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Alesci RS, Hecking C, Weissmann MV. Identification of an Unmet Medical Need: Height of Depression, Hypersomnia, and Sleep Apnea Positively Correlate With the Level of Fatigue in Patients With Immune Thrombocytopenia. Cureus 2023; 15:e47003. [PMID: 37965409 PMCID: PMC10641264 DOI: 10.7759/cureus.47003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Immune thrombocytopenia (ITP) is a rare chronic disease, frequently accompanied by fatigue, which is an important comorbidity associated with this disease. Patients experience difficulties in managing their daily activities and a reduction in their overall quality of life (QoL). The causes of fatigue in ITP are not clarified yet, and underlying causes seem to be multifactorial. The development of fatigue may not solely be influenced by a decrease in platelet count but also by unknown factors as well as psychological reasons. METHODS This prospective, multicenter, exploratory, pilot study aimed to investigate which parameters contribute to the occurrence of fatigue in patients with ITP. Adult patients with ITP and with or without fatigue who visited the study center for their regular appointments were asked to complete questionnaires pertaining to patient-reported outcome measures regarding bleeding symptoms, depression, sleep apnea, and hypersomnia. Blood tests included platelet count as well as different parameters like vitamin D. RESULTS A total of 36 patients (100%; 27 females (75%) and nine males (25%)) with primary ITP, with a median age of 46.5 years (range 19‑83 years) were analyzed. The median duration of ITP was 4.5 years (min‑max 0-21). Approximately one-third of patients (29.4%; 10/34 patients) had no comorbidities. The two most frequently used current treatment options were "watch-and-wait" (38.9%; 14/36 patients) and "avatrombopag" (30.6%; 11/36 patients); eight patients (22.2%; 8/36 patients) needed rescue therapy with corticosteroids. There was a statistically negative correlation between fatigue and year of diagnosis (r=-0.41, p=0.014). Results indicated no statistically significant relationship between fatigue and age or differences in fatigue between the genders. Ferritin predicted fatigue with statistical significance. Platelet count was not correlated with the level of fatigue. A significant correlation was obvious between fatigue, depression, and obstructive sleep apnea syndrome (OSAS) as well as sleep-related problems (p<0.01). DISCUSSION Patient characteristics were comparable to that of other studies. The level of fatigue negatively impacts the lives of patients with ITP. Age and gender were not correlated with fatigue in ITP, which is in line with other reports. Interestingly, the fatigue level was higher in patients presenting with additional depression and poor sleeping quality due to, e.g., hypersomnia, which seems common. Fatigue levels seem independent from thrombocyte levels, which were reported elsewhere. CONCLUSION Patients diagnosed with ITP several years ago cope with their condition better than patients with a more recent diagnosis, who have higher levels of fatigue. Concurrent depression, hypersomnia, and sleep apnea are important underestimated factors, which do have a negative effect on the QoL of patients with ITP. We were able to show that patients with ITP might face an unmet medical need in terms of delayed diagnosis and supportive therapy. To our knowledge, this is the first report on combined findings of depression, hypersomnia, and sleep apnea in patients with ITP.
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Affiliation(s)
- Rosa S Alesci
- Blood Coagulation Centre, Medizinisches Versorgungszentrum (MVZ) Institut für Medizinische Diagnostik (IMD) GmbH, Bad Homburg, DEU
| | - Carola Hecking
- Blood Coagulation Centre, Medizinisches Versorgungszentrum (MVZ) Institut für Medizinische Diagnostik (IMD) GmbH, Bad Homburg, DEU
| | - Maike V Weissmann
- Blood Coagulation Centre, Medizinisches Versorgungszentrum (MVZ) Institut für Medizinische Diagnostik (IMD) GmbH, Mannheim, DEU
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van Dijk WE, Nap-van der Vlist MM, Knoop H, Schutgens RE. Possible Targets to Reduce Fatigue in Chronic Immune Thrombocytopenia Patients – An Explorative Study. TH OPEN 2022; 6:e387-e395. [DOI: 10.1055/s-0042-1758546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background Fatigue in immune thrombocytopenia (ITP) is frequent and burdensome, but we lack the knowledge to help these patients.
Aim The aim of the study is to explore the role of disease activity and other potentially modifiable factors in fatigue.
Method This cross-sectional study included adult chronic ITP patients (n = 59). Univariable linear regression (corrected for confounders) was used to determine the relationship between disease activity (platelet count <30 × 109/L or treatment), disease-specific factors (bleeding symptoms, ferritin), and transdiagnostic factors (FACT-G physical/functional/emotional/social well-being subscales, physical activity level, and vitamin D) and fatigue (Checklist Individual Strength fatigue subscale). Several multivariable models with clustered sets of variables were used to compare the proportion of explained variance of fatigue (adjusted R
2).
Results Significant relations with moderate effect sizes (>0.50) were found for physical and functional well-being and fatigue, and physical activity and fatigue. Other significant relations with fatigue (effect size 0.30–0.47) included skin and organ bleeding, emotional and social well-being, vitamin D, and disease activity. Notably, the models with disease activity and disease-specific factors explained <20% of the variance in fatigue, while the models with transdiagnostic factors (functioning and physical activity) explained >50%. Vitamin D alone explained 12% of the variance in fatigue.
Conclusion Transdiagnostic (non-disease-specific) rather than disease-specific factors explained a large part of the variance in ITP-related fatigue. Many factors related to fatigue are potentially modifiable and should be investigated as targets for interventions.
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Affiliation(s)
- Wobke E.M. van Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Merel M. Nap-van der Vlist
- Department of Social Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, The Netherlands
| | - Roger E.G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Cooper N, Kruse A, Kruse C, Watson S, Morgan M, Provan D, Ghanima W, Arnold DM, Tomiyama Y, Santoro C, Michel M, Laborde S, Lovrencic B, Hou M, Bailey T, Taylor‐Stokes G, Haenig J, Bussel JB. Immune thrombocytopenia (ITP) World Impact Survey (iWISh): Patient and physician perceptions of diagnosis, signs and symptoms, and treatment. Am J Hematol 2021; 96:188-198. [PMID: 33170956 PMCID: PMC7898610 DOI: 10.1002/ajh.26045] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is now well-known to reduce patients' health-related quality of life. However, data describing which signs and symptoms patients and physicians perceive as having the greatest impact are limited, as is understanding the full effects of ITP treatments. I-WISh (ITP World Impact Survey) was an exploratory, cross-sectional survey designed to establish the multifaceted impact of ITP, and its treatments, on patients' lives. It focused on perceptions of 1507 patients and 472 physicians from 13 countries regarding diagnostic pathway, frequency and severity of signs and symptoms, and treatment use. Twenty-two percent of patients experienced delayed diagnosis (caused by several factors), 73% of whom felt anxious as a result. Patients rated fatigue among the most frequent, severe symptom associated with ITP at diagnosis (58% most frequent; 73% most severe), although physicians assigned it lower priority (30%). Fatigue was one of the few symptoms persisting at survey completion (50% and 65%, respectively) and was the top symptom patients wanted resolved (46%). Participating physicians were experienced at treating ITP, thereby recognizing the need to limit corticosteroid use to newly-diagnosed or first-relapse patients and espoused increased use of thrombopoietin receptor agonists and anti-CD20 after relapse in patients with persistent/chronic disease. Patient and physicians were largely aligned on diagnosis, symptoms, and treatment use. I-WISh demonstrated that patients and physicians largely align on overall ITP symptom burden, with certain differences, for example, fatigue. Understanding the emotional and clinical toll of ITP on the patient will facilitate shared decision-management, setting and establishment of treatment goals and disease stage-appropriate treatment selection.
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Affiliation(s)
- Nichola Cooper
- Department of Haematology Hammersmith Hospital, Imperial College London London UK
| | | | - Caroline Kruse
- Platelet Disorder Support Association Cleveland Ohio USA
| | - Shirley Watson
- Patient Representative for the UK ITP Forum Bolnhurst UK
| | | | - Drew Provan
- Academic Haematology Unit, Blizard Institute Barts and The School of Medicine and Dentistry London UK
| | - Waleed Ghanima
- Department of Medicine Østfold Hospital Trust Kalnes Norway
- Department of Hematology Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - Donald M. Arnold
- Department of Medicine, McMaster Centre for Transfusion Research McMaster University Hamilton Ontario Canada
| | - Yoshiaki Tomiyama
- Department of Blood Transfusion Osaka University Hospital Osaka Japan
| | | | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult Immune Cytopenias Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris‐Est Créteil Créteil France
| | | | - Barbara Lovrencic
- Italian Association of Immune Thrombocytopenic Purpura Caprino Veronese Italy
| | - Ming Hou
- Department of Hematology Shandong University Jinan China
| | - Tom Bailey
- Bespoke Team Adelphi Real World Macclesfield UK
| | | | | | - James B. Bussel
- Division of Hematology/Oncology Weill Cornell Medicine New York New York USA
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Cooper N, Kruse A, Kruse C, Watson S, Morgan M, Provan D, Ghanima W, Arnold DM, Tomiyama Y, Santoro C, Michel M, Laborde S, Lovrencic B, Hou M, Bailey T, Taylor‐Stokes G, Haenig J, Bussel JB. Immune thrombocytopenia (ITP) World Impact Survey (I-WISh): Impact of ITP on health-related quality of life. Am J Hematol 2021; 96:199-207. [PMID: 33107998 PMCID: PMC7898815 DOI: 10.1002/ajh.26036] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022]
Abstract
Immune thrombocytopenia (ITP) has a substantial, multifaceted impact on patients' health-related quality of life (HRQoL). Data describing which aspects of ITP physicians and patients perceive as having the greatest impact are limited. The ITP World Impact Survey (I-WISh) was a cross-sectional survey, including 1507 patients and 472 physicians, to establish the impact of ITP on HRQoL and productivity from patient and physician perspectives. Patients reported that ITP reduced their energy levels (85% of patients), capacity to exercise (77%), and limited their ability to perform daily tasks (75%). Eighty percent of physicians reported that ITP symptoms reduced patient HRQoL, with 66% reporting ITP-related fatigue substantially reduced patient HRQoL. Patients believed ITP had a substantial impact on emotional well-being (49%) and 63% worried their condition would worsen. Because of ITP, 49% of patients had already reduced, or seriously considered reducing their working hours, and 29% had considered terminating their employment. Thirty-six percent of patients employed at the time of the survey felt ITP decreased their work productivity, while 51% of patients with high/very high symptom burden reported that ITP affected their productivity. Note, I-WISh demonstrated substantive impact of ITP on patients' HRQoL both directly for patients and from the viewpoint of their physicians. Patients reported reduced energy levels, expressed fears their condition might worsen, and those who worked experienced reduced productivity. Physicians should be aware not only of platelet counts and bleeding but also the multi-dimensional impact of ITP on patients' lives as an integral component of disease management.
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Affiliation(s)
- Nichola Cooper
- Department of HaematologyHammersmith Hospital, Imperial College LondonLondonUK
| | | | | | | | | | - Drew Provan
- Academic Haematology Unit, Blizard InstituteBarts and The School of Medicine and DentistryLondonUK
| | - Waleed Ghanima
- Department of MedicineØstfold Hospital TrustKalnesNorway
- Department of Hematology, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Donald M. Arnold
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster UniversityHamiltonOntarioCanada
| | | | | | - Marc Michel
- Department of Internal Medicine, National Referral Center for Adult Immune CytopeniasHenri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris‐Est CréteilCréteilFrance
| | | | - Barbara Lovrencic
- Italian Association of Immune Thrombocytopenic PurpuraCaprino VeroneseItaly
| | - Ming Hou
- Department of HematologyShandong UniversityJinanChina
| | - Tom Bailey
- Bespoke TeamAdelphi Real WorldMacclesfieldUK
| | | | | | - James B. Bussel
- Division of Hematology/OncologyWeill Cornell MedicineNew YorkNew YorkUSA
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Newland A, Bentley R, Jakubowska A, Liebman H, Lorens J, Peck-Radosavljevic M, Taieb V, Takami A, Tateishi R, Younossi ZM. A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia. ACTA ACUST UNITED AC 2020; 24:679-719. [PMID: 31581933 DOI: 10.1080/16078454.2019.1662200] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Investigate globally, current treatment patterns, benefit-risk assessments, humanistic, societal and economic burden of platelet transfusion (PT). Methods: Publications from 1998 to June 27, 2018 were identified, based on databases searches including MEDLINE®; Embase and Cochrane Database of Systematic Reviews. Data from studies meeting pre-specified criteria were extracted and validated by independent reviewers. Data were obtained for efficacy and safety from randomized controlled trials (RCTs); data for epidemiology, treatment patterns, effectiveness, safety, humanistic and societal burden from real-world evidence (RWE) studies; and economic data from both. Results: A total of 3425 abstracts, 194 publications (190 studies) were included. PT use varied widely, from 0%-100% of TCP patients; 1.7%-24.5% in large studies (>1000 patients). Most were used prophylactically rather than therapeutically. 5 of 43 RCTs compared prophylactic PT with no intervention, with mixed results. In RWE studies PT generally increased platelet count (PC). This increase varied by patient characteristics and hence did not always translate into a clinically significant reduction in bleeding risk. Safety concerns included infection risk, alloimmunization and refractoriness with associated cost burden. Discussion: In RCTs and RWE studies there was significant heterogeneity in study design and outcome measures. In RWE studies, patients receiving PT may have been at higher risk than those not receiving PT creating potential bias. There were limited data on humanistic and societal burden. Conclusion: Although PTs are used widely for increasing PC in TCP, it is important to understand the limitations of PTs, and to explore the use of alternative treatment options where available.
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Affiliation(s)
- Adrian Newland
- Barts Health National Health Service (NHS) Trust , London , UK
| | | | | | - Howard Liebman
- Jane Anne Nohl Division of Hematology, USC Norris Cancer Hospital , Los Angeles , CA , USA
| | | | - Markus Peck-Radosavljevic
- Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt , Klagenfurt , Austria.,Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna , Austria
| | | | - Akiyoshi Takami
- Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine , Nagakute , Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Zobair M Younossi
- Department of Medicine, Inova Fairfax Hospital , Falls Church , VA , USA
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Trotter P, Hill QA. Immune thrombocytopenia: improving quality of life and patient outcomes. PATIENT-RELATED OUTCOME MEASURES 2018; 9:369-384. [PMID: 30568522 PMCID: PMC6267629 DOI: 10.2147/prom.s140932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is an immune-mediated disorder characterized by a reduced platelet count and patients may develop bruising or mucosal bleeding. Since 2003, generic health-related quality of life (HRQoL) measures have been applied and ITP-specific measures developed, alongside trials of novel therapeutic agents. These have identified significant morbidity in patients with ITP, including fatigue, fear of bleeding and a negative impact on role, social and work activities. This review critically evaluates HRQoL data in adults and children with ITP. It also considers the impact of treatment and how patient-reported outcomes might be applied to care to optimize patients' quality of life.
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Affiliation(s)
- Patrick Trotter
- Department of Surgery, University of Cambridge, Cambridge, UK.,National Health Service Blood and Transplant, Organ Donation and Transplant Directorate, Bristol, UK
| | - Quentin A Hill
- Department of Haematology, St James's University Hospital, Leeds, UK,
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