Mendeleeva
- National Research Center for Hematology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Xin Yu
- Bristol Myers Squibb, Summit, NJ, USA
| | | | - Tsvetan Biyukov
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Sujith Dhanasiri
- Celgene International Sàrl, a Bristol Myers Squibb Company, Boudry, Switzerland
| | - Paul Richardson
- Jerome Lipper Multiple Myeloma Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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31
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Roussel M, Hebraud B, Hulin C, Perrot A, Caillot D, Stoppa AM, Macro M, Escoffre M, Arnulf B, Belhadj K, Karlin L, Garderet L, Facon T, Guo S, Weng J, Dhanasiri S, Leleu X, Moreau P, Attal M. Health-related quality of life results from the IFM 2009 trial: treatment with lenalidomide, bortezomib, and dexamethasone in transplant-eligible patients with newly diagnosed multiple myeloma. Leuk Lymphoma 2020; 61:1323-1333. [DOI: 10.1080/10428194.2020.1719091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| | - Benjamin Hebraud
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| | | | | | | | | | | | - Martine Escoffre
- Hematologie clinique, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Lionel Karlin
- Hématologie clinique, CHU de Lyon HCL – GH Sud, Pierre-Bénite, France
| | | | | | | | | | - Sujith Dhanasiri
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | | | | | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
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32
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Badi AA, Al-Allawi N, Yassin A, Safar B, Abdulla B, Shamoon R, Amin T, Mohamed Z, Mohammed A, Hussein D, Hasan K, Mohammed N, Rajab R, Hiwaizi F, Karim K, Hassan A, Getta H, Khoshnaw N, Jalal SH, Mohammed A, Abdullah D. Health-related quality of life in multiple myeloma in Kurdistan Iraq. IRAQI JOURNAL OF HEMATOLOGY 2020. [DOI: 10.4103/ijh.ijh_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sharpley FA, Djebbari F, Fourali S, Kothari J, Lynes JA, McLain-Smith S, Ramasamy K. Clinical outcomes with fixed-duration therapy (UK real-world data) compared with continuous lenalidomide and low-dose dexamethasone therapy (FIRST trial; MM-020) for transplant-ineligible patients with newly-diagnosed multiple myeloma. Leuk Lymphoma 2019; 61:732-736. [PMID: 31771382 DOI: 10.1080/10428194.2019.1683737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Faye A Sharpley
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Faouzi Djebbari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Samih Fourali
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jaimal Kothari
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre Blood Theme, Oxford, UK
| | | | | | - Karthik Ramasamy
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre Blood Theme, Oxford, UK
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Sayuti NA, Andayani TM, Endarti D, Taroeno-Hariadi KW. Health- Related Quality of Life for Multiple Myeloma Patients with Bone Metastases in Indonesia: A Cross-Sectional Study. Asian Pac J Cancer Prev 2019; 20:3161-3166. [PMID: 31653168 PMCID: PMC6982659 DOI: 10.31557/apjcp.2019.20.10.3161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Indexed: 12/09/2022] Open
Abstract
Objective: Multiple myeloma (MM) with bone metastases causes a skeletal-related event (SRE), and decreases health-related quality of life (HRQoL). HRQoL needs to be evaluated for health technology assessment (HTA). Furthermore, HRQoL is calculated as a health state utility and is used in the Markov Model for HTA. Therefore, this study aimed to describe the HRQoL of MM patients with bone metastases, using The EuroQol five-dimension five levels (EQ -5D-5L) in Indonesia. Methods: a cross-sectional, multicenter study for MM patients with bone metastases (aged over 18 years old) that consulted a physician between November 2018 - May 2019 was conducted. The calculated HRQoL illustrated the health state utility, which was assessed using the EQ-5D-5L questionnaire, with the Indonesian value set. In addition, Mann-Whitney analyses were performed to determine the difference in utility scores at different points within the Durie-Salmon staging system and skeletal condition. Results: in 93 patients who completed the questioner, pain was their major concern with prevalence of over 60% (all levels inclusive). Moreover, the mean utility of patients in stage II and III were 0.735 (SD = 0.205) and 0.383 (SD = 0.555), and those without SRE was 0.753 (SD = 0.213) while patients with SRE was 0.302 (SD = 0.562). Therefore, the lessened values were observed at stage III and SRE condition (p<0.05). Conclusion: MM patients with bone metastases have poor HRQoL, with pain as the most frequently reported challenge, which is associated with an advanced stage of MM and SRE event.
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Affiliation(s)
- Nutrisia Aquariushinta Sayuti
- Doctoral Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Indonesian Herbal Medicine Department, Health Polytechnic of Surakarta, Ministry of Health Indonesia, Surakarta, Indonesia
| | - Tri Murti Andayani
- Doctoral Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dwi Endarti
- Doctoral Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kartika Widayati Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Health-related quality of life in Croatian general population and multiple myeloma patients assessed by the EORTC QLQ-C30 and EORTC QLQ-MY20 questionnaires. Radiol Oncol 2019; 53:337-347. [PMID: 31553711 PMCID: PMC6765165 DOI: 10.2478/raon-2019-0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The impact of disease and treatment on the patient's overall well-being and functioning is a topic of growing interest in clinical research and practice. The aim of this study is to obtain reference data on quality of life of Croatian general population. Further, we aim to assess the impact of the disease and its primary systemic treatment on their health related quality of life (HrQoL) in multiple myeloma (MM) patients. Patients and methods Participants for the first part of the study were randomly selected from adult Croatian population. In the clinical part of the study MM patients were included as prospectively diagnosed within two years in two major Croatian haematological centres. The EORTC QLQ-C30 in both trials and QLQ-MY20 in MM patients only were applied for HrQoL assessment. Results Gender, age and place of residence have great impact on quality of life scores in Croatian population. The MM patients at the time of diagnosis have lower QLQ-C30 scores for global quality of life, functional and symptom scale scores, as well as single items. The type of disease followed by the choice of therapy options are important HrQoL determinants. Conclusions The norm values available now for Croatian population will help to interpret HrQoL for clinicians and aid in planning cancer care interventions. This study identified treatment effect consistent with those from other observational studies and provided new data on HrQoL across two different treatment choices for MM patients.
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Niscola P, Scaramucci L, Efficace F. Towards the integration of patient-reported outcomes into the global clinical management of multiple myeloma. Expert Rev Hematol 2019; 12:703-705. [PMID: 31317793 DOI: 10.1080/17474086.2019.1645005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | | | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA) , Rome , Italy
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