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Robinson D, Leonard H, Baldi GG, Tap WD, Jones RL, Stacchiotti S, Pantziarka P. The patient perspective on sirolimus for epithelioid hemangioendothelioma (EHE): results of a community survey highlighting the importance of equitable access to treatments. Front Oncol 2024; 14:1367237. [PMID: 38469238 PMCID: PMC10925709 DOI: 10.3389/fonc.2024.1367237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Background Epithelioid hemangioendothelioma (EHE) is an ultra-rare, vascular sarcoma with clinical presentation ranging from an indolent to an aggressive form. Over 50% of patients present with metastatic disease, requiring systemic therapy, although no systemic therapies are specifically approved for EHE. Retrospective evidence supports the activity of mTOR inhibitors (e.g. sirolimus), although available only off-label. EHE patients and advocates are therefore working to support approval of effective treatments by collecting data on patient perspectives and experiences. Materials and methods In February 2023, the EHE Rare Cancer Charity (UK) and The EHE Foundation (US), with other advocates, conducted a survey of perspectives and experiences of EHE patients regarding the use and accessibility of sirolimus. The survey consisted of 20 questions designed for individuals undergoing treatment, those who had been treated, or had never been treated with the drug. Widely promoted within the patient community, the online survey categorized patients into three cohorts for the analysis: liver transplant patients, non-transplant patients who had ever taken sirolimus and sirolimus-naïve non-transplant patients. Results The survey evaluated data from 129 patient responses from 21 countries, mostly from USA, UK, Australia, and Canada (70%). The liver transplant, sirolimus and non-sirolimus cohorts were 16%, 25% and 59%, respectively. In the sirolimus group 66% reported treatment durations exceeding one year, with 16% exceeding five years, indicating the drug's efficacy. In the non-sirolimus group, the drug was not available for 42% and for 11% sirolimus was available but not selected for treatment because of its off-label status. Overall, 87% of all patients across all cohorts expressed the importance of the drug's availability as hugely or very important. Conclusion The survey responses highlight the activity of sirolimus for EHE and the importance of securing a label extension for the drug delivering equitable access to this treatment for patients.
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Affiliation(s)
| | - Hugh Leonard
- EHE Rare Cancer Charity UK, Kingston-Upon-Thames, United Kingdom
| | - Giacomo Giulio Baldi
- Department of Oncology, Hospital of Prato, Azienda USL Toscana Centro, Prato, Italy
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, United States
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pan Pantziarka
- Anticancer Fund, Meise, Belgium
- George Pantziarka TP53 Trust, London, United Kingdom
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Abstract
The drug development process is a long and arduous one, especially for rare diseases. Patient and patient representatives can and should be involved in this process from an early stage, since they have the perspective of living with a disease on a daily basis and can best identify which symptoms are the largest burden and which benefits would be more important to them. In this perspective, we outline how patients can be involved optimally in drug development. We outline success factors such as finding the right partners, bilateral education, having realistic expectations, and an open and honest dialog with all stakeholders.
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Affiliation(s)
- Annemieke Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Daniel O'Reilly
- RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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DiPietro JL, Mackiewicz Seghete KL, Krans EE, Snider KE, Bower R, Parker K, Gullickson J, Potter AS, Garavan H, Vatalaro TC, Thomason ME, Sullivan EL, Graham AM. Stakeholder Perspectives on Advancing Understanding of Prenatal Opioid Exposure and Brain Development From the iOPEN Consortium of the Healthy Brain and Child Development Study. Front Psychol 2021; 12:698766. [PMID: 34393931 PMCID: PMC8361604 DOI: 10.3389/fpsyg.2021.698766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: There is a dire need for research regarding the implications of opioid use during pregnancy on fetal and childhood development to better inform both medical practice and policy. The Healthy Brain and Child Development Study will examine brain and behavioral development from birth through the first decade of life. Due to large scope and anticipated complexity of this initiative, an 18-month planning phase was implemented across 28 sites across the nation. A core element of the Phase I initiative involved the development of Stakeholder Advisory Committees to inform the next phase of the initiative. Methods: Phase I stakeholder meetings were conducted at Oregon Health and Science University, New York University Langone Medical Center, the University of Pittsburgh, and the University of Vermont to better understand perspectives and inform upcoming research. Despite differences in the structure of the stakeholder meetings by site, the overarching goals for the meetings included establishing relationships, gathering input, and learning about research engagement. Documents from each meeting were reviewed for location, duration, attendees, common research themes, and pertinent suggestions for improving research approaches. Results: All stakeholders had high levels of interest in research for pregnant people with substance use disorders and agreed on research priorities including collaboration, connection, communication, and support. Different stakeholders offered unique perspectives on various aspects of study design and themes that emerged through meetings. Discussion: Overall, there was excitement about the research, especially the opportunity to include the voices of people with lived experience; collaboration between providers, peer support specialists, patients, and others; and excitement around contributing to research that could elucidate new and pertinent findings in the realm of addiction medicine and child development. Sites also found that there is mistrust between people with substance use disorder and the medical system, and this could be addressed by including people with lived experience on the research team, forming connections, communicating clearly, training the research team in implicit bias, and practicing trauma-informed care. In conclusion, these stakeholder meetings provided valuable information for structuring upcoming studies; however, researchers would have benefitted from more time and more opportunities for in-person connection.
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Affiliation(s)
- Jennifer L. DiPietro
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | | | - Elizabeth E. Krans
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburg, PA, United States
- Magee-Women's Research Institute and Foundation, Pittsburgh, PA, United States
| | | | - Reina Bower
- Mental Health Addiction Association of Oregon, Portland, OR, United States
| | - Kea Parker
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Janie Gullickson
- Mental Health Addiction Association of Oregon, Portland, OR, United States
| | - Alexandra S. Potter
- Department of Psychiatry, University of Vermont, Burlington, VT, United States
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont, Burlington, VT, United States
| | - Tessa C. Vatalaro
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, United States
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, New York University Medical Center, New York, NY, United States
- Department of Population Health, New York University Medical Center, New York, NY, United States
| | - Elinor L. Sullivan
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | - Alice M. Graham
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
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Lloyd V, Cox M, Bailey J, Roy C. Patient Lyme disease websites prioritize science; public health websites prioritize consistent messaging-Comment on 'Lyme disease prevention: A content analysis of Canadian patient group and government websites'. Zoonoses Public Health 2021; 68:854-858. [PMID: 33749140 DOI: 10.1111/zph.12794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Vett Lloyd
- Department of Biology, Mount Allison University, Sackville, NB, Canada
| | - Marilyn Cox
- Mount St. Vincent University, Halifax, NS, Canada
| | - Jane Bailey
- Department of Biology, Mount Allison University, Sackville, NB, Canada
| | - Chris Roy
- Department of Biology, Mount Allison University, Sackville, NB, Canada
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Gilmore NJ, Canin B, Whitehead M, Sedenquist M, Griggs L, Finch L, Grossman V, Targia V, Wells M, Kamen C, Flannery M, Magnuson A, Plumb S, Obrecht S, Lowenstein LM, Lopez G, Anderson J, Berenberg J, Vogel V, Bearden J, Dale W, Mohile SG. Engaging older patients with cancer and their caregivers as partners in cancer research. Cancer 2019; 125:4124-4133. [PMID: 31420878 PMCID: PMC6856383 DOI: 10.1002/cncr.32402] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 11/08/2022]
Abstract
Active patient partner engagement with SCOREboard – a diverse group of older patients with cancer, caregivers of older patients with cancer, survivors, and patient advocates – to conduct the largest randomized geriatric assessment clinical trial to date, has been shown to be feasible and resulted in tangible and invaluable benefits for both the research team and patient partners alike. Actively engaging patient partners should be an essential component in the development, conduct, and completion of all clinical research.
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Affiliation(s)
- Nikesha J Gilmore
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Beverly Canin
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Mary Whitehead
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Margaret Sedenquist
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lorraine Griggs
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lynn Finch
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Valerie Grossman
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Valerie Targia
- SCOREboard Stakeholder Advisory Group, James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Megan Wells
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Charles Kamen
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Sandy Plumb
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Spencer Obrecht
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Lisa M Lowenstein
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Gilberto Lopez
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jainy Anderson
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jeffrey Berenberg
- Hawaii Minority Underserved National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii
| | - Victor Vogel
- Hematology and Oncology, Cancer Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - James Bearden
- Southeast Clinical Oncology Research Consortium (SCOR), Winston-Salem, North Carolina
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Supriya G Mohile
- James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Abstract
The role of nurses as patient advocates is well recognised by healthcare professionals, yet the processes and practices involved in patient advocacy are not clearly understood. A suboptimal level of advocacy is often apparent in the literature, encompassing paternalistic concepts of protecting patients from harm. This article examines the concept of patient advocacy and its relevance to nursing, associated goals and outcomes of advocacy and the processes and practices involved. It provides insights into how nurses practise patient advocacy in healthcare settings and how they may develop this role further, through formal education, workplace learning, role modelling by expert nurses and promoting an organisational culture conducive to patient advocacy.
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Affiliation(s)
- Pin Pin Choi
- Division of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong, China
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Trimble EL, Ledermann J, Law K, Miyata T, Imamura CK, Nam BH, Kim YH, Bang YJ, Michaels M, Ardron D, Amano S, Ando Y, Tominaga T, Kurokawa K, Takebe N. International models of investigator-initiated trials: implications for Japan. Ann Oncol 2012; 23:3151-3155. [PMID: 22843420 PMCID: PMC3501232 DOI: 10.1093/annonc/mds168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/05/2012] [Accepted: 04/23/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Academic/institutional investigator-initiated clinical trials benefit individuals and society by supplementing gaps in industry-sponsored clinical trials. MATERIALS In May 2010, experts from Japan, the Republic of Korea, the UK, and the United States, met at a symposium in Tokyo, Japan, to discuss how policies related to the conduct of clinical trials, which have been shown to be effective, may be applied to other regions of the world. RESULTS In order to increase the availability of anticancer drugs world-wide, nations including Japan should examine the benefits of increasing the number of investigator-initiated clinical trials. These trials represent one of the most effective ways to translate basic scientific knowledge into clinical practice. These trials should be conducted under GCP guidelines and include Investigational New Drug application submissions with the ultimate goal of future drug approval. CONCLUSIONS To maximize the effectiveness of these trials, a policy to educate health care professionals, cancer patients and their families, and the public in general on the benefits of clinical trials should be strengthened. Finally, policies that expedite the clinical development of novel cancer drugs which have already been shown to be effective in other countries are needed in many nations including Japan to accelerate drug approval.
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Affiliation(s)
- E L Trimble
- Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Rockville, USA
| | - J Ledermann
- UCL and UCL Hospitals Comprehensive Biomedical Research Centre, University College of London, London
| | - K Law
- Cancer Research UK, London, UK
| | - T Miyata
- Research and Development Division, Health Policy Bureau, Ministry of Heath, Labour, and Welfare, Government of Japan, Tokyo
| | - C K Imamura
- Department of Clinical Pharmacokinetics and Pharmacodynamics, School of Medicine, Keio University, Tokyo, Japan
| | - B-H Nam
- Clinical Research Coordination Center, Biometric Research Branch, National Cancer Center, Geonggi-do
| | - Y H Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Y-J Bang
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - M Michaels
- Education Network to Advance Clinical Trials (ENACCT), Bethesda, USA
| | - D Ardron
- National Cancer Research Institute Consumer Liaison Group, University of Leeds, Leeds, UK
| | | | - Y Ando
- Pharmaceuticals and Medical Devices Agencies (PMDA), Tokyo
| | - T Tominaga
- Pharmaceuticals and Medical Devices Agencies (PMDA), Tokyo
| | - K Kurokawa
- Health and Global Policy Institute, Tokyo, Japan
| | - N Takebe
- Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Rockville, USA.
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