1
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Glad DM, Pardej SK, Olszewski E, Klein-Tasman BP. Pilot study of the effectiveness of a telehealth group for improving peer relationships for adolescents with neurofibromatosis type 1. Orphanet J Rare Dis 2024; 19:115. [PMID: 38475852 DOI: 10.1186/s13023-024-03093-1] [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] [Received: 09/26/2023] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Interventions for social difficulties have not been investigated in the neurofibromatosis type 1 (NF1) population despite observations of elevated rates of social difficulties. In this pilot study, the effectiveness of a 14-week telehealth PEERS® intervention with nineteen adolescents with NF1 (Mage=13.79 years, SD = 1.32) with social skills difficulties was examined. Measures of social outcomes were completed at three timepoints (before, immediately after, and at 14-week follow-up). RESULTS Caregiver-reported social-emotional skills, social impairment, caregiver-reported number of adolescent get-togethers, and teen social knowledge showed significant improvement following the intervention. CONCLUSIONS The PEERS® intervention is promising to support the social and friendship skills of adolescents with NF1 who have social difficulties.
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Affiliation(s)
- Danielle M Glad
- Department of Psychology, University of Wisconsin- Milwaukee, 2441 E Hartford Ave, Wisconsin, 53211, Milwaukee, USA.
| | - Sara K Pardej
- Department of Psychology, University of Wisconsin- Milwaukee, 2441 E Hartford Ave, Wisconsin, 53211, Milwaukee, USA
| | - Ellen Olszewski
- Department of Psychology, University of Wisconsin- Milwaukee, 2441 E Hartford Ave, Wisconsin, 53211, Milwaukee, USA
| | - Bonita P Klein-Tasman
- Department of Psychology, University of Wisconsin- Milwaukee, 2441 E Hartford Ave, Wisconsin, 53211, Milwaukee, USA
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2
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Macaluso M, Rothenberg ME, Ferkol T, Kuhnell P, Kaminski HJ, Kimberlin DW, Benatar M, Chehade M. Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey. JMIR Public Health Surveill 2024; 10:e48430. [PMID: 38354030 PMCID: PMC10868638 DOI: 10.2196/48430] [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: 04/23/2023] [Revised: 09/20/2023] [Accepted: 12/15/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). OBJECTIVE This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. METHODS US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. RESULTS Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. CONCLUSIONS Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary.
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Affiliation(s)
- Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Marc E Rothenberg
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Thomas Ferkol
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Pierce Kuhnell
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Henry J Kaminski
- Department of Neurology and Rehabilitation Medicine, George Washington University, Washington, DC, United States
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, United States
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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3
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Bogart KR, Hartinger A, Klaus M, Jenkinson E. A shock to the (health) system: experiences of adults with rare disorders during the first COVID-19 wave. Orphanet J Rare Dis 2024; 19:33. [PMID: 38291466 PMCID: PMC10829377 DOI: 10.1186/s13023-024-03033-z] [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: 03/14/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Before COVID-19, people with rare diseases (RD) experienced numerous disparities in quality of life and healthcare access and quality, yet little is known about the experiences of this underserved group during the pandemic. RESULTS During the first wave of the COVID-19 pandemic in the United States, spring and summer of 2020, 759 participants representing 231 unique RDs responded to open-ended questions about the impact of the pandemic on life with a RD, healthcare access, and coping. Qualitative conventional content analysis was used to analyze responses. Identified themes represented positive and negative dimensions of change, including a shock to the (health) system, coping with uncertainty, and the value of social support while isolated. CONCLUSIONS Limitations in healthcare access and quality were the most frequently described as impacts of COVID-19. Other major negative impacts included exacerbation of symptoms, psychological distress, and a lack of usual social support and reliable information. However, participants also noted silver linings, especially in healthcare. For some, expanded telehealth enhanced their ability to access medical and mental health providers and RD specialists. Finally, many participants hoped that, by highlighting social and health inequities faced by people with RDs and other minorities, the pandemic would prompt greater understanding and policies that could improve the quality of life of the RD community.
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Affiliation(s)
- Kathleen R Bogart
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA.
| | - Annelise Hartinger
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Maggie Klaus
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA
| | - Elizabeth Jenkinson
- Centre for Appearance Research, University of the West of England, Bristol, UK
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4
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Curry M, Peterson I, Belter L, Sarr F, Whitmire S, Schroth M, Jarecki J. Effects of the COVID-19 Pandemic on SMA Screening and Care: Physician and Community Insights. Neurol Ther 2023; 12:1631-1647. [PMID: 37347432 PMCID: PMC10444727 DOI: 10.1007/s40120-023-00516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVE As part of efforts to reduce diagnostic delays and enhance clinical trials, Cure SMA evaluated the effects of COVID-19 on SMA care and clinical trial conduct. INTRODUCTION Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease characterized by progressive, potentially debilitating muscle weakness and atrophy. Uninterrupted access to early diagnosis, disease-modifying treatment, and care for SMA is vital to avoiding irreversible motor neuron death and achieving optimal patient outcomes. METHODS Two surveys were conducted: a provider survey and a community survey. The Provider Impact Survey, distributed from November 24, 2020, through March 8, 2021, assessed COVID-19's effects on referrals for evaluation of suspected SMA, cancellations and delays of SMA-related care, and clinical trials. The Community Impact Survey was fielded in three waves between April 7, 2020 and July 19, 2021, in tandem with Cure SMA COVID-19 support programs. RESULTS A total of 48 completed provider surveys (22 from care sites, 26 from care-and-trial sites) reflected decreases in referrals for suspected SMA, increases in appointment cancellations and delays, and patient reluctance to attend in-person visits due to COVID-19. One-third of care-and-trial sites reported trial recruitment delays, and one-quarter reported pausing trial enrollment. Results of the Community Impact Survey, completed by 2047 individuals, showed similar disruptions, with 55% reporting changes or limitations in accessing essential SMA-related services. CONCLUSIONS This research evaluates the pandemic's interruption of SMA care and research. These insights can help mitigate and increase preparedness for future disruptive events. Expanded use of virtual tools including telehealth and remote monitoring may enhance continuity and access. However, additional research is required to evaluate their effectiveness. While this research was specific to SMA, its findings may have relevance for other patient communities.
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Affiliation(s)
- Mary Curry
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA.
| | - Ilse Peterson
- Faegre Drinker Biddle and Reath LLP, 1500 K Street NW, Suite 1100, Washington, DC, 20005, USA
| | - Lisa Belter
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Fatou Sarr
- Faegre Drinker Biddle and Reath LLP, 1500 K Street NW, Suite 1100, Washington, DC, 20005, USA
| | - Sarah Whitmire
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Mary Schroth
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
| | - Jill Jarecki
- Cure SMA, 925 Busse Road, Elk Grove Village, IL, 60007, USA
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5
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Martin JA, Robertson K, Richards C, Scerif G, Baker K, Tye C. Experiences of parents of children with rare neurogenetic conditions during the COVID-19 pandemic: an interpretative phenomenological analysis. BMC Psychol 2023; 11:179. [PMID: 37291611 PMCID: PMC10249551 DOI: 10.1186/s40359-023-01205-3] [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: 10/18/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has impacted parental and child mental health and wellbeing in the UK. This study aimed to explore the experiences of parents of children with rare neurological and neurodevelopmental conditions with a known or suspected genetic cause (neurogenetic) across the first year of the pandemic in the UK. METHODS Semi-structured interviews were conducted with 11 parents of children with rare neurogenetic conditions. Parents were recruited via opportunity sampling from the CoIN Study, a longitudinal quantitative study exploring the impact of the pandemic on the mental health and wellbeing of families with rare neurogenetic conditions. Interviews were analysed using Interpretative Phenomenological Analysis. RESULTS Four main themes were identified: (1) "A varied impact on child wellbeing: from detrimental to 'no big drama'"; (2) "Parental mental health and wellbeing: impact, changes, and coping"; (3) "'The world had shut its doors and that was that': care and social services during the pandemic"; and (4) "Time and luck: abstract concepts central to parents' perspectives of how they coped during the pandemic". The majority of parents described experiencing an exacerbation of pre-pandemic challenges due to increased uncertainty and a lack of support, with a minority reporting positive effects of the pandemic on family wellbeing. CONCLUSIONS These findings offer a unique insight into the experiences parents of children with rare neurogenetic conditions across the first year of the pandemic in the UK. They highlight that the experiences of parents were not pandemic-specific, and will continue to be highly relevant in a non-pandemic context. Future support should to be tailored to the needs of families and implemented across diverse future scenarios to promote coping and positive wellbeing.
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Affiliation(s)
- Jessica A Martin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
| | - Kathryn Robertson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Charlotte Tye
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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6
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Banerjee J, Friedman JM, Klesse LJ, Yohay KH, Jordan JT, Plotkin SR, Allaway RJ, Blakeley JO. COVID-19 in people with neurofibromatosis 1, neurofibromatosis 2, or schwannomatosis. Genet Med 2023; 25:100324. [PMID: 36565307 PMCID: PMC9579183 DOI: 10.1016/j.gim.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE People with pre-existing conditions may be more susceptible to severe COVID-19 when infected by SARS-CoV-2. The relative risk and severity of SARS-CoV-2 infection in people with rare diseases such as neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), or schwannomatosis (SWN) is unknown. METHODS We investigated the proportions of people with NF1, NF2, or SWN in the National COVID Cohort Collaborative (N3C) electronic health record data set who had a positive test result for SARS-CoV-2 or COVID-19. RESULTS The cohort sizes in N3C were 2501 (NF1), 665 (NF2), and 762 (SWN). We compared these with N3C cohorts of patients with other rare diseases (98-9844 individuals) and the general non-NF population of 5.6 million. The site- and age-adjusted proportion of people with NF1, NF2, or SWN who had a positive test result for SARS-CoV-2 or COVID-19 (collectively termed positive cases) was not significantly higher than in individuals without NF or other selected rare diseases. There were no severe outcomes reported in the NF2 or SWN cohorts. The proportion of patients experiencing severe outcomes was no greater for people with NF1 than in cohorts with other rare diseases or the general population. CONCLUSION Having NF1, NF2, or SWN does not appear to increase the risk of being SARS-CoV-2 positive or of being a patient with COVID-19 or of developing severe complications from SARS-CoV-2.
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Affiliation(s)
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura J Klesse
- Division of Hematology/Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Kaleb H Yohay
- Departments of Neurology and Pediatrics, NYU Langone Health, New York, NY
| | - Justin T Jordan
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA
| | - Scott R Plotkin
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | | | - Jaishri O Blakeley
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD.
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7
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Genodermatoses – Opportunities for Early Detection and Cancer Prevention. CURRENT GENETIC MEDICINE REPORTS 2022; 10:1-13. [PMID: 36213090 PMCID: PMC9531856 DOI: 10.1007/s40142-022-00203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 10/28/2022]
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8
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Ardizzone A, Capra AP, Campolo M, Filippone A, Esposito E, Briuglia S. Neurofibromatosis: New Clinical Challenges in the Era of COVID-19. Biomedicines 2022; 10:biomedicines10050940. [PMID: 35625677 PMCID: PMC9138859 DOI: 10.3390/biomedicines10050940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
Rare diseases constitute a wide range of disorders thus defined for their low prevalence. However, taken together, rare diseases impact a considerable percentage of the world population, thus representing a public healthcare problem. In particular, neurofibromatoses are autosomal-dominant genetic disorders that include type 1 neurofibromatosis (NF1), type 2 neurofibromatosis (NF2) and schwannomatosis. Each of the three types is a genetically distinct disease with an unpredictable clinical course and for which there is still no resolutive cure. Therefore, a personalized therapeutic approach directed at improving the symptomatology as well as the search for new pharmacological strategies for the management of neurofibromatosis represents a priority for positive outcomes for affected patients. The coronavirus disease 2019 (COVID-19) pandemic has severely affected health systems around the world, impacting the provision of medical care and modifying clinical surveillance along with scientific research procedures. COVID-19 significantly worsened exchanges between healthcare personnel and neurofibromatosis patients, precluding continuous clinical monitoring in specialized clinic centers. In this new scenario, our article presents, for the first time, a comprehensive literature review on the clinical challenges for neurofibromatosis clinical care and research during the COVID-19 pandemic health emergency. The review was performed through PubMed (Medline) and Google Scholar databases until December 2021.
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Affiliation(s)
- Alessio Ardizzone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Anna Paola Capra
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Michela Campolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Alessia Filippone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
| | - Emanuela Esposito
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy; (A.A.); (A.P.C.); (M.C.); (A.F.)
- Correspondence: ; Tel.: +39-090-676-5208
| | - Silvana Briuglia
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy;
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9
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Gregory TA, Molina PSB, Phillips GD, Henson JW. Impact of neurofibromatosis type 1 in an adult community population. Neurooncol Pract 2022; 9:229-235. [PMID: 35601964 PMCID: PMC9113236 DOI: 10.1093/nop/npac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is a common tumor predisposition syndrome with varying manifestations and severity. Adult NF1 patients often experience fragmented care, so we sought to characterize the health and demographic features of a community-based population of adults with NF1 and hypothesized that lack of a specialty clinic for adult NF1 patients correlates with unmet needs. Methods Retrospective case-control study of all adult cases of NF1 among 4.06 million medical records in a Pacific Northwest population. 122 case charts were reviewed to ascertain NF1 disease features, comorbidities, and severity of disease. A 1:1 control cohort was selected by matching case/control by age, sex, and ZIP code to compare demographic features and health status. Results Adult NF1 patients were less likely to have private insurance, be employed, and have children, but were equally likely to be married. One half of cases had disease features compromising health and well-being, and care involved 26 different specialties. Excluding neurofibromas, 43% of cases had cancer compared to 10% of controls [P < .0001, OR 5.38 (2.53-11.4)]. Only 27% of women ages 30-50 had undergone age-appropriate enhanced breast cancer surveillance. Behavioral health problems were found in 60% of NF1 patients compared to 37% of controls [P < .001, OR 2.61 (1.52-4.50)]. 93% of cases referred to a NF1 specialty center underwent a change in management upon establishing care. Conclusions NF1 patients may benefit from coordinated management of care in a specialty center.
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Affiliation(s)
- Timothy A Gregory
- Department of Medicine, Neurology Madigan Army Medical Center, Tacoma, Washington, USA,Present affiliation: Department of Neuro-Oncology The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Simon B Molina
- Department of Medicine, Neurology Madigan Army Medical Center, Tacoma, Washington, USA
| | - Gregory D Phillips
- Department of Neurology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - John W Henson
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment Swedish Medical Center, Seattle, Washington, USA,Corresponding Author: John W. Henson, MD, Georgia Neurofibromatosis Clinic and Hereditary Cancer Clinic, Georgia Cancer Center, Medical College of Georgia, Augusta University, 1411 Laney Walker Blvd, Augusta, GA 30912, USA (). Present affiliation: Georgia Neurofibromatosis Clinic and Hereditary Cancer Clinic, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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10
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Chapin J, Cohen AR, Neufeld EJ, Vichinsky E, Giardina PJ, Boudreaux J, Le BC, Kenney K, Trimble S, Thompson AA. An update on the US adult thalassaemia population: a report from the CDC thalassaemia treatment centres. Br J Haematol 2021; 196:380-389. [PMID: 34775608 DOI: 10.1111/bjh.17920] [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: 06/17/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Thalassaemia is caused by genetic globin defects leading to anaemia, transfusion-dependence and comorbidities. Reduced survival and systemic organ disease affect transfusion-dependent thalassaemia major and thalassaemia intermedia. Recent improvements in clinical management have reduced thalassaemia mortality. The therapeutic landscape of thalassaemia may soon include gene therapies as functional cures. An analysis of the adult US thalassaemia population has not been performed since the Thalassemia Clinical Research Network cohort study from 2000 to 2006. The Centers for Disease Control and Prevention supported US thalassaemia treatment centres (TTCs) to compile longitudinal information on individuals with thalassaemia. This dataset provided an opportunity to evaluate iron balance, chelation, comorbidities and demographics of adults with thalassaemia receiving care at TTCs. Two adult cohorts were compared: those over 40 years old (n = 75) and younger adults ages 18-39 (n = 201). The older adult cohort was characterized by higher numbers of iron-related comorbidities and transfusion-related complications. By contrast, younger adults had excess hepatic and cardiac iron and were receiving combination chelation therapy. The ethnic composition of the younger cohort was predominantly of Asian origin, reflecting the demographics of immigration. These findings demonstrate that comprehensive care and periodic surveys are needed to ensure optimal health and access to emerging therapies.
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Affiliation(s)
- John Chapin
- Division of Hematology & Medical Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Alan R Cohen
- Division of Hematology, Children's Hospital Philadelphia, Philadelphia, PA, USA
| | - Ellis J Neufeld
- Boston Children's Hospital- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Elliott Vichinsky
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Patricia J Giardina
- Division of Pediatric Hematology/Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jeanne Boudreaux
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
| | - Binh C Le
- Bleeding Team, Epidemiology & Surveillance Branch, Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Kenney
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Trimble
- NCIRD, Immunization Services Division, Vaccine Supply and Assurance Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexis A Thompson
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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11
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Wolters PL, Reda S, Martin S, Al Ghriwati N, Baker M, Berg D, Erickson G, Franklin B, Merker VL, Oberlander B, Reeve S, Rohl C, Rosser T, Toledo-Tamula MA, Vranceanu AM. Impact of the coronavirus pandemic on mental health and health care in adults with neurofibromatosis: Patient perspectives from an online survey. Am J Med Genet A 2021; 188:71-82. [PMID: 34536052 PMCID: PMC8652613 DOI: 10.1002/ajmg.a.62490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/19/2021] [Accepted: 08/10/2021] [Indexed: 01/25/2023]
Abstract
The coronavirus pandemic increased anxiety and stress and prevented access to health care worldwide; it is unclear how COVID-19 affected adults with a multisystem genetic disorder such as neurofibromatosis (NF). An anonymous online survey was distributed through an international registry and foundations to adults with NF (June-August 2020) to assess the impact of the pandemic on mental health and NF health care. Six hundred and thirteen adults (18-81 years; M = 45.7) with NF1 (77.8%), NF2 (14.2%), and schwannomatosis (7.8%) provided complete responses. Respondents rated moderate-to-high amounts of worry about the impact of COVID-19 on their emotional (46.3%) and physical health (46.7%), and 54.8% endorsed moderate-to-high pandemic-related stress. Adults with diagnosed/suspected mental health disorders or moderate-to-severe NF symptom impact as well as females endorsed higher COVID-19 stress (ps < 0.01). Less than half who missed a doctor's appointment for their NF care (43.4%) used telehealth. Of these, 33.3% and 46.2% reported that telehealth met their needs to a moderate or high degree, respectively. Results indicated that subgroups of adults with NF experience higher COVID-19-related worries and stress and may need additional support. Furthermore, telehealth is under-utilized and could help NF providers connect with patients, although improved delivery and patient training may facilitate expanded use of these services.
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Affiliation(s)
- Pamela L Wolters
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephanie Reda
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nour Al Ghriwati
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa Baker
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dale Berg
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Gregg Erickson
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Network, Wheaton, Illinois, USA
| | - Barbara Franklin
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beverly Oberlander
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Network, Wheaton, Illinois, USA
| | - Stephanie Reeve
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration
| | - Claas Rohl
- Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration.,NF Kinder, NF Patients United, Vienna, Austria
| | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mary Anne Toledo-Tamula
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Raymond M, Ghanouni A, Brooks K, Clark SM, Mattox DE. Adherence to Long-Term Follow-up in Patients With Sporadic Vestibular Schwannomas Managed With Serial Observation. OTO Open 2021; 5:2473974X211036653. [PMID: 34396030 PMCID: PMC8358519 DOI: 10.1177/2473974x211036653] [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: 04/29/2021] [Accepted: 07/14/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To examine the long-term adherence to serial imaging of patients with sporadic vestibular schwannoma and analyze factors associated with being lost to follow-up. Study Design Retrospective chart review with telephone interview. Setting Single tertiary care center. Methods Patients with a sporadic vestibular schwannoma and started on observational surveillance management between January 2005 and December 2010 were included. Demographic data, tumor size, hearing and vestibular changes, and follow-up length were recorded. Patient factors were analyzed for association with being lost to follow-up. Results In total, 122 patients were included with a median length of follow-up of 5 months (range, 0-146). After initial surveillance, 22.1% (n = 27) of patients had a change in management to either microsurgery or radiosurgery. Of the remaining 77.9% (n = 95), nearly half (44.2%, n = 42) never returned for a second visit, and all but 3 were eventually lost to follow-up. There was no association between sex, race, age at diagnosis, initial tumor size, insurance status, household income, or driving distance to hospital and being lost to follow-up. Of 26 interviewed patients initially lost to follow-up, 11 (42.3%) sought care at another institution, 5 (19.2%) chose to no longer receive care, 1 (3.8%) had transportation difficulties, and 9 (36.4%) had poor understanding of their diagnosis or instructions. Conclusions The length of follow-up for patients undergoing surveillance of sporadic vestibular schwannoma varies widely, and patients are commonly lost to follow-up. Further efforts should be made to identify at-risk patients and provide adequate education to improve long-term surveillance.
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Affiliation(s)
- Mallory Raymond
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Arian Ghanouni
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kaitlyn Brooks
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah M. Clark
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Douglas E. Mattox
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Douglas E. Mattox, MD, Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street NE 11th Floor, Atlanta, GA 30308, USA.
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13
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Establishment of in-hospital clinical network for patients with neurofibromatosis type 1 in Nagoya University Hospital. Sci Rep 2021; 11:11933. [PMID: 34099792 PMCID: PMC8184989 DOI: 10.1038/s41598-021-91345-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a genetic multisystem disorder. Clinicians must be aware of the diverse clinical features of this disorder in order to provide optimal care for it. We have set up an NF1 in-hospital medical care network of specialists regardless of patient age, launching a multidisciplinary approach to the disease for the first time in Japan. From January 2014 to December 2020, 246 patients were enrolled in the NF1 patient list and medical records. Mean age was 26.0 years ranging from 3 months to 80 years. The number of patients was higher as age at first visit was lower. There were 107 males (41%) and 139 females. After 2011, the number of patients has increased since the year when the medical care network was started. Regarding orthopedic signs, scoliosis was present in 60 cases (26%), and bone abnormalities in the upper arm, forearm, and tibia in 8 cases (3.5%). Neurofibromas other than cutaneous neurofibromas were present in 90 cases (39%), and MPNST in 17 cases (7.4%). We launched a multidisciplinary NF1 clinic system for the first time in Japan. For patients with NF1, which is a hereditary and systemic disease associated with a high incidence of malignant tumors, it will be of great benefit when the number of such clinics in Japan and the rest of Asia is increased.
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