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Parsons SK, Rodday AM, Upshaw JN, Scharman CD, Cui Z, Cao Y, Tiger YKR, Maurer MJ, Evens AM. Harnessing multi-source data for individualized care in Hodgkin Lymphoma. Blood Rev 2024; 65:101170. [PMID: 38290895 DOI: 10.1016/j.blre.2024.101170] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Hodgkin lymphoma is a rare, but highly curative form of cancer, primarily afflicting adolescents and young adults. Despite multiple seminal trials over the past twenty years, there is no single consensus-based treatment approach beyond use of multi-agency chemotherapy with curative intent. The use of radiation continues to be debated in early-stage disease, as part of combined modality treatment, as well as in salvage, as an important form of consolidation. While short-term disease outcomes have varied little across these different approaches across both early and advanced stage disease, the potential risk of severe, longer-term risk has varied considerably. Over the past decade novel therapeutics have been employed in the retrieval setting in preparation to and as consolidation after autologous stem cell transplant. More recently, these novel therapeutics have moved to the frontline setting, initially compared to standard-of-care treatment and later in a direct head-to-head comparison combined with multi-agent chemotherapy. In 2018, we established the HoLISTIC Consortium, bringing together disease and methods experts to develop clinical decision models based on individual patient data to guide providers, patients, and caregivers in decision-making. In this review, we detail the steps we followed to create the master database of individual patient data from patients treated over the past 20 years, using principles of data science. We then describe different methodological approaches we are taking to clinical decision making, beginning with clinical prediction tools at the time of diagnosis, to multi-state models, incorporating treatments and their response. Finally, we describe how simulation modeling can be used to estimate risks of late effects, based on cumulative exposure from frontline and salvage treatment. The resultant database and tools employed are dynamic with the expectation that they will be updated as better and more complete information becomes available.
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Affiliation(s)
- Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Jenica N Upshaw
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; The CardioVascular Center and Advanced Heart Failure Program, Tufts Medical Center, Boston, MA, United States of America
| | | | - Zhu Cui
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America
| | - Yenong Cao
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America
| | - Yun Kyoung Ryu Tiger
- Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJ, United States of America
| | - Matthew J Maurer
- Division of Clinical Trials and Biostatistics and Division of Hematology, Mayo Clinic, Rochester, MN, United States of America
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJ, United States of America
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Rask Kragh Jørgensen R, Bergström F, Eloranta S, Tang Severinsen M, Bjøro Smeland K, Fosså A, Haaber Christensen J, Hutchings M, Bo Dahl-Sørensen R, Kamper P, Glimelius I, E Smedby K, K Parsons S, Mae Rodday A, J Maurer M, M Evens A, C El-Galaly T, Hjort Jakobsen L. Machine Learning-Based Survival Prediction Models for Progression-Free and Overall Survival in Advanced-Stage Hodgkin Lymphoma. JCO Clin Cancer Inform 2024; 8:e2300255. [PMID: 38608215 DOI: 10.1200/cci.23.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Patients diagnosed with advanced-stage Hodgkin lymphoma (aHL) have historically been risk-stratified using the International Prognostic Score (IPS). This study investigated if a machine learning (ML) approach could outperform existing models when it comes to predicting overall survival (OS) and progression-free survival (PFS). PATIENTS AND METHODS This study used patient data from the Danish National Lymphoma Register for model development (development cohort). The ML model was developed using stacking, which combines several predictive survival models (Cox proportional hazard, flexible parametric model, IPS, principal component, penalized regression) into a single model, and was compared with two versions of IPS (IPS-3 and IPS-7) and the newly developed aHL international prognostic index (A-HIPI). Internal model validation was performed using nested cross-validation, and external validation was performed using patient data from the Swedish Lymphoma Register and Cancer Registry of Norway (validation cohort). RESULTS In total, 707 and 760 patients with aHL were included in the development and validation cohorts, respectively. Examining model performance for OS in the development cohort, the concordance index (C-index) for the ML model, IPS-7, IPS-3, and A-HIPI was found to be 0.789, 0.608, 0.650, and 0.768, respectively. The corresponding estimates in the validation cohort were 0.749, 0.700, 0.663, and 0.741. For PFS, the ML model achieved the highest C-index in both cohorts (0.665 in the development cohort and 0.691 in the validation cohort). The time-varying AUCs for both the ML model and the A-HIPI were consistently higher in both cohorts compared with the IPS models within the first 5 years after diagnosis. CONCLUSION The new prognostic model for aHL on the basis of ML techniques demonstrated a substantial improvement compared with the IPS models, but yielded a limited improvement in predictive performance compared with the A-HIPI.
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Affiliation(s)
- Rasmus Rask Kragh Jørgensen
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Fanny Bergström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Tang Severinsen
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Alexander Fosså
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Martin Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Kamper
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Susan K Parsons
- Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Angie Mae Rodday
- Department of Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Matthew J Maurer
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJ
| | - Tarec C El-Galaly
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lasse Hjort Jakobsen
- Department of Hematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
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Alsoubani M, Chow JK, Rodday AM, Kent D, Snydman DR. Comparative Effectiveness of Fidaxomicin vs Vancomycin in Populations With Immunocompromising Conditions for the Treatment of Clostridioides difficile Infection: A Single-Center Study. Open Forum Infect Dis 2024; 11:ofad622. [PMID: 38204563 PMCID: PMC10781433 DOI: 10.1093/ofid/ofad622] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
Background Clostridioides difficile infection (CDI) is a leading cause of morbidity in immunocompromised hosts with increased risk of complications and recurrences. In this study, we examined the clinical effectiveness of fidaxomicin vs vancomycin in treating CDI in this patient population. Methods This single-center retrospective study evaluated patients with CDI between 2011 and 2021. The primary outcome was a composite of clinical failure, relapse at 30 days, or CDI-related death. A multivariable cause-specific Cox proportional hazards model was used to test the relationship between treatment and the composite outcome, adjusting for confounders and treating death from other causes as a competing risk. Results This study analyzed 238 patients who were immunocompromised and treated for CDI with oral fidaxomicin (n = 38) or vancomycin (n = 200). There were 42 composite outcomes: 4 (10.5%) in the fidaxomicin arm and 38 (19.0%) in the vancomycin arm. After adjustment for sex, number of antecedent antibiotics, CDI severity and type of immunosuppression, fidaxomicin use significantly decreased the risk of the composite outcome as compared with vancomycin (10.5% vs 19.0%; hazard ratio, 0.28; 95% CI, .08-.93). Furthermore, fidaxomicin was associated with 70% reduction in the combined risk of 30- and 90-day relapse following adjustment (hazard ratio, 0.27; 95% CI, .08-.91). Conclusions The findings of this study suggest that the use of fidaxomicin for treatment of CDI reduces poor outcomes in patients who are immunocompromised.
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Affiliation(s)
- Majd Alsoubani
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jennifer K Chow
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Angie Mae Rodday
- Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts, USA
| | - David Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - David R Snydman
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- The Stuart B. Levy Center for the Integrated Management of Antimicrobial Resistance, School of Medicine, Tufts University, Boston, Massachusetts, USA
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Olivieri-Mui B, Rodday AM, Rao V, Baker B, Peary A, Johnson R, Dias R, Board R, Strout K, Robinson K. Characteristics of Maine and Massachusetts nurses interested in advanced nursing degrees. J Prof Nurs 2024; 50:53-60. [PMID: 38369372 DOI: 10.1016/j.profnurs.2023.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Maine (ME) and Massachusetts (MA) nursing programs aim to develop collaborative training programs, but need to identify which nurses have interest in such programs. PURPOSE We sought to determine sociodemographics of nurses seeking advanced nursing degrees nationally, and in ME and MA using the 2018 publicly available, National Sample Survey of Registered Nurses (NSSRN). METHODS Weighted multivariable logistic regression for advanced degree-seeking, adjusted for sociodemographics. RESULTS Of the n = 47,274 nurses (weighted n [Wn] = 3,608,633), 90.7 % were female, 74.1 % were white, and 15.8 % sought an advanced nursing degree on average 12.7 (SD 0.2) years after their first. Females vs. males had lower odds (OR 0.63, 95%CI [0.44-0.90]) and Black vs. White race had higher odds (OR 1.30, 95%CI [1.05-1.60]) of seeking doctorates. In Maine (Wn = 20,389), age 24-29 had higher odds (OR 2.98 (95%CI [1.06-3.74]), but in Massachusetts (Wn = 101,984), age 30+ had lower odds (OR 0.32, 95%CI [0.13-0.78]) of degree-seeking vs. <24 years. Initial nursing degrees earned between 1980 and 1989 had higher odds (OR 1.99, 95%CI [1.06-3.74]) in Maine, but between 2010 and 2014 had lower odds (OR 0.32, 95%CI [0.14-0.72]) in Massachusetts of degree-seeking, vs. before 1980. CONCLUSIONS Targets for advanced nursing training programs may vary by state and sociodemographic profile.
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Affiliation(s)
- Brianne Olivieri-Mui
- 360 Huntington Avenue, Department of Health Sciences, Northeastern University, Boston, MA 02115, United States of America; The Roux Institute, Northeastern University, Boston, MA 02115, United States of America.
| | - Angie Mae Rodday
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA 02111, United States of America.
| | - Vikram Rao
- 360 Huntington Avenue, College of Science, Northeastern University, Boston, MA 02115, United States of America.
| | - Breac Baker
- The Roux Institute, Northeastern University, Boston, MA 02115, United States of America.
| | - Alexandra Peary
- 168 College Avenue, School of Nursing, University of Maine, Orono, ME 04469, United States of America.
| | - Ryan Johnson
- 168 College Avenue, School of Nursing, University of Maine, Orono, ME 04469, United States of America.
| | - Rebecca Dias
- 168 College Avenue, School of Nursing, University of Maine, Orono, ME 04469, United States of America.
| | - Rhonda Board
- School of Nursing, Northeastern University, Boston, MA 02115, United States of America.
| | - Kelley Strout
- 168 College Avenue, School of Nursing, University of Maine, Orono, ME 04469, United States of America.
| | - Kathryn Robinson
- 168 College Avenue, School of Nursing, University of Maine, Orono, ME 04469, United States of America.
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Parsons SK, Rodday AM, Pei Q, Keller FG, Wu Y, Henderson TO, Cella D, Kelly KM, Castellino SM. Performance of the FACT-GOG-Ntx to assess chemotherapy-induced peripheral neuropathy (CIPN) in pediatric high risk Hodgkin lymphoma: report from the Children's Oncology Group AHOD 1331 study. J Patient Rep Outcomes 2023; 7:113. [PMID: 37947987 PMCID: PMC10638179 DOI: 10.1186/s41687-023-00653-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is an under-recognized complication of several chemotherapy agents used as part of curative-intent therapy for Hodgkin Lymphoma (HL). In the absence of validated self- or proxy-report measures for children and adolescents, CIPN reporting has relied on clinician rating, with grading scales often restricted to severe manifestations. In a proof-of-concept study, we assessed the feasibility and psychometric performance of the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx), a unidimensional CIPN symptom scale widely used adults with CIPN, in pediatric HL at risk for CIPN. METHODS Youth (11+ years) and parents of all children (5-17.9 years) with newly diagnosed high-risk HL enrolled on Children's Oncology Group AHOD1331 (NCT02166463) were invited to complete the FACT-GOG-Ntx and a health-related quality of life (HRQL) measure at pre-treatment (Time 1), and during cycles 2 (Time 2) and 5 (Time 3) of chemotherapy during the first half of study accrual. Clinical grading of CIPN by providers was also assessed using the Balis Pediatric Neuropathy Scale. We evaluated Cronbach's alpha, construct validity, and agreement between raters. Change in FACT-GOG-Ntx scores over time was assessed using a repeated measures model. RESULTS 306 patients had at least one completed FACT-GOG-Ntx with time-specific completion rates of > 90% for both raters. Cronbach's alpha was > 0.7 for youth and parent-proxy report at all time points. Correlations between FACT-GOG-Ntx and HRQL scores were moderate (0.41-0.48) for youth and parent-proxy raters across all times. Youth and parent-proxy raters both reported worse FACT-GOG-Ntx scores at Time 3 for those who had clinically-reported CIPN compared to those who did not. Agreement between raters was moderate to high. Compared to baseline scores, those at Time 3 were significantly lower for youth (β = - 2.83, p < 0.001) and parent-proxy raters (β = - 1.99, p < 0.001). CONCLUSIONS High completion rates at all time points indicated feasibility of eliciting youth and parent report. Psychometric performance of the FACT-GOG-Ntx revealed acceptable reliability, evidence of validity, and strong inter-rater agreement, supporting the use of this self- or proxy-reported measure of CIPN in youth with high-risk HL exposed to tubulin inhibitors, as part of a Phase 3 clinical trial. CLINICAL TRIAL INFORMATION Clinical Trials Registry, NCT02166463. Registered 18 June 2014, https://clinicaltrials.gov/ct2/show/study/NCT02166463.
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Affiliation(s)
- Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Qinglin Pei
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
| | - Yue Wu
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - David Cella
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Patient-Centered Outcomes, Northwestern University, 420 E. Superior St, Chicago, IL, 60611, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St, Buffalo, NY, 14203, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
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Daudelin DH, Cabrera A, Thompson AL, Concannon TW, Sege R, Leary E, Rodday AM. 120 Using Implementation Science to Develop a TL1 D&I Science Training Implementation Plan - ADDENDUM. J Clin Transl Sci 2023; 7:e135. [PMID: 37432840 PMCID: PMC10308418 DOI: 10.1017/cts.2023.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
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Upshaw JN, Nelson J, Rodday AM, Kumar AJ, Klein AK, Konstam MA, Wong JB, Jaffe IZ, Ky B, Friedberg JW, Maurer M, Kent DM, Parsons SK. Association of Preexisting Heart Failure With Outcomes in Older Patients With Diffuse Large B-Cell Lymphoma. JAMA Cardiol 2023; 8:453-461. [PMID: 36988926 PMCID: PMC10061311 DOI: 10.1001/jamacardio.2023.0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/22/2022] [Indexed: 03/30/2023]
Abstract
Importance Anthracycline-containing regimens are highly effective for diffuse large B-cell lymphoma (DLBCL); however, patients with preexisting heart failure (HF) may be less likely to receive anthracyclines and may be at higher risk of lymphoma mortality. Objective To assess the prevalence of preexisting HF in older patients with DLBCL and its association with treatment patterns and outcomes. Design, Setting, and Participants This longitudinal cohort study used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry from 1999 to 2016. The SEER registry is a system of population-based cancer registries, capturing more than 25% of the US population. Linkage to Medicare offers additional information from billing claims. This study included individuals 65 years and older with newly diagnosed DLBCL from 2000 to 2015 with Medicare Part A or B continuously in the year prior to lymphoma diagnosis. Data were analyzed from September 2020 to December 2022. Exposures Preexisting HF in the year prior to DLBCL diagnosis ascertained from billing codes required one of the following: (1) 1 primary inpatient discharge diagnosis, (2) 2 outpatient diagnoses, (3) 3 secondary inpatient discharge diagnoses, (4) 3 emergency department diagnoses, or (5) 2 secondary inpatient discharge diagnoses plus 1 outpatient diagnosis. Main Outcomes and Measures The primary outcome was anthracycline-based treatment. The secondary outcomes were (1) cardioprotective medications and (2) cause-specific mortality. The associations between preexisting HF and cancer treatment were estimated using multivariable logistic regression. The associations between preexisting HF and cause-specific mortality were evaluated using cause-specific Cox proportional hazards models with adjustment for comorbidities and cancer treatment. Results Of 30 728 included patients with DLBCL, 15 474 (50.4%) were female, and the mean (SD) age was 77.8 (7.2) years. Preexisting HF at lymphoma diagnosis was present in 4266 patients (13.9%). Patients with preexisting HF were less likely to be treated with an anthracycline (odds ratio, 0.55; 95% CI, 0.49-0.61). Among patients with preexisting HF who received an anthracycline, dexrazoxane or liposomal doxorubicin were used in 78 of 1119 patients (7.0%). One-year lymphoma mortality was 41.8% (95% CI, 40.5-43.2) with preexisting HF and 29.6% (95% CI, 29.0%-30.1%) without preexisting HF. Preexisting HF was associated with higher lymphoma mortality in models adjusting for baseline and time-varying treatment factors (hazard ratio, 1.24; 95% CI, 1.18-1.31). Conclusions and Relevance In this study, preexisting HF in patients with newly diagnosed DLBCL was common and was associated with lower use of anthracyclines and lower use of any chemotherapy. Trials are needed for this high-risk population.
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Affiliation(s)
- Jenica N. Upshaw
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Jason Nelson
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Anita J. Kumar
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Division of Hematology-Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Andreas K. Klein
- Division of Hematology-Oncology, Tufts Medical Center, Boston, Massachusetts
| | | | - John B. Wong
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Iris Z. Jaffe
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, Massachusetts
| | - Bonnie Ky
- Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jonathan W. Friedberg
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Matthew Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - David M. Kent
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Susan K. Parsons
- Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Division of Hematology-Oncology, Tufts Medical Center, Boston, Massachusetts
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Patel K, Vaughan DA, Rodday AM, Penzias A, Sakkas D. Compared to conventional insemination, intracytoplasmic sperm injection provides no benefit in cases of non-male factor infertility as evidenced by comparable euploidy rate. Fertil Steril 2023:S0015-0282(23)00305-9. [PMID: 37085098 DOI: 10.1016/j.fertnstert.2023.04.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To evaluate if differences in euploidy rates exist between intracytoplasmic sperm injection (ICSI) and conventional insemination (CI) in non-male factor infertility cases. DESIGN Retrospective cohort study. SETTING Single, academically affiliated infertility center in the U.S. SUBJECTS A total of 3,554 patients who underwent in-vitro fertilization (IVF) cycles from January 2014 to December 2021. All cycles that had pre-implantation testing for aneuploidy (PGT-A) performed by trophectoderm biopsy and had a post preparation sperm concentration >4 million total motile sperm per milliliter were included. MAIN OUTCOME MEASURES The primary outcome was embryo euploidy rate per embryo biopsied in the ICSI versus CI group. Secondary outcomes included fertilization rate and number of embryos biopsied. Generalized estimating equations with a Poisson distribution was used to estimate the euploid rate ratio (with total embryos biopsied as an offset), while accounting for multiple retrievals per patient. To adjust for confounding, a propensity score model was fit for ICSI using 14 baseline female and male characteristics. RESULTS Oocytes retrieved and number of embryos biopsied were similar in both groups, while fertilization rate per oocyte retrieved was significantly lower with ICSI (0.64 vs 0.66, p=0.04). The proportion of euploid embryos in the ICSI group was significantly lower when compared to CI (0.47 vs 0.52), with a euploid rate ratio of 0.89 (p<0.001). Interestingly, when accounting for variation in PGT reference laboratories over the study time period, adjusting for date of procedure did not change the relationship between ICSI and euploid rate (RR=0.89, p<0.001); however, after adjusting for PGT reference laboratory, the relationship between ICSI and euploid rate was no longer significant (RR=0.97, p=0.07). CONCLUSION In the setting of non-male factor infertility, ICSI resulted in a lower fertilization rate and an 11% lower embryo euploid rate compared to CI. Although the data is not statistically significant when adjusted for PGT reference laboratory, we can still conclude that ICSI does not provide any benefit. This data supports the recommendation that CI should be the preferred methodology of fertilization in non-male factor infertility cases.
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Affiliation(s)
- Karishma Patel
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA 02111, U.S.A.
| | - Denis A Vaughan
- Boston IVF - The Eugin Group, Waltham MA 02451, U.S.A.; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, U.S.A; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA 02115, U.S.A
| | - Angie Mae Rodday
- Tufts Clinical and Translational Science Institute, Boston, MA 02111, U.S.A
| | - Alan Penzias
- Boston IVF - The Eugin Group, Waltham MA 02451, U.S.A.; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, U.S.A
| | - Denny Sakkas
- Boston IVF - The Eugin Group, Waltham MA 02451, U.S.A
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Rodday AM, Parsons SK, Upshaw JN, Friedberg JW, Gallamini A, Hawkes E, Hodgson D, Johnson P, Link BK, Mou E, Savage KJ, Zinzani PL, Maurer M, Evens AM. The Advanced-Stage Hodgkin Lymphoma International Prognostic Index: Development and Validation of a Clinical Prediction Model From the HoLISTIC Consortium. J Clin Oncol 2023; 41:2076-2086. [PMID: 36495588 PMCID: PMC10082254 DOI: 10.1200/jco.22.02473] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The International Prognostic Score (IPS) has been used in classic Hodgkin lymphoma (cHL) for 25 years. However, analyses have documented suboptimal performance of the IPS among contemporarily treated patients. Harnessing multisource individual patient data from the Hodgkin Lymphoma International Study for Individual Care consortium, we developed and validated a modern clinical prediction model. METHODS Model development via Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines was performed on 4,022 patients with newly diagnosed advanced-stage adult cHL from eight international phase III clinical trials, conducted from 1996 to 2014. External validation was performed on 1,431 contemporaneously treated patients from four real-world cHL registries. To consider association over a full range of continuous variables, we evaluated piecewise linear splines for potential nonlinear relationships. Five-year progression-free survival (PFS) and overall survival (OS) were estimated using Cox proportional hazard models. RESULTS The median age in the development cohort was 33 (18-65) years; nodular sclerosis was the most common histology. Kaplan-Meier estimators were 0.77 for 5-year PFS and 0.92 for 5-year OS. Significant predictor variables included age, sex, stage, bulk, absolute lymphocyte count, hemoglobin, and albumin, with slight variation for PFS versus OS. Moreover, age and absolute lymphocyte count yielded nonlinear relationships with outcomes. Optimism-corrected c-statistics in the development model for 5-year PFS and OS were 0.590 and 0.720, respectively. There was good discrimination and calibration in external validation and consistent performance in internal-external validation. Compared with the IPS, there was superior discrimination for OS and enhanced calibration for PFS and OS. CONCLUSION We rigorously developed and externally validated a clinical prediction model in > 5,000 patients with advanced-stage cHL. Furthermore, we identified several novel nonlinear relationships and improved the prediction of patient outcomes. An online calculator was created for individualized point-of-care use.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Jenica N. Upshaw
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- The CardioVascular Center and Advanced Heart Failure Program, Tufts Medical Center, Boston, MA
| | - Jonathan W. Friedberg
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Center, Nice, France
| | - Eliza Hawkes
- Australasian Lymphoma and Related Diseases Registry, Monash University, Melbourne, Australia
| | - David Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter Johnson
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, United Kingdom
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seragnoli” Dipartimento di Medicina Specialistica, Diagnostica Sperimentale Università di Bologna, Bologna, Italy
| | - Matthew Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJ
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Penney JA, Rodday AM, Sebastiani P, Snydman DR, Doron S. Effecting the culture: Impact of changing urinalysis with reflex to culture criteria on culture rates and outcomes. Infect Control Hosp Epidemiol 2023; 44:210-215. [PMID: 35924370 DOI: 10.1017/ice.2022.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the impact of changes to urinalysis with reflex to culture (UARC) reflex criteria on culture performance and clinical decision outcomes. DESIGN Retrospective study utilizing interrupted time series analysis from December 2018 to November 2020. Primary outcomes were measures of culture performance. Secondary outcomes were rates of antimicrobial prescription for suspected urinary tract infection (UTI) and catheter-associated urinary tract infection (CAUTI). We also assessed harmful events related to antimicrobial prescription for all causes and UTI, UTI symptoms, and sepsis. SETTING A 415-bed, academic, tertiary-care, medical center. PATIENTS Hospitalized adult patients with urine testing performed. INTERVENTION UARC reflex criteria were changed on October 22, 2019, from ≥5×109/L white blood cells (WBCs) or trace leukocyte esterase or positive nitrite units on urinalysis to only ≥15×109/L WBCs. RESULTS The study included 11,322 unique UARC tests. We detected a significant decrease in the rate of urine cultures performed from UARC after the intervention (32.5-8.7 cultures per 1,000 patient days; P < .001), with improved diagnostic efficacy (ie, culture positivity increased from 34.8% to 62.1%). CAUTI rates did not change. We detected a significant decrease in antimicrobial prescription rates (P = .05), this was primarily driven by preintervention changes. One case of sepsis occurred secondary to a missed UTI, and UTIs were rarely missed after the intervention. CONCLUSIONS Implementation of a stricter UARC reflex criterion was associated with a decrease in culture rates with improved diagnostic efficacy without significant adverse events. Continued education is needed to change antimicrobial prescribing practices.
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Affiliation(s)
- Jessica A Penney
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Paola Sebastiani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - David R Snydman
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
| | - Shira Doron
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
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11
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Linendoll N, Murphy-Banks R, Sae-Hau M, Rodday AM, DiFilippo C, Jain A, Reinhart C, Rapkin B, Weiss E, Parsons SK. Evaluating the role of financial navigation in alleviating financial distress among young adults with a history of blood cancer: A hybrid type 2 randomized effectiveness-implementation design. Contemp Clin Trials 2023; 124:107019. [PMID: 36414208 PMCID: PMC9839613 DOI: 10.1016/j.cct.2022.107019] [Citation(s) in RCA: 2] [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: 07/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Young adulthood (YA) is a complex phase of life, marked by key developmental goals, including educational and vocational attainment, housing independence, maintenance of social relationships, and financial stability. A cancer diagnosis during, or prior to, this phase of life can compromise the achievement of these milestones. Studies of adults with cancer have demonstrated that >70% report experiencing financial side-effects, which are associated with increased mortality, diminished health-related quality of life, and forgone medical care. The goal of this project is to evaluate financial distress of YA-aged survivors of blood cancers, and the impact of financial navigation on alleviating this distress. METHODS This three-arm, multi-site, hybrid type 2 randomized effectiveness-implementation design (EID) study will be conducted through remote consent, remote data capture and telephone-based/virtual financial navigation. Participants will be aged 18-39, and more than three years from their blood cancer diagnosis. In this six-month intervention, the study will compare the primary outcome of financial distress in three arms: (1) usual care (2) participant-initiated, ad hoc navigation, and (3) study-directed proactive navigation. The study will be evaluated via the five-component Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) outcome strategy with a mixed-methods approach through quantitative assessment of participant-reported financial distress using the Personal Financial Wellness Scale™, as the primary outcome measure, and qualitative assessment through interviews. CONCLUSION The study will address many unanswered questions regarding financial navigation within the YA survivor population and will inform the most successful strategies to mitigate financial distress in this vulnerable population.
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Affiliation(s)
- Nadine Linendoll
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA; Division of Hematology/Oncology, Tufts Medical Center Cancer Center, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Rachel Murphy-Banks
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Courtney DiFilippo
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Annika Jain
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Crystal Reinhart
- Center for Prevention Research and Development, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Bruce Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - Susan K Parsons
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA; Division of Hematology/Oncology, Tufts Medical Center Cancer Center, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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12
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Patel K, Vaughan DA, Rodday AM, Sakkas D. FERTILIZATION BY INTRACYTOPLASMIC SPERM INJECTION (ICSI) IS ASSOCIATED WITH LOWER RATES OF EUPLOIDY IN NON-MALE FACTOR INFERTILITY COMPARED TO CONVENTIONAL INSEMINATION (CI). Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Penney JA, Rodday AM, Sebastiani P, Snydman DR, Doron SI. Impact of provider-selected indication requirement on urine test utilization and positivity. Antimicrob Steward Healthc Epidemiol 2022; 2:e103. [PMID: 36483372 PMCID: PMC9726588 DOI: 10.1017/ash.2022.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the impact of the addition of an indication specification requirement to isolated urine-culture ordering on testing utilization. DESIGN Retrospective study utilizing interrupted time series analysis with negative binomial regression. The preintervention period was October 1, 2018-November 11, 2019, and the postintervention period was November 12, 2019-October 31, 2020. The primary outcome was isolated culture rate per 1,000 patient days. Secondary outcomes were the proportion of all urine tests ordered as isolated urine culture and culture positivity. An exploratory analysis assessed the appropriateness of selected testing indications. SETTING A 415-bed, urban, academic medical center. PATIENTS Adult patients with urine testing performed during hospital admission. In total, 1,494 unique isolated urine-culture orders were included in the analysis. INTERVENTIONS On November 12, 2019, the laboratory order interface was changed to require the ordering provider to select an indication for isolated urine culture. RESULTS Isolated urine-culture rates did not significantly change after the intervention (11.2-7.8 cultures per 1,000 patient days; P = .17) nor did culture positivity (26.9% vs 26.8%). Most ordering providers left the indication for testing blank, and of those charts reviewed, 67% did not have a documented condition for which isolated urine culture was the most appropriate initial test. CONCLUSIONS The addition of an order-specification requirement for isolated urine-culture testing did not significantly affect ordering practices. The test remains overused as the initial diagnostic evaluation for a suspected urinary tract infection. Further provider education and continued changes in provider workflow are needed to achieve lasting change in practice.
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Affiliation(s)
- Jessica A. Penney
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Paola Sebastiani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - David R. Snydman
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
| | - Shira I. Doron
- Division of Geographic Medicine and Infectious Disease, Tufts Medical Center, Boston, Massachusetts
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14
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Waheed A, Rodday AM, Kumar AJ, Miller KB, Parsons SK. Hematopoietic Stem-Cell Transplant Utilization in Relapsed/Refractory Hodgkin Lymphoma: A Population-Level Analysis of Statewide Claims Data. JCO Clin Cancer Inform 2022; 6:e2100135. [PMID: 35584337 DOI: 10.1200/cci.21.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although hematologic malignancies affect adults of all ages, few data exist on the real-world patterns of care for patients younger than 65 years in the United States. Understanding patterns of care from diagnosis through relapsed disease may provide insight about care across community and academic centers. We used a large statewide claims database to describe the path of Hodgkin lymphoma (HL) treatment among adults age < 65 years at diagnosis. METHODS We defined a cohort of commercially insured patients with HL who underwent hematopoietic stem-cell transplantation (HSCT) from 2009 to 2013 in the Massachusetts All-Payer Claims Database (APCD). The primary goals of our study were to accurately identify patients and their treatment patterns who had relapsed/refractory HL and underwent HSCT. We also characterized time to treatment failure and overall survival. RESULTS A total of 7,613 patients had International Classification of Diseases, Ninth Revision, diagnostic codes for HL. From our algorithm, we identified 117 patients as part of the final cohort who underwent autologous and/or allogeneic HSCT. Median age was 39.0 years and 50.4% were female. Initial therapy was identified for 68 of the 117 patients (58.1%). Most (> 74.4%) of the identified transplants were autologous, and 19 patients (16.2%) underwent allogeneic transplant, with or without prior autologous transplant. Of the 68 patients with initial therapy data, the median time to HSCT after completion of initial treatment was 223.5 days (Q1 = 151.5, Q3 = 414.5). CONCLUSION We used the Massachusetts APCD to create a cohort of patients age < 65 years with relapsed/refractory HL. Our findings support the use of APCD for the large-scale analysis of patient characteristics, treatment patterns, and outcomes for young adult patients with hematologic malignancies.
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Affiliation(s)
- Anem Waheed
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Anita J Kumar
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Kenneth B Miller
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Susan K Parsons
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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15
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Khuvis J, Alsoubani M, Mae Rodday A, Doron S. Impact of Diagnostic Stewardship Interventions on Clostridiodes difficile test ordering practices and results. Clin Biochem 2022; 117:23-29. [DOI: 10.1016/j.clinbiochem.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022]
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16
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Kumar AJ, Chao CR, Rodday AM, Chang H, Xu L, Evens AM, Parsons SK. Treatment patterns for relapsed and refractory Hodgkin lymphoma in a community oncology setting. Leuk Lymphoma 2021; 63:1119-1126. [PMID: 34886751 DOI: 10.1080/10428194.2021.2012660] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is little data about treatment practices for relapsed/refractory Hodgkin Lymphoma (HL) in nonacademic settings. We describe sequential treatments and outcomes among HL patients who experienced treatment failure in an integrated community-oncology setting. We performed a retrospective cohort study among patients ≥12 years diagnosed with Stage II-IV HL from 2007 to 2012 at Kaiser Permanente Southern California (KPSC). Of 463 HL patients, 75 (16.1%) experienced treatment failure. Patients with failure received between 1 and 8 salvage therapies; 28% received ≥4 lines of therapy. Fifty-nine of 75 (79%) were initially salvaged with ifosfamide-based therapy, 44 of whom underwent hematopoietic cell transplant. Ultimately, 47% of patients died, with most deaths due to HL. Survival was shorter with increasing age at diagnosis (p = 0.02) and with greater number of lines of therapy (p = 0.02). In a community oncology setting, HL patients received multiple lines of salvage. Despite extensive treatment, nearly half of patients died of HL following relapsed/refractory disease.
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Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Angie Mae Rodday
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Hong Chang
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc., Solon, OH, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan K Parsons
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA.,Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, USA
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17
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Grant HM, Rodday AM, Breeze JL, Tirabassi MV, Stefan MS. Racial and Ethnic Disparity in the Surgical Management of Colorectal Cancer in the Non-Elective Setting. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
IMPORTANCE Hodgkin lymphoma is an aggressive blood cancer that is highly curable in younger patients who receive multiagent chemotherapy. Worse survival in older patients may reflect less-aggressive treatment, competing risks of death, or different disease biological factors. OBJECTIVE To examine the association between treatment intensity and cause-specific mortality among older adults with Hodgkin lymphoma. DESIGN, SETTING, AND PARTICIPANTS This was a population-based cohort study of patients aged 65 years or older with Medicare Part A and B fee-for-service coverage who received a diagnosis of Hodgkin lymphoma from 2000 to 2013. The association between treatment intensity and cause-specific mortality was estimated separately for early-stage and advanced-stage disease with Cox proportional hazards models. Multivariable adjustment and propensity score weighting helped control for confounding. Data are from the 1999 to 2016 Surveillance, Epidemiology, and End Results Medicare database. Data analysis was performed from April 2020 to June 2021. EXPOSURES First-line treatment categorized as (1) full chemotherapy regimen, (2) partial chemotherapy regimen, (3) single chemotherapy agent or radiotherapy, or (4) no treatment. MAIN OUTCOMES AND MEASURES The main outcome was 3-year Hodgkin lymphoma-specific and other-cause mortality. RESULTS Among 2686 patients (mean [SD] age, 75.7 [6.9] years; 1333 men [50%]), 1307 had early-stage disease and 1379 had advanced-stage disease. For Hodgkin lymphoma-specific mortality in patients with early-stage disease, hazard ratios (HRs) were higher for partial regimens (HR, 1.77; 95% CI, 1.22-2.57) or no treatment (HR, 1.91; 95% CI, 1.31-2.79) than for full regimens; there was no difference between single-agent chemotherapy or radiotherapy and full regimens. For other-cause mortality in patients with early-stage disease, HRs were higher for partial regimens (HR, 1.69; 95% CI, 1.18-2.44), single-agent chemotherapy or radiotherapy (HR, 1.62; 95% CI, 1.13-2.33), or no treatment (HR, 2.71; 95% CI, 1.95-3.78) than for full regimens. For Hodgkin lymphoma-specific mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 3.26; 95% CI, 2.44-4.35), single-agent chemotherapy or radiotherapy (HR, 2.85; 95% CI, 1.98-4.11), or no treatment (HR, 4.06; 95% CI, 3.06-5.37) than for full regimens. For other-cause mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 1.76; 95% CI, 1.32-2.33), single-agent chemotherapy or radiotherapy (HR, 1.65; 95% CI, 1.15-2.37), or no treatment (HR, 2.24; 95% CI, 1.71-2.94) than for full regimens. CONCLUSIONS AND RELEVANCE This cohort study found variability in the magnitude of the association between treatment intensity and mortality by stage and cause-specific mortality, possibly reflecting competing risks of death. However, full chemotherapy regimens were associated with lower mortality and could be considered for older adults who can tolerate them.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School Baystate, Springfield
| | | | | | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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19
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Kumar AJ, Nelson J, Rodday AM, Evens AM, Friedberg JW, Wildes TM, Parsons SK. Development and validation of a prediction model for 1-year mortality among older adults with Hodgkin Lymphoma who receive dose-intense chemotherapy. J Geriatr Oncol 2021; 12:1233-1239. [PMID: 34330667 DOI: 10.1016/j.jgo.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/12/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Older adults with Hodgkin Lymphoma (HL) have poorer outcomes than younger patients. There are little data about which baseline patient and disease factors inform prognosis among older patients. We sought to create a prediction model for 1-year mortality among older patients with new HL who received dose-intense chemotherapy. METHODS We included adults ≥65 years old with a new diagnosis of classical HL between 2000-2013 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset who received full-regimen chemotherapy. Through a non-random 2:1 split, we created development and validation cohorts. Multiple imputation was used for missing data. Using stepwise selection and logistic regression, we identified predictive variables for 1-year mortality. The model was applied to the validation cohort. A final model was then fit in the full cohort. RESULTS We included 1315 patients. In the development cohort (n = 813), we identified significant predictors of 1-year mortality including age, Charlson comorbidity index (CCI), B symptoms at diagnosis, and advanced stage at diagnosis. The c-statistic was 0.70. When this model was applied to the validation cohort (n = 502), the c-statistic was 0.65. Predictors of 1-year mortality in the final model were CCI (OR = 1.41), B symptoms (OR = 1.54), advanced stage (OR = 1.44), and older age at diagnosis (OR = 1.33). CONCLUSION We present a prediction model for use among older adults with HL who receive intensive chemotherapy. We identify risk factors for death within 1 year of diagnosis. Future work will build upon prognostication and shared decision-making after diagnosis for this population.
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Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America.
| | - Jason Nelson
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Angie Mae Rodday
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Jonathan W Friedberg
- Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States of America
| | - Tanya M Wildes
- Cancer and Aging Research Group, United States of America
| | - Susan K Parsons
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America; Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, United States of America
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20
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Yen E, Murphy HJ, Friedman H, Lucke AM, Rodday AM. Neonatal abstinence syndrome practice variations across pediatric subspecialty. J Perinatol 2021; 41:1512-1514. [PMID: 32968221 PMCID: PMC7985043 DOI: 10.1038/s41372-020-00831-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/22/2020] [Accepted: 09/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Elizabeth Yen
- Department of Pediatrics, Tufts Medical Center, Boston, MA, USA.
| | - Heidi J Murphy
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Ashley M Lucke
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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21
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Parsons SK, Rodday AM, Weidner RA, Morris E, Braniecki S, Shenoy S, Talano JA, Moore TB, Panarella A, Flower A, Fabricatore S, Cairo MS. Children’s Health-Related Quality of Life (HRQL) after Myeloimmuno Ablative Conditioning (MAC) Familial Haploidentical (FHI) T-Cell Depleted (TCD) with T-Cell Addback Stem Cell Transplantation (SCT) for Poor Risk Sickle Cell Disease (SCD): Significant Improvement of Child Physical and Emotional Functioning at 2 Years (IND 14359). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodday AM, Esham KS, Savidge N, Parsons SK. Clusters of pain trajectories among patients with sickle cell disease hospitalized for vaso-occlusive crisis: a data-driven approach. EJHaem 2020; 1:426-437. [PMID: 33709084 PMCID: PMC7941740 DOI: 10.1002/jha2.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaso-occlusive crises (VOC) are the hallmark of sickle cell disease (SCD), with higher severity among hospitalized patients. Clustering hospitalizations with similar pain trajectories could identify vulnerable patient subgroups. Aims were to (1) identify clusters of hospitalizations based on pain trajectories; (2) identify factors associated with these clusters; and (3) determine the association between these clusters and 30-day readmissions. METHODS We retrospectively included 350 VOC hospitalizations from 2013-2016 among 59 patients. Finite mixture modeling identified clusters of hospitalizations from intercepts and slopes of pain trajectories during the hospitalization. Generalized estimating equations for multinomial and logistic models were used to identify factors associated with clusters of hospitalizations based on pain trajectories and 30-day readmissions, respectively, while accounting for multiple hospitalizations per patient. RESULTS Three clusters of hospitalizations based on pain trajectories were identified: slow (n=99), moderate (n=207), and rapid (n=44) decrease in pain scores. In multivariable analysis, SCD complications, female gender, and affective disorders were associated with clusters with slow or moderate decrease in pain scores (compared to rapid decrease). Although univariate analysis found that the cluster with moderate decrease in pain scores was associated with lower odds of 30-day readmissions compared to the cluster with slow decrease, it was non-significant in multivariable analysis. SCD complications were associated with higher odds of 30-day readmissions and older age was associated with lower odds of 30-day readmissions. CONCLUSIONS Our results highlight variability in pain trajectories among patients with SCD experiencing VOC and provide a novel approach for identifying subgroups of patients that could benefit from more intensive follow-up.
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Affiliation(s)
- Angie Mae Rodday
- The Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusetts
| | - Kimberly S. Esham
- Division of Hematology/OncologyTufts Medical CenterBostonMassachusetts
| | - Nicole Savidge
- The Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusetts
| | - Susan K. Parsons
- The Institute for Clinical Research and Health Policy StudiesTufts Medical CenterBostonMassachusetts
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Rodday AM, Esham KS, Savidge N, Parsons SK. Patterns of healthcare utilization among patients with sickle cell disease hospitalized with pain crises. ACTA ACUST UNITED AC 2020; 1:438-447. [PMID: 34350423 PMCID: PMC8330517 DOI: 10.1002/jha2.84] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Vaso‐occlusive crises (VOC) are the hallmark of sickle cell disease (SCD). Adults experiencing VOC often have high rates of unexpected healthcare utilization. We characterized prior and future healthcare utilization among adults hospitalized with VOC at an urban, academic medical center. Methods We identified 449 VOC hospitalizations among 63 patients from 2013 to 2016. Patients were categorized based on receiving established care at the medical center and prior utilization: (a) not established (n = 21); (b) newly established (n = 10); (c) established with low utilization in past 12 months (<4 VOC hospitalizations) (n = 22); and (d) established with high utilization in past 12 months (≥4 VOC hospitalizations) (n = 10). Patient and hospitalization characteristics and future utilization were compared across categories. Results Median age was 26 years (Q1 = 22, Q3 = 29) and 55.6% were female. Established patients with high prior utilization tended to have higher median pain scores at admission (10, P = .08). Thirty‐day readmissions were highest in established patients with high prior utilization (P = .06), but 30‐day clinic visits were highest in established patients with low prior utilization (P = .08). Adjusted linear regression found that newly established patients (β = −4.6, P < .01) and established patients with low prior utilization (β = −5.6, P < .01) had fewer VOC hospitalizations in the ensuing 12 months than established patients with high prior utilization. Conclusion Among patients with SCD hospitalized for VOC, there was heterogeneity in healthcare utilization, with persistence in utilization over time for some patients. Efforts are needed to shift care from the acute setting to the outpatient clinic, which may lead to improved outcomes.
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Affiliation(s)
- Angie Mae Rodday
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kimberly S Esham
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Hematology and Oncology, Boston, Massachusetts, USA
| | - Nicole Savidge
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Susan K Parsons
- Tufts Medical Center, The Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Medical Center, Hematology and Oncology, Boston, Massachusetts, USA
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24
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Rodday AM, Hackenyos D, Masood R, Savidge N, Lin M, Weidner RA, Parsons SK. Assessment of patients' understanding of and adherence to oral anticancer medication (OAM): Results of a cross-sectional institutional pilot study. J Oncol Pharm Pract 2020; 27:1569-1577. [PMID: 33019872 DOI: 10.1177/1078155220960809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although oral anticancer medications (OAM) provide opportunity for treatment at home, challenges include prescription filling, monitoring side effects, safe handling, and adherence. We assessed understanding of and adherence to OAM in vulnerable patients. METHODS This 2018 pilot study defined vulnerable patients based on Chinese language, older age (≥65 years), and subsidized insurance. All participants had a cancer diagnosis and were taking an OAM filled through the hospital's specialty pharmacy. Participants reported on OAM taking (days per week, times per day, special instructions) and handling (handling, storage, disposal). The specialty pharmacist classified patient-reported responses about OAM taking and handling as adequate or inadequate. OAM regimens were classified by complexity. RESULTS Of 61 eligible patients, 55 participated. Mean age was 68 years (standard deviation [SD] = 12) and 53% were female. Patient subgroups were: 27% Chinese, 64% ≥65 years, and 9% subsidized insurance. Forty-nine percent were on frontline therapy and median time on OAM was 1 year (Quartile 1 = 0.4, Quartile 3 = 1.7). Adequacy of OAM taking (30%) and handling (15%) were low; 15% had adequacy in both. Adequacy of OAM taking and handling did not vary by patient subgroup or regimen complexity. Mean patient-reported adherence was high (5.4, SD = 1, possible range 1-6) and did not vary by adequacy of OAM taking or handling. CONCLUSIONS Understanding of OAM taking and handling in this group of vulnerable patients was low and did not align with patient-reported adherence. Future interventions should ensure that patients understand how to safely take and handle OAM, thereby optimizing their therapeutic potential.
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Lin M, Hackenyos D, Savidge N, Weidner RA, Murphy-Banks R, Fleckner T, Parsons SK, Rodday AM. Enhancing patients' understanding of and adherence to oral anticancer medication: Results of a longitudinal pilot intervention. J Oncol Pharm Pract 2020; 27:1409-1421. [PMID: 32996363 DOI: 10.1177/1078155220960800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Oral anticancer medications (OAM) make administration more convenient for patients, but shifts the responsibility of care from clinical providers to the patients themselves. Following an institutional pilot study showing inadequate understanding and adherence among vulnerable patients taking OAM, a longitudinal intervention was developed using an oncology specialty pharmacist and medication navigators to enhance OAM understanding and adherence. METHODS Patients initiating OAM were approached for four formalized teaching and check-in sessions, supplemented with medication information sheets and individualized calendars. At each session, participants were assessed on their OAM understanding and adherence using teach-back and validated measures. A study evaluation elicited feedback from participants on the usefulness of the intervention. RESULTS Of 80 eligible patients, 58 (72.5%) received formal OAM teaching from the specialty pharmacist. Of those, 54 (93.1%) enrolled in the study with 39 (72%) completing the intervention for final analysis. At study completion, all participants adequately understood OAM taking, but 41.0% had inadequate understanding of OAM handling. Throughout the study, participants reported issues that were addressed by the intervention team (28.2% to 31.6%) as well as those requiring additional assistance from the treatment team (26.3% to 38.5%), Most participants found the intervention to be very beneficial (initial evaluation, 86.5%; final evaluation, 76.9%). CONCLUSIONS This pilot intervention addressed gaps identified by our institutional assessment through formalized OAM teaching and follow-up. Improved understanding of taking and handling OAM through this subsequent study illustrated the enhanced effect of a multidisciplinary and multicomponent intervention to better educate and support patients on OAM.
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Affiliation(s)
| | | | | | | | | | - Tara Fleckner
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, USA
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26
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Rodday AM, Hahn T, Kumar AJ, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. First-line treatment in older patients with Hodgkin lymphoma: a Surveillance, Epidemiology, and End Results (SEER)-Medicare population-based study. Br J Haematol 2020; 190:222-235. [PMID: 32090325 PMCID: PMC7368808 DOI: 10.1111/bjh.16525] [Citation(s) in RCA: 8] [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: 09/27/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
While Hodgkin lymphoma (HL) is highly curable in younger patients, older patients have higher relapse and death rates, which may reflect age-related factors, distinct disease biology and/or treatment decisions. We described the association between patient, disease and geographic factors and first-line treatment in older patients (≥65 years) with incident HL using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1999 to 2014 (n = 2825). First-line treatment initiated at ≤4 months after diagnosis was categorised as: full chemotherapy regimen (n = 699, 24·7%); partial chemotherapy regimen (n = 1016, 36·0%); single chemotherapy agent or radiotherapy (n = 382, 13·5%); and no treatment (n = 728, 25·8%). Among the fully treated, ABVD [doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine]/AVD was most common (n = 635, 90·8%). Adjusted multinomial logistic regression identified factors associated with treatment. Older age, Medicaid dual eligibility, not married, frailty, cardiac comorbidity, prior cancer, earlier diagnosis date, histology, advanced disease Stage, B symptoms and South region were independently associated with increased odds of not receiving full chemotherapy regimens. In conclusion, we found variability in first-line HL treatment for older patients. Treatment differences by Medicaid and region may indicate disparities. Even after adjusting for frailty and cardiac comorbidity, age was associated with treatment, suggesting factors such as end-of-life care or shared decision-making may influence treatment in older patients.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, MA
| | | | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
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Khoury M, Rodday AM, Mackie AS, Gill P, McLaughlin T, Harris KC, Wong P, McCrindle BW, Birken CS, de Ferranti SD. Pediatric Lipid Screening and Treatment in Canada: Practices, Attitudes, and Barriers. Can J Cardiol 2020; 36:1545-1549. [PMID: 32502521 DOI: 10.1016/j.cjca.2020.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022] Open
Abstract
The pediatric lipid screening and treatment practices, attitudes, and perceived barriers of Canadian pediatricians are not known. We sought to evaluate this in a survey of pediatricians through the Canadian Pediatric Surveillance Program (CPSP) in March 2019. The survey included an assessment of lipid screening of 9- to 11-year-old youth and a hypothetical case of persistent severe dyslipidemia to ascertain management practices. There were 759 respondents (28% response rate, 759 of 2742), of whom 236 provided outpatient primary care to 9- to 11-year-old youth as part of their routine clinical practice. Among primary care-providing pediatricians, universal lipid screening of healthy 9- to 11-year-old youth most or all of the time was reported by 3% (8 of 230). Reported screening practices most or all of the time were more common for youth with risk factors such as overweight and obesity (54%, 127 of 235) and a family history of premature cardiovascular disease (39%, 85 of 217). Most respondents would refer a child with severe persistent dyslipidemia to dieticians (69%, 152 of 220) and a lipid specialist (64%, 144 of 220) most or all of the time, whereas 7% (16 of 220) would start statin therapy themselves. A lack of Canadian pediatric lipid guidelines was reported as a major barrier for 49% (114 of 233) and minor barrier for 40% (93 of 213). The rate of routine lipid screening of healthy 9- to 11-year-old youth among Canadian primary care-providing pediatricians is low and at odds with current US guidelines. This discrepancy may be due at least in part to a lack of Canadian guidelines on pediatric dyslipidemia, the development of which may address certain perceived barriers and influence future attitudes.
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Affiliation(s)
- Michael Khoury
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Gill
- Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children. University of Toronto, Ontario, Canada
| | - Tom McLaughlin
- Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kevin C Harris
- Division of Cardiology, Department of Pediatrics, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Wong
- Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children. University of Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Center, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children. University of Toronto, Ontario, Canada
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Parsons SK, Bhakta N, Rodday AM, Scharman C, André M, Federico M, Friedberg JW, Friedman DL, Gallamini A, Hay AE, Kahl BS, Keller FG, Kelly KM, Meyer RM, Raemaekers J, Robison LL, Hudson MM, Cohen JT, Evens AM, Wong FL. Lifelong disease burden of chemotherapy in Hodgkin lymphoma (HL): A simulation study from the St. Jude Lifetime (SJLIFE) Cohort and HL International Study for Individual Care (HoLISTIC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12068 Background: Current emphasis for childhood and young adults with HL is to maintain high cure rates while concurrently identifying regimens to reduce excess long-term mortality/morbidity. Thus, understanding the late effects (LE) of contemporary clinical trials (CCT) for HL is critical. Methods: We used simulation to estimate the projected life expectancy (LExp), quality adjusted life-expectancy (QALE) & cause of death (COD) in a large cohort of HL CCT patients (pts) in the recently established HoLISTIC consortium by linking long-term risk models from the SJLIFE cohort. Individual patient data (IPD) on bleomycin, alkylating agents and anthracycline were extracted & harmonized for 982 HL pts in 5 prospective CCT (mean diagnosis age 19y, range 3-30y; 51% male; all treated with chemotherapy only; progression-free survival [PFS] >5y) in the HoLISTIC database. LExp, QALE & COD were projected using a previously developed microsimulation model (Bhakta, Blood [Supplement], 2019) that incorporated mortality & incidence of LEs by diagnosis age, sex, race, treatment exposures & attained age estimated from 5,522 adult 10-y survivors of childhood cancers in the SJLIFE cohort (56% male; mean age at last follow-up 35y, range 19-68). Microsimulation was applied to 10,000 randomly selected survivors of HL CCT cohort, from 10y after HL diagnosis until death to project the LExp, QALE & COD. Results: Assuming 10-y PFS, LExp and QALEs projected for the HL CCT cohort using adjusted US general population rates linked with the SJLIFE microsimulation model, COD and trial-specific exposures are shown in the Table. Conclusions: A novel lifetime simulation approach was used to project LExp, QALE & COD by linking together IPD from CCTs with the long-term risk model of the SJLIFE survivorship cohort. Despite differences in PFS, reflecting in part the variation in risk/stage status, the projected long-term outcomes were similar. Our approach highlights a new opportunity to inform future clinical trial design and aid provider & patient decision-making. [Table: see text]
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Affiliation(s)
| | | | | | | | - Marc André
- Université Catholique de Louvain, CHU UCL Namur, Department of Hematology, Yvoir, Belgium
| | - Massimo Federico
- Dept of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Debra L. Friedman
- Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | - Annette E. Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Frank G. Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | - Kara M. Kelly
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ralph M. Meyer
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
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Parsons SK, Rodday AM, Scharman C, André M, Federico M, Friedberg JW, Friedman DL, Gallamini A, Hay AE, Hoskin P, Johnson P, Kahl BS, Keller FG, Kelly KM, Meyer RM, Radford JA, Raemaekers J, Zinzani PL, Cohen JT, Evens AM. The Hodgkin lymphoma international study for individual care (HoLISTIC): Enhancing decision making in pediatric and adult Hodgkin lymphoma (HL). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20019 Background: Decision making in HL is complicated by clinical trial results that differ, a growing range of treatment options, and the absence of ideal, objective information on long term outcomes from modern therapy. Methods: We formed an international consortium, HoLISTIC, consisting of 50+ pediatric & adult HL providers, decision scientists, statisticians, epidemiologists, and patient (pt) advocates and are creating a data repository of individual pt data (IPD) from 16 contemporary, pediatric & adult clinical trials for newly diagnosed pts with HL, and 6 large HL registries/survivorship cohorts, the latter enriched with LE data (Table). We will enhance our prior decision model (DM) from group-level data (Parsons S et al. B J Haem 2018) to establish a dynamic HL DM from IPD. Using statistical and simulation modeling of IPD, the enhanced DM will project outcomes of interest, including quality-adjusted life years (QALYs), reflecting both mortality and morbidity. Results will be validated and calibrated against prominent external cohorts (e.g., St. Jude LIFE Cohort, Dutch HL registry). The DM then will be converted to a web-based platform that we will test and evaluate among HL providers and pts at the point of care. Results: To date, we have harmonized IPD from 10 trials (~8,000 HL pts), ranging in size from 165-1925 pts. At diagnosis, median age was 26 y (IQR 18-38); 51.5% were male. 43% had B symptoms, 34% had mediastinal bulk, and 79% had nodular sclerosis histology. Median follow up was 5.0 y (IQR 3.5-7.4). IPD harmonization is ongoing, which will be followed by creation of the enhanced DM. Conclusions: HoLISTIC capitalizes on a multidisciplinary pediatric & adult oncology collaborative, harmonizing extensive IPD by linking data from clinical trials and real world registries/survivorship cohorts. This work will inform questions about the influence of Tx options on both acute and potential long term events and how those options align with pt values and preferences. [Table: see text]
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Affiliation(s)
| | | | | | - Marc André
- Université Catholique de Louvain, CHU UCL Namur, Department of Hematology, Yvoir, Belgium
| | - Massimo Federico
- Dept of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Debra L. Friedman
- Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | - Annette E. Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Peter Hoskin
- Mount Vernon Cancer Centre, London, United Kingdom
| | - Peter Johnson
- Cancer Research UK Centre, Southampton, United Kingdom
| | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Frank G. Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | - Kara M. Kelly
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ralph M. Meyer
- Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada
| | - John A. Radford
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Pier Luigi Zinzani
- Institute of Hematology Seràgnoli, University of Bologna, Bologna, Italy
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Esham KS, Rodday AM, Smith HP, Noubary F, Weidner RA, Buchsbaum RJ, Parsons SK. Assessment of health-related quality of life among adults hospitalized with sickle cell disease vaso-occlusive crisis. Blood Adv 2020; 4:19-27. [PMID: 31891655 PMCID: PMC6960476 DOI: 10.1182/bloodadvances.2019000128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/25/2019] [Indexed: 01/25/2023] Open
Abstract
Sickle cell disease (SCD) is characterized by painful vaso-occlusive crises (VOCs). Self-reported pain intensity is often assessed with the Numeric Rating Scale (NRS), whereas newer patient-reported outcome measures (PROMs) assess multidimensional pain in SCD. We describe pain experiences among hospitalized adults with VOCs, using 2 PROMs: the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health and the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me). Adults with SCD hospitalized with VOCs at 2 academic centers in Boston, Massachusetts, from April 2016 to October 2017 were eligible. Participants completed the NRS and PROMs at admission and 7 days postdischarge. PROM scores were described and compared with population norms. Length of stay (LOS) and 30-day readmission rates were assessed. Forty-two (96%) of 44 eligible patients consented and completed admission assessments. Mean age was 30.2 years (standard deviation, 9.1), 60% were women, 76% were non-Hispanic black, and 64% had hemoglobin SS. Twenty-seven participants (64%) completed postdischarge assessments. Sixty percent had ≥4 VOCs in the last year. Nearly all PROMIS Global Health and ASCQ-Me scores were worse than population norms. NRS and PROMIS Global Physical Health scores improved after discharge, the latter driven principally by improvements in pain. Overall median LOS was 7 days, and 30-day readmission rate was 40.5%. Administration of PROMs among adults with SCD hospitalized for VOCs is feasible and demonstrates participants experienced recurrent, prolonged, and severe VOCs. PROMIS Global and ASCQ-Me scores indicated substantial suffering, and the striking 30-day readmission rate highlights the vulnerability of these patients.
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Affiliation(s)
- Kimberly S Esham
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Hedy P Smith
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Farzad Noubary
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Ruth Ann Weidner
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Rachel J Buchsbaum
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Division of Hematology/Oncology and
- Department of Medicine, Tufts Medical Center, Boston, MA; and
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA
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Lin M, Hackenyos DW, Parsons SK, Rodday AM, Murphy-Banks R, Weidner RA, Savidge N. Pilot study to assess a pharmacist- and medication navigator-led intervention of oral anticancer medication (OAM) adherence. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
58 Background: While advances in OAM make treatment more convenient for patients, OAM must be taken and handled correctly. Studies show gaps in patients’ knowledge of taking/handling OAM, suboptimal adherence, and worse outcomes. A prior study at our institution showed low patient understanding of OAM taking (30%) and handling (15%). Other pharmacist (RPh)- or nurse-led interventions have included patient education, short-term follow-up, and reminder tools. No studies have examined multisession interventions co-led by an RPh and medication navigator (MN). This ongoing pilot study assesses the feasibility of such an intervention, its impact on patients’ understanding and adherence, and patient acceptability. Methods: Patients at our institution met with an RPh and MN for an education and teach-back session at OAM initiation (T1). Patients were given a Drug Information Sheet and Medication Calendar as educational tools. Patients were then invited to enroll in a multisession intervention, including an RPh-led re-education at the first refill (T3) and MN-led boosters (T2, T4). At each session, teach-back responses were recorded and participants completed study measures and evaluations. Preliminary results on T1 and T2 are presented. Results: To date, 37 (95%) patients enrolled at T1 and 33 completed the MN-led booster a week later (T2). At T1 and T2, 85% of participants demonstrated sufficient understanding of OAM taking and handling. However, despite high levels of self-reported adherence, 48% lacked knowledge about when or where to get a refill. At T1 (32%) and T2 (60%), of patients raised issues that were not previously shared with their clinical team. Patients were highly satisfied with the intervention and found the education session, booster, and educational tools useful. Conclusions: While data collection is ongoing, preliminary results suggest this intervention is feasible, enhances patient understanding and adherence to their medications, and is acceptable to patients undergoing OAM treatment. Integration of RPh and MN into oncology teams can enhance care delivery and provide timely assistance for OAM-related issues, providing insight into future models of care.
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Affiliation(s)
- Mingqian Lin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | | | | | | | | | - Ruth Ann Weidner
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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Rodday AM, Hahn T, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. The role of frailty and comorbidity in treatment (tx) of elderly patients with Hodgkin lymphoma (HL). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e19011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19011 Background: While HL is highly curable in younger patients, older patients have higher rates of tx failure and death, which may reflect age-related factors, tx decisions, or disease biology. We described first-line tx in elderly patients with HL by frailty, comorbidity, and age. Methods: We analyzed Surveillance, Epidemiology and End Results (SEER)-Medicare data from 1999-2014. Patients with incident classical HL and Medicare Part A and B fee for service were included. First-line tx within 4 months of diagnosis (dx) was determined from inpatient, outpatient, and physician/supplier claims using chemotherapy J-codes, HCPCS codes, and DRG codes and was categorized as standard regimen, any other tx, and no tx. Pre-existing frailty and comorbidity ≤6 months prior to dx were separately defined using validated claims-based algorithms. Multinomial logistic regression estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify whether frailty, comorbidity, or age at dx were associated with first-line tx; their 3- and 2-way interactions were tested and removed if p < 0.1. We adjusted for race/ethnicity, Medicaid dual enrollment, population density, histology, stage, B symptoms, year (yr) of dx, and SEER registry. Results: Analyses included 2789 patients: median age was 76 yrs. 65% were frail, 79% of patients had ≥1 comorbidity, and 61% were frail and had comorbidity. 41% received a standard regimen, 32% received other tx, and 27% received no tx. No interactions were significant. Frailty, comorbidity, and older age were associated more use of other tx or no tx then standard regimens (Table). Conclusions: Frailty, comorbidity, and age were associated with first-line tx in elderly patients with HL. This may reflect physician tx decision, end-of-life care, or unique disease biology in older patients. Future research will study the relationships between first-line tx and outcomes. [Table: see text]
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Castellino SM, Rodday AM, Pei Q, Bush R, Keller FG, Henderson TO, Kelly KM, Cella D, Parsons SK. Performance of FACT-GOG-Ntx to assess chemotherapy-induced peripheral neuropathy (CIPN) in pediatric Hodgkin lymphoma (HL) patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10064 Background: CIPN is a common, but under-recognized complication of tubulin toxins, which are key to curative therapy for HL. In the absence of validated, self- or proxy-report measures for children, CIPN reporting has depended on clinical grading scales. The goal of this study was to assess the psychometric properties of the FACT-GOG-Ntx measure in a pediatric population. Methods: Youth (11+ yrs) and parents of all children (5-18 yrs) with newly diagnosed high risk HL, enrolled on AHOD1331 (NCT02166463), serially completed the FACT-GOG-Ntx, a validated measure of CIPN in adults. Cronbach’s alpha coefficient (reliability) and intra-class coefficients (ICC) were calculated. FACT-GOG-Ntx total scale and 4-item sensory subscale scores (Ntx4) at Cycle 5 (dose peak) and 6-8 weeks after last cycle (End Rx) were compared to mandatory clinical grading, using the Balis Scale with any neuropathy defined as > grade 1 on Balis. Results: 279 youth and 291 parents completed study measures. Cronbach’s alpha exceeded 0.80 for both raters. Inter-rater agreement was strong (ICC=0.89). Sixty (20%) patients had any neuropathy on Balis. Those with CIPN had significantly lower total and Ntx4 scores than those without at cycle 5 and End Rx and for both raters (p<0.05) (Table). Conclusions: This is the first application of the FACT-GOG-Ntx in a pediatric HL trial. We demonstrate that the measure was reliable for both raters and had strong intra-rater agreement. Validity was demonstrated by significantly lower FACT-GOG-Ntx scores among patients with evidence of CIPN on clinical exam. Comparisons between study arms will be evaluated after study accrual is completed. [Table: see text]
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Affiliation(s)
| | | | | | | | - Frank G. Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA
| | | | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute and Oishei Children's Hospital, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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Rodday AM, Hackenyos DW, Masood R, Savidge N, Lin M, Mao D, Wang FQ, Murphy-Banks R, Weidner RA, Buchsbaum RJ, Erban JK, Parsons SK. Patients’ understanding and adherence to oral anti-cancer medication (OAM): Results of an institutional pilot study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18280 Background: Advancements in biopharmaceuticals have led to increasing availability and use of OAM. While oral medications allow patients (pts) to receive treatment at home, OAM use introduces new challenges related to prescription filling, monitoring for and reporting of side effects, safe medication handling, and adherence. We assessed understanding of and adherence to OAM in pts vulnerable to these home-based challenges. Methods: This 2018 pilot study defined vulnerable pts based on spoken language (Chinese), older age (≥65 yrs), and public insurance ( < 65 yrs). All pts had a cancer diagnosis, had been taking an OAM, and received prescriptions through the hospital’s specialty pharmacy. Prior to a clinic visit, pts completed patient-reported measures about OAM taking and handling. Clinical characteristics were extracted from medical records; medication information was extracted from pharmacy records. The study team’s specialty pharmacist (DH) classified patient-reported responses about OAM taking (days per week, times per day, special instructions) and handing (handling, storage, disposal) as adequate or inadequate. OAM regimens were classified by complexity based on number of drugs and schedule. Results: Of 61 eligible pts, 55 participated (90%). Mean age was 68 yrs (SD 12) and 53% were female. Pt subgroups were: 27% Chinese, 64% ≥65 yrs, and 9% < 65 yrs with public insurance. 33% had solid tumor and 67% had hematologic malignancy; tyrosine kinase inhibitor was the most OAM type (42%). 49% of pts were on front-line therapy and overall median time on OAM was 1 year (Q1 0.4, Q3 1.7). Adequacy of OAM taking (30%) and handling (15%) were low; only 15% had adequacy in both. Pt subgroup and regimen complexity did not vary by adequacy of OAM taking or handling. Patient-reported adherence was high 5.4 (SD 1) (possible range 1-6) and did not vary by adequacy of OAM taking or handling. Conclusions: Understanding of how OAM should be taken and handled in a group of vulnerable pts was strikingly low and did not align with pts’ self-reports of adherence. Future interventions are needed to ensure that pts understand how to safely take and handle OAM, thereby optimizing their therapeutic potential.
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Affiliation(s)
| | | | | | | | - Mingqian Lin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | | | | | | | - Ruth Ann Weidner
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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Bucholz EM, Rodday AM, Kolor K, Khoury MJ, de Ferranti SD. Prevalence and Predictors of Cholesterol Screening, Awareness, and Statin Treatment Among US Adults With Familial Hypercholesterolemia or Other Forms of Severe Dyslipidemia (1999-2014). Circulation 2018; 137:2218-2230. [PMID: 29581125 PMCID: PMC6381601 DOI: 10.1161/circulationaha.117.032321] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) and other extreme elevations in low-density lipoprotein cholesterol significantly increase the risk of atherosclerotic cardiovascular disease; however, recent data suggest that prescription rates for statins remain low in these patients. National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown. METHODS Data from the 1999 to 2014 National Health and Nutrition Examination Survey were used to estimate prevalence rates of self-reported screening, awareness, and statin therapy among US adults (n=42 471 weighted to represent 212 million US adults) with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol levels ≥190 mg/dL). Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. RESULTS The estimated US prevalence of definite/probable FH was 0.47% (standard error, 0.03%) and of severe dyslipidemia was 6.6% (standard error, 0.2%). The frequency of cholesterol screening and awareness was high (>80%) among adults with definite/probable FH or severe dyslipidemia; however, statin use was uniformly low (52.3% [standard error, 8.2%] of adults with definite/probable FH and 37.6% [standard error, 1.2%] of adults with severe dyslipidemia). Only 30.3% of patients with definite/probable FH on statins were taking a high-intensity statin. The prevalence of statin use in adults with severe dyslipidemia increased over time (from 29.4% to 47.7%) but not faster than trends in the general population (from 5.7% to 17.6%). Older age, health insurance status, having a usual source of care, diabetes mellitus, hypertension, and having a personal history of early atherosclerotic cardiovascular disease were associated with higher statin use. CONCLUSIONS Despite the high prevalence of cholesterol screening and awareness, only ≈50% of adults with FH are on statin therapy, with even fewer prescribed a high-intensity statin; young and uninsured patients are at the highest risk for lack of screening and for undertreatment. This study highlights an imperative to improve the frequency of cholesterol screening and statin prescription rates to better identify and treat this high-risk population. Additional studies are needed to better understand how to close these gaps in screening and treatment.
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Affiliation(s)
- Emily M Bucholz
- Department of Medicine (E.M.B.)
- Boston Children's Hospital, MA. Harvard Medical School, Boston, MA (E.M.B., S.D.d.F.)
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (A.M.R.)
| | - Katherine Kolor
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (K.K., M.J.K.)
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA (K.K., M.J.K.)
| | - Sarah D de Ferranti
- Department of Cardiology (S.D.d.F.)
- Boston Children's Hospital, MA. Harvard Medical School, Boston, MA (E.M.B., S.D.d.F.)
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Waheed A, Rodday AM, Kumar AJ, Parsons SK. Hematopoietic stem cell transplant (HSCT) utilization in Hodgkin lymphoma (HL) after treatment failure from a statewide claims database. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Parsons SK, Lerner D, Rodday AM, Curtis R, Kelly K, Conti R, Castellino SM, Henderson TO. Parental work limitations at diagnosis of advanced stage pediatric Hodgkin lymphoma—Results of caregiver work limitations questionnaire (CG WLQ). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Kara Kelly
- Roswell Park Cancer Institute, Buffalo, NY
| | - Rena Conti
- University of Chicago Medicine, Chicago, IL
| | - Sharon M. Castellino
- Emory University, Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
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Rodday AM, Terrin N, Leslie LK, Graham RJ, Parsons SK. Understanding the Relationship Between Child Health-Related Quality of Life and Parent Emotional Functioning in Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Psychol 2018; 42:804-814. [PMID: 28369555 DOI: 10.1093/jpepsy/jsx047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/09/2017] [Indexed: 11/12/2022] Open
Abstract
Objective Explore interrelationships between domains of child health-related quality of life (HRQL) and parent emotional functioning using parent-proxy and child report in the context of hematopoietic stem cell transplant (HSCT). Methods Data on 258 parent-child dyads were used from two longitudinal studies. Domains of HRQL included physical, emotional, and role functioning, and HSCT-related worry. We used structural equation modeling to model the outcome of parent emotional functioning using primary and alternative conceptual models. Results Parent-proxy raters reported lower child HRQL than child raters. Structural equation models demonstrated relationships between child emotional functioning, child HSCT-related worry, and parent emotional functioning, with some differences by raters. Conclusions Relationships between child HRQL and parent emotional functioning within the context of HSCT are complex. To optimize the child's health outcomes, providing psychosocial support for children and their families may be necessary, especially for those experiencing distress or facing treatment complications.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,Department of Medicine, Tufts University
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,Department of Medicine, Tufts University
| | - Laurel K Leslie
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,American Board of Pediatrics, Chapel Hill, NC
| | - Robert J Graham
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital.,Department of Anesthesia, Harvard Medical School
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center.,Department of Medicine, Tufts University
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Kumar AJ, Henzer T, Rodday AM, Parsons SK. Risk factors for length of stay and charge per day differ between older and younger hospitalized patients with AML. Cancer Med 2018; 7:2744-2752. [PMID: 29663689 PMCID: PMC6010796 DOI: 10.1002/cam4.1492] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 02/02/2023] Open
Abstract
Acute myeloid leukemia (AML) is associated with frequent hospitalizations. We evaluated factors associated with length of stay (LOS) and charge per day (CPD) for admissions in older (≥60 years) and younger patients (<60 years). We identified patients with ICD‐9‐CM codes for AML or myeloid sarcoma in the 2012 HCUP‐NIS. In separate models based on age, we examined patient (sex, race, income, insurance payer, chronic conditions, chemotherapy administration, death) and hospital (type, geography) characteristics. Multivariable negative binomial regression estimated factor effects on LOS and CPD using rate ratios, with HCUP‐NIS weights. In 43,820 discharges, LOS was longer in patients <60 than ≥60 (6.8 vs. 5.4 days). For patients <60, longer LOS was seen with more chronic conditions (RR = 1.10), Black race (RR = 1.16), chemotherapy (RR = 2.27), and geography; shorter LOS was associated with older age (RR = 0.93), Medicare (RR = 0.83), and hospital type. For patients ≥60, longer LOS associated with chronic conditions (RR = 1.07) and Asian race (RR = 1.33). Shorter LOS associated with older age (RR = 0.86), higher income (RR = 0.93), and hospital type. For patients <60, higher CPD associated with chronic conditions (RR = 1.05), death (RR = 1.93), and geography; lower CPD associated with increasing age (RR = 0.96), Medicaid (RR = 0.93), and rural hospitals (RR = 0.65). For patients ≥60, higher CPD associated with Medicare (RR = 1.05), more chronic conditions (RR = 1.02), younger age (RR = 1.1), west geography (RR = 1.37), death (RR = 1.45), and Hispanic race (RR = 1.15). We identify predictors for increased healthcare utilization in hospitalized patients with AML, which differ within age groups. Future efforts are needed to link utilization outcomes with clinical treatments and response.
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Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Tobi Henzer
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
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Henderson JR, Kiernan E, McNeer JL, Rodday AM, Spencer K, Henderson TO, Parsons SK. Patient-Reported Health-Related Quality-of-Life Assessment at the Point-of-Care with Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2018; 7:97-102. [DOI: 10.1089/jayao.2017.0046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Joseph R. Henderson
- The Section of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois
| | - Elizabeth Kiernan
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Jennifer L. McNeer
- The Section of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Katherine Spencer
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Tara O. Henderson
- The Section of Pediatric Hematology/Oncology and Stem Cell Transplantation, Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
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Fu J, Upshaw J, Cohen J, Rodday AM, Saunders T, Kelly M, Evens AM, Parsons SK. Assessing the risk of cardiac toxicity after contemporary treatment for Hodgkin lymphoma: a systematic review. Leuk Lymphoma 2017; 59:1976-1980. [PMID: 29214876 DOI: 10.1080/10428194.2017.1406086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Julie Fu
- a Division for Hematology/Oncology , Tufts Medical Center , Boston , MA , USA.,b Center for Health Solutions, Institute for Clinical Research and Health Policy Studies (ICRHPS) , Tufts Medical Center , Boston , MA , USA.,c Tufts University School of Medicine , Boston , MA , USA.,d Tufts Medical Center Cancer Center of Stoneham , Stoneham , MA , USA
| | - Jenica Upshaw
- c Tufts University School of Medicine , Boston , MA , USA.,e CardioVascular Center , Tufts Medical Center , Boston , MA , USA
| | - Joshua Cohen
- c Tufts University School of Medicine , Boston , MA , USA.,f Center for the Evaluation of Value and Risk in Health (ICRHPS) , Tufts Medical Center , Boston , MA , USA
| | - Angie Mae Rodday
- b Center for Health Solutions, Institute for Clinical Research and Health Policy Studies (ICRHPS) , Tufts Medical Center , Boston , MA , USA.,c Tufts University School of Medicine , Boston , MA , USA
| | - Tully Saunders
- b Center for Health Solutions, Institute for Clinical Research and Health Policy Studies (ICRHPS) , Tufts Medical Center , Boston , MA , USA
| | - Michael Kelly
- c Tufts University School of Medicine , Boston , MA , USA.,g Division of Pediatric Hematology/Oncology , Floating Hospital for Children at Tufts Medical Center , Boston , MA , USA
| | - Andrew M Evens
- a Division for Hematology/Oncology , Tufts Medical Center , Boston , MA , USA.,c Tufts University School of Medicine , Boston , MA , USA
| | - Susan K Parsons
- a Division for Hematology/Oncology , Tufts Medical Center , Boston , MA , USA.,b Center for Health Solutions, Institute for Clinical Research and Health Policy Studies (ICRHPS) , Tufts Medical Center , Boston , MA , USA.,c Tufts University School of Medicine , Boston , MA , USA
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Rodday AM, Graham RJ, Weidner RA, Rothrock NE, Dewalt DA, Parsons SK. Leveraging pediatric PROMIS item banks to assess physical functioning in children at risk for severe functional loss. J Patient Rep Outcomes 2017; 1:10. [PMID: 29757321 PMCID: PMC5934938 DOI: 10.1186/s41687-017-0011-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/04/2017] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric neuromuscular illnesses often result in decreased health-related quality of life (HRQL), notably in physical functioning. Generic HRQL measures have been developed for use in general populations, but may not adequately assess patients with severe functional loss. To address this measurement gap, we created two custom parent-proxy physical functioning short forms for use among children at risk for low levels of functioning, using pediatric Patient Reported Outcomes Measurement Information System (PROMIS) item banks for Upper Extremity and Mobility. Methods Two custom short forms from PROMIS Upper Extremity (13 items) and Mobility (13 items) parent-proxy item banks were created and administered to parents of children (ages 5 - 22 years) enrolled in an integrated care program for management of chronic respiratory insufficiency, largely due to neuromuscular illnesses. Standardized PROMIS T-scores have a mean of 50 (SD = 10); higher scores indicate better functioning. Physicians rated clinical severity. Single proxy-rated items on mental and physical health from the Child Health Rating Inventories (CHRIs) global health scale were completed by parents. Psychometric properties, including known groups comparisons, were explored. Results Fifty-seven parents completed the parent-proxy custom PROMIS short forms. The mean Upper Extremity T-score was 21 (SD = 13); the mean Mobility T-score was 22 (SD = 11). Some participants scored at the measurement floor; two items on assistive devices did not perform well in this sample and were excluded from the Mobility T-score. Known groups comparisons showed that those with lower clinical severity had better median Upper Extremity (22 vs. 14, p < 0.001) and Mobility (28 vs. 16, p = 0.004) function than those with worse clinical severity. Both Upper Extremity and Mobility T-scores were higher in the subgroups defined by better physical and mental health, as measured by the CHRIs. Conclusions Upper Extremity and Mobility T-scores were nearly three standard deviations below the PROMIS pediatric calibration population mean. Preliminary psychometrics demonstrated the potential to more accurately measure lower physical functioning using items from PROMIS item banks. However, some participants scored at the measurement floor despite targeting items at the lower end of the scale. Further short form refinement, enrichment of the item banks, and larger-scale field testing are needed.
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Affiliation(s)
- Angie Mae Rodday
- 1Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, 800 Washington St, Box 345, Boston, MA 02111 USA
| | - Robert J Graham
- 2Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Department of Anesthesia, Harvard Medical School, 300 Longwood Avenue, Bader 629, Boston, MA 02115 USA
| | - Ruth Ann Weidner
- 3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 345, Boston, MA 02111 USA
| | - Nan E Rothrock
- 4Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine625, North Michigan Avenue, Suite 2700, Chicago, IL 60611 USA
| | - Darren A Dewalt
- 5Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 5041 Old Clinic Building, CB 7110, Chapel Hill, NC 27599 USA
| | - Susan K Parsons
- 6Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, 800 Washington St, Box 345, Boston, MA 02111 USA
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Rodday AM, Graham RJ, Weidner RA, Terrin N, Leslie LK, Parsons SK. Predicting Health Care Utilization for Children With Respiratory Insufficiency Using Parent-Proxy Ratings of Children's Health-Related Quality of Life. J Pediatr Health Care 2017. [PMID: 28629924 PMCID: PMC5653401 DOI: 10.1016/j.pedhc.2017.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Children with chronic respiratory insufficiency and mechanical ventilation often experience acute illnesses requiring unscheduled hospitalizations. Health-related quality of life (HRQL) may predict future health care utilization. METHODS Participants were 30 days to 22 years old with chronic respiratory insufficiency (N = 120). Parent-proxies completed global HRQL and general health measures. Outcomes were total health care (emergency department, outpatient, inpatient) and inpatient days over 6 months. Adjusted negative binomial regression estimated the effects of global HRQL and general health on utilization. RESULTS Three quarters of children had any utilization; 32% had hospitalizations. Children with poor/fair global HRQL had 3.7 times more health care days than those with very good/excellent global HRQL. Children with poor/fair global HRQL had 6.3 times more inpatient days than those with very good/excellent global HRQL. Similar relationships existed between general health and utilization. DISCUSSION HRQL was associated with health care and inpatient days. Clinical teams can use HRQL as a marker for utilization risk, enabling potentially earlier intervention, better outcomes, and lower costs.
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de Ferranti SD, Rodday AM, Parsons SK, Cull WL, O'Connor KG, Daniels SR, Leslie LK. Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians. J Pediatr 2017; 185:99-105.e2. [PMID: 28209292 DOI: 10.1016/j.jpeds.2016.12.078] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/28/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds. STUDY DESIGN American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled. RESULTS Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?<?.001). Only 58% agreed with universal screening, and 23% felt screening was low priority. Pediatricians uniformly provided lifestyle counseling but access to healthy food (81%), exercise (83%), and adherence to lifestyle recommendations (96%) were reported barriers. One-half of pediatricians (55%) reported a lack of local subspecialists. Although 62% and 89% believed statins were appropriate for children and adolescents with high low-density lipoprotein cholesterol (200?mg/dL) unresponsive to lifestyle, a minority initiated statins (8%, 21%). CONCLUSIONS US pediatricians report lipid screening and treatment practices that are largely at odds with existing recommendations, likely because of lack of knowledge and conflicts among national guidelines, and concern about treatment efficacy and harms. Education regarding pediatric lipid disorders could promote guideline implementation.
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Affiliation(s)
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
| | - William L Cull
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL
| | - Karen G O'Connor
- Department of Research, American Academy of Pediatrics, Elk Grove Village, IL
| | | | - Laurel K Leslie
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA; American Board of Pediatrics, Chapel Hill, NC
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Lee AC, Driban JB, Price LL, Harvey WF, Rodday AM, Wang C. Responsiveness and Minimally Important Differences for 4 Patient-Reported Outcomes Measurement Information System Short Forms: Physical Function, Pain Interference, Depression, and Anxiety in Knee Osteoarthritis. J Pain 2017; 18:1096-1110. [PMID: 28501708 DOI: 10.1016/j.jpain.2017.05.001] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/27/2017] [Indexed: 01/11/2023]
Abstract
Patient-Reported Outcomes Measurement Information System (PROMIS) instruments can provide valid, interpretable measures of health status among adults with osteoarthritis (OA). However, their ability to detect meaningful change over time is unknown. We evaluated the responsiveness and minimally important differences (MIDs) for 4 PROMIS Short Forms: Physical Function, Pain Interference, Depression, and Anxiety. We analyzed adults with symptomatic knee OA from our randomized trial comparing Tai Chi and physical therapy. Using baseline and 12-week scores, responsiveness was evaluated according to consensus standards by testing 6 a priori hypotheses of the correlations between PROMIS and legacy change scores. Responsiveness was considered high if ≥5 hypotheses were confirmed, and moderate if 3 or 4 were confirmed. MIDs were evaluated according to prospective change for people achieving previously-established MID on legacy comparators. The lowest and highest MIDs meeting a priori quality criteria formed a MID range for each PROMIS Short Form. Among 165 predominantly female (70%) and white (57%) participants, mean age was 61 years and body mass index was 33. PROMIS Physical Function had 5 confirmed hypotheses and Pain Interference, Depression, and Anxiety had 3 or 4. MID ranges were: Depression = 3.0 to 3.1; Anxiety = 2.3 to 3.4; Physical Function = 1.9 to 2.2; and Pain Interference = 2.35 to 2.4. PROMIS Physical Function has high responsiveness, and Depression, Anxiety, and Pain Interference have moderate responsiveness among adults with knee OA. We established the first MIDs for PROMIS in this population, and provided an important standard of reference to better apply or interpret PROMIS in future trials or clinical practice. PERSPECTIVE This study examined whether PROMIS Short Form instruments (Physical Function, Pain Interference, Depression, and Anxiety) were able to detect change over time among adults with knee OA, and provided minimally important change estimates for each measure. This standard of reference can help apply or interpret these instruments in the future.
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Affiliation(s)
- Augustine C Lee
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts
| | - Jeffrey B Driban
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts
| | - Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - William F Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts.
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Ullrich CK, Rodday AM, Bingen KM, Kupst MJ, Patel SK, Syrjala KL, Harris LL, Recklitis CJ, Chang G, Guinan EC, Terrin N, Tighiouart H, Phipps S, Parsons SK. Three sides to a story: Child, parent, and nurse perspectives on the child's experience during hematopoietic stem cell transplantation. Cancer 2017; 123:3159-3166. [PMID: 28387946 DOI: 10.1002/cncr.30723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The experience of children undergoing hematopoietic stem cell transplantation (HSCT), including the ways in which different participants (ie, children, parents, and nurses) contribute to the overall picture of a child's experience, is poorly characterized. This study evaluated parent, child, and nurse perspectives on the experience of children during HSCT and factors contributing to interrater differences. METHODS Participants were enrolled in a multicenter, prospective study evaluating child and parent health-related quality of life over the year after HSCT. Children (n = 165) and their parents and nurses completed the Behavioral, Affective, and Somatic Experiences Scale (BASES) at baseline (before/during conditioning), 7 days after the stem cell infusion (day+7), and 21 days after the stem cell infusion (day+21). The BASES domains included Somatic Distress, Mood Disturbance, Cooperation, and Getting Along. Higher scores indicated more distress/impairment. Repeated measures models by domain assessed differences by raters and changes over time and identified other factors associated with raters' scores. RESULTS Completion rates were high (≥73% across times and raters). Multivariate models revealed significant time-rater interactions, which varied by domain. For example, parent-rated Somatic Distress scores increased from baseline to day+7 and remained elevated at day+21 (P < .001); children's scores were lower than parents' scores across time points. Nurses' baseline scores were lower than parents' baseline scores, although by day+21 they were similar. Older child age was associated with higher Somatic Distress and Mood Disturbance scores. Worse parent emotional functioning was associated with lower scores across raters and domains except for Cooperation. CONCLUSIONS Multirater assessments are highly feasible during HSCT. Ratings differ by several factors; considering ratings in light of such factors may deepen our understanding of the child's experience. Cancer 2017;123:3159-66. © 2017 American Cancer Society.
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Affiliation(s)
- Christina K Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Kristin M Bingen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Jo Kupst
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sunita K Patel
- Department of Population Sciences, City of Hope Medical Center, Duarte, California.,Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, California
| | - Karen L Syrjala
- Department of Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lynnette L Harris
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Christopher J Recklitis
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Eva C Guinan
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Norma Terrin
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Sean Phipps
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.,Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
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Parsons SK, Rodday AM, Weidner RA, Morris E, Moore TB, Shenoy S, Talano JAM, Minzer S, Fabricatore S, Braniecki S, Cairo MS. Trajectories of Children's Health-Related Quality of Life (HRQL) after Myeloimmuno Ablative Conditioning (MAC) Familial Haploidentical (FHI) T-Cell Depleted (TCD) with T-Cell Addback Stem Cell Transplantation (SCT) for Poor Risk SCD. Biol Blood Marrow Transplant 2017. [DOI: 10.1016/j.bbmt.2016.12.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Parsons SK, Weisberg T, Boehm L, O'Rourke A, Rodday AM, Linendoll N, Erban JK. Development of phase-specific breast cancer survivorship care plans (SCPs). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.5_suppl.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
61 Background: There are nearly 3 million breast cancer (BC) survivors in the US. Among the recently diagnosed, accrediting organizations (e.g., Commission on Cancer) now require SCPs at the completion of curative therapy. Within the Oncology Care Model, the preparation and delivery of SCPs is recognized as one of the 13 quality metrics. SCPs, combining treatment summaries (TS) and follow-up care plans (FUCPs), assist patients and providers in the delivery of high quality long-term care. BC presents a unique challenge, as the risk of recurrence extends decades past initial treatment; adjuvant risk reduction may extend up to 15 years. Periodic FUCPs provide a mechanism to review updated information and may allow providers to catch up with longer term BC survivors whose care was delivered prior to SCPs. We explored the role of phase-specific SCPs within the heterogeneous BC survivor population. Methods: Oncologists and nurse practitioners (NPs) from the Breast Health and Survivorship Programs at Tufts MC, an academic medical center in Boston, and New England Cancer Specialists, a community-based private oncology practice in Maine--together caring for more than 2,000 BC survivors--convened to develop and test phase-specific survivorship tools. Using an adapted ASCO template for BC, TS were completed at the end of initial therapy by trained NPs. FUCPs for initial, 5-year, and 10-year visits were designed with clinical input, literature reviews, and existing guidelines. Results: FUCPs were pilot tested and refined before incorporation into the electronic health record. Further testing is planned to identify barriers to effective survivorship care, particularly involving documentation of changes in recommendations and the transition from oncologist to primary care physician. Conclusions: SCPs are critical for providing quality health care to BC survivors, but a single SCP, written at the conclusion of curative treatment, might not be sufficient to address changing needs of individuals as they progress through survivorship. Thus, phase-specific SCPs enable providers to focus on salient aspects of care that may change over time. Despite growing recognition of the value of SCPs, implementation remains a challenge across cancer programs.
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Parsons SK, Guy GP, Peacock S, Cohen JT, Rodday AM, Kiernan EA, Feeny D. Economic Evaluation in Adolescent and Young Adult Cancer: Methodological Considerations and the State of the Science. Cancer in Adolescents and Young Adults 2017. [DOI: 10.1007/978-3-319-33679-4_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Graham RJ, Rodday AM, Weidner RA, Parsons SK. The Impact on Family of Pediatric Chronic Respiratory Failure in the Home. J Pediatr 2016; 175:40-6. [PMID: 27289498 DOI: 10.1016/j.jpeds.2016.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/15/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the family impact of managing severe, chronic respiratory failure (CRF) at home. Better understanding will inform parental counseling and serve as a point of reference for interventions. STUDY DESIGN Families of children with CRF completed the Impact on Family Scale (IFS) and Consumer Assessment of Healthcare Providers and Systems. Using multivariable linear regression, we assessed the relationship between IFS and family, clinical, and utilization characteristics. RESULTS A total of 118 parents (60%) completed the IFS; 114 parents (58%) completed all measures. The 15-item IFS mean total score was 40 (SD = 10) with a possible range of 15-60 (greater scores indicate more impact). Modeling identified a negative association with parent emotional functioning, parent-rated child health, and private insurance only (compared with both private/public), and other family characteristics (eg, parental education, marital status, and income) were not associated with IFS scores. CONCLUSION Families of children with CRF are greatly impacted by their child's health. In contrast to other children with special health care needs, family characteristics were not associated with IFS scores, excluding insurance type. These results may reflect more uniform demands and stressors related to CRF. Future research should identify interventions to attenuate the impact of CRF.
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Affiliation(s)
- Robert J Graham
- Division of Critical Care, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Angie Mae Rodday
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA; Tufts University School of Medicine, Boston, MA
| | - Ruth Ann Weidner
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA
| | - Susan K Parsons
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA; Tufts University School of Medicine, Boston, MA
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