P2682Long-term effects of enhanced external counterpulsation treatment on symptom burden, usage of nitrates, physical capacity and health-related quality of life in patients with refractory angina pectoris

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Wu ◽  
L Desta ◽  
A Brostrom ◽  
J Martensson
Keyword(s):  
Symptom Burden ◽  
Physical Capacity ◽  
Refractory Angina ◽  
Cardiac Anxiety ◽  
Related Quality ◽  
Health Related ◽  
Refractory Angina Pectoris ◽  
Enhanced External Counterpulsation

Abstract Background Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimized medical therapy. Recurrent angina symptoms are strongly associated with psychological distress and cardiac anxiety (i.e., a subtype of anxiety related to cardiac sensations). Enhanced external counterpulsation (EECP) is an alternative non-invasive treatment for these patients. An EECP course includes 35 1-hour sessions over 7 weeks. No previous study has explored long-term EECP effects on cardiac anxiety in patients with RAP. Objective To evaluate the effects of EECP treatment in patients with RAP regarding usage of nitrates, physical capacity, cardiac anxiety and HRQoL. Methods A quasi experimental design with long-term follow-up (6 months) involving 50 patients (men=37, 47–91 years) who had finished one course of EECP. Assessment of average use of nitrates, six-minute walk test, functional class with Canadian Cardiovascular Society (CCS) classification and questionnaires for cardiac anxiety and HRQoL were collected pre and post treatment. In addition, the questionnaires were collected 6 months after completion of EECP. Results Patients used significantly less nitrates (p<0.001) compared to at the start of treatment. They enhanced the walking distance on average by 46 m after EECP (p<0.001) and CCS class also improved (p<0.001). All subscales except for one in cardiac anxiety were significantly reduced (p<0.05). All dimensions in HRQoL improved significantly (p<0.01). The positive effects in both cardiac anxiety and HRQoL were maintained 6 months after the treatment. Conclusions Patients with RAP received beneficial effects from EECP. Reduced symptom burden and improved physical capacity enable engagement in physical activities. Furthermore, less cardiac anxiety and improved HRQoL may enhance life satisfaction for these patients. EECP treatment should be considered to a greater extent to improve the life situation for these patients.

Long-Term Health Related Quality Of Life and Symptom Burden In Patients With Acute Promyelocytic Leukemia Treated With All-Trans Retinoic Acid (ATRA) and Chemotherapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 770-770 ◽  
Author(s):  
Fabio Efficace ◽  
Alessandro Rambaldi ◽  
Eros Di Bona ◽  
Francesco Fabbiano ◽  
Francesco Cottone ◽  
...  
Keyword(s):  
General Population ◽  
Symptom Burden ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
And Gender

Abstract Background The combination of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy regimens is currently considered the standard of care for newly diagnosed acute promyelocytic leukemia (APL) patients. This combination has greatly contributed to convert APL from a frequently fatal disease to a highly curable one. However, there is lack of data on the impact of such therapies on patients’ health-related quality of life (HRQOL). Objective The main objective of this study was thus to investigate long-term HRQOL of APL patients previously treated with ATRA plus anthracycline-based chemotherapy. The physical and mental HRQOL profile of these patients was compared with that of matched control subjects from the general population to identify specific areas most in need of attention in long-term follow-up care. A secondary objective was to outline symptoms’ burden from the patients’ perspective. Patients and Methods Data were gathered through an ongoing multicenter survivorship study that recruits APL patients previously enrolled in two large GIMEMA trials (i.e., AIDA0493 and AIDA 2000). In both trials, APL patients were treated with ATRA plus Idrarubicin (AIDA). The main inclusion criterion was having survived the initial diagnosis for more than 5 years and being in complete remission (CR). Generic HRQOL was assessed with the SF-36 that consists of 36 items covering eight generic health status/QoL domains: physical functioning (PF), role limitations due to physical health (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE) and mental health (MH). All scales ranged between 0 and 100, with the higher scores representing better outcomes. Clinical significance was evaluated and eight points were considered to be a minimally important difference for the eight SF-36 scales. Mean SF-36 scores were compared to available national general population reference values (i.e., 1997 subjects without cancer) and all analyses were adjusted for age and gender. Symptom burden was assessed according to the M.D. Anderson Symptom Inventory (MDASI). Symptom severity was assessed for the following symptoms: fatigue, pain, sleep disturbance, drowsiness, poor appetite, shortness of breath, nausea, vomiting, dry mouth, numbness, difficulty remembering, distress and sadness. All items were rated on a numeric rating scale from 0 to 10, with the higher scores indicating a higher level of symptoms. These were categorized as “mild” (ratings between 0 and 3) and “moderate to severe” (ratings between 4 to 10). Results Analysis is based on 136 adult APL patients who agreed to participate. At study participation, the mean age of patients was 52 years (55% males and 45% females) and the median time from diagnosis was 13 years (range: 4.5-20). Age and gender adjusted comparisons between APL patients and the general population norms revealed worse outcomes for the following scales: RP (P&lt;.001) and RE (P&lt;.001). Such differences were more than six times the magnitude of a clinically meaningful difference (i.e., at least 8 points), respectively for the physical (Δ=51 points) and the emotional scales (Δ=49 points) of the SF-36. Analysis within our patient cohort revealed that older APL patients (i.e., those aged more than 52 years) had a statically significant lower physical functioning (P&lt;.001) and higher pain severity (P=.0448) than younger ones. Investigation of the HRQOL profile of patients by trial participation (i.e., AIDA 0493 vs. AIDA 2000) or time since diagnosis (cut-off median time of 13 years) revealed no difference in all scales of the SF-36. Fatigue was the most burdensome symptom being reported as moderate to severe in 35% of patients. Other frequently reported moderate to severe symptoms were: difficulty in remembering (30%), sadness and distress (29%). Conclusions Although ATRA plus anthracycline-based chemotherapy regimens have greatly increased cure rates in APL, the HRQOL of these patients is heavily affected by the consequences of the disease and treatment, that persists many years after diagnosis and treatment. Disclosures: No relevant conflicts of interest to declare.

Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia

Leukemia ◽  
2018 ◽  
Vol 33 (7) ◽  
pp. 1598-1607 ◽  
Author(s):  
Fabio Efficace ◽  
Massimo Breccia ◽  
Giuseppe Avvisati ◽  
Francesco Cottone ◽  
Tamara Intermesoli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Acute Promyelocytic Leukemia ◽  
Symptom Burden ◽  
Promyelocytic Leukemia ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Long Term Survivors

Health Related Quality of Life of Long-Term Survivors of Acute Promyelocytic Leukemia Treated with All-Trans Retinoic Acid and Chemotherapy

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2415-2415 ◽  
Author(s):  
Fabio Efficace ◽  
Franco Mandelli ◽  
Erika Borlenghi ◽  
Massimo Breccia ◽  
Alessandro Rambaldi ◽  
...  
Keyword(s):  
General Population ◽  
Symptom Burden ◽  
Trans Retinoic Acid ◽  
All Trans Retinoic Acid ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related ◽  
Long Term Survivors

Abstract Background: Combined treatment with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy regimens has remarkably contributed to improve treatment outcomes in patients with Acute Promyelocytic Leukemia (APL) patients leading to cure rates above 80%. However, information is lacking on how these patients might recover in the long-term period. Objective: The primary objective of this study was to investigate long-term health-related quality of life (HRQOL) and symptom burden in APL and to examine factors predicting better long-term HRQOL outcomes. Patients and Methods: Patients with APL treated within two large GIMEMA trials (i.e., AIDA0493 and AIDA 2000) were considered. All patients received ATRA plus Idarubicin (AIDA) for induction followed by consolidation that was risk-adapted in AIDA2000 and in most cases, maintenance for 2 years . The main inclusion criterion was having survived the initial diagnosis for more than 5 years and being in complete remission (CR) at the time of study inclusion. The SF-36 was used to assess generic HRQOL. This questionnaire consists of 36 items covering eight generic health status/QoL domains: physical functioning (PF), role limitations due to physical health (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE) and mental health (MH). Mean SF-36 scores were compared between APL patients and those from general population. To minimize bias, all comparisons were performed between APL patients and corresponding propensity score-matched peers from general population, further adjusting for education, family status and geographical area using a multivariate linear mixed model. For descriptive purposes, a cut-off of 30 years was considered to distinguish between younger and older patients at the time of diagnosis and the corresponding HRQoL profiles were compared using multivariate linear regression analysis to adjust for key potential confounders. Also, M.D. Anderson Symptom Inventory (MDASI) was assessed to investigate the profile and prevalence symptom burden Results: Of the 307 patients, potentially eligible for this analysis and invited to participate in the study, 244 completed a HRQOL questionnaire (compliance 79.5%). No differences were found in the main socio-demographic and clinical characteristics between patients with or without a HRQOL evaluation. Mean age of patients was 52 years (range 20-90) and there were 47% males and 53% females. Median time from diagnosis was 14 years (range: 4-20). There were 81% of patients reporting at least 1 comorbidity at the time of HRQOL evaluation. APL long-term survivors reported a HRQOL profile broadly similar to that of their peers in the general population. However, the RP scale was statistically (P=0.016) and clinically meaningful worse in APL patients. Fatigue was the most prevalent symptom with 70% of patients reporting it with any level of concern, as well the most frequently reported moderate to severe symptom by 29 % of patients. Being distressed and problem with remembering things were the other two most prevalent symptoms reported by 65% and 62% of patients respectively. Being diagnosed at a younger age (<30 years) was a key factor associated with better long-term HRQOL outcomes. This was particularly relevant in physical health aspects. Detailed results of adjusted mean differences in SF-36 scores between age groups are reported in Table 1. Conclusions APL patients successfully treated with AIDA-like regimens may expect to have broadly similar HRQOL outcomes when compared to their peers witout cancer in the general population. However, significant limitations in work or other daily activities due to physical and emotional problems still persist after many years from diagnosis in the majority of patients. Our results also show that on the long-term period, younger APL patients recover better than older ones in terms of HRQOL outcomes. Disclosures Efficace: TEVA: Consultancy, Research Funding; Seattle Genetics: Consultancy; Bristol Myers Squibb: Consultancy; Lundbeck: Research Funding. Breccia:Novartis: Consultancy, Honoraria; Bristol Myers Squibb: Honoraria; Celgene: Honoraria; Ariad: Honoraria; Pfizer: Honoraria. Angelucci:Novartis oncology, celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Lo Coco:Teva: Consultancy, Honoraria, Speakers Bureau; Lundbeck: Honoraria, Speakers Bureau; Novartis: Consultancy; Baxalta: Consultancy; Pfizer: Consultancy.

scholarly journals Symptom Burden and Quality of Life After Successful Ablation in Patients With Low Burden of Symptomatic Premature Ventricular Complexes

2022 ◽  
Author(s):  
muzakkir amir ◽  
Peter Kabo ◽  
Pendrik Tandean ◽  
Ilham Patellongi ◽  
Muchtar Siregar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Life Quality ◽  
Symptom Burden ◽  
Physical And Mental Health ◽  
Premature Ventricular Complexes ◽  
Symptom Load ◽  
Related Quality ◽  
Health Related

Abstract It is essential to enhance life quality in patients with premature ventricular complexes (PVCs) with the use of radiofrequency ablation (RFA). The aim of the study was to assess symptom burden and life quality in patients with a low PVC burden following RFA. 31 individuals with a low PVC burden in whom RFA was indicated were included in the study. At baseline and after a year following RFA, the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) scale was used for appraisal. A 24-hour Holter electrocardiogram was used to detect recurrent PVCs 12 months after the RFA intervention. ASTA scores related to symptom burden, including the near-syncope score, health-related quality of life (HRQOL) scales pertaining to physical and mental health, and consequently the total HRQOL score, were all diminished a year after RFA (p<0.001). The ASTA score for syncope symptoms was also reduced (p<0.05). A fall in mean PVC burden was seen from 8.0% to 0.8% (p<0.001). The long-term clinical endpoint in individuals with a low PVC burden following RFA is reported. Symptom load, life quality and ultimate PVC burden were all enhanced. Additional studies incorporating longer follow-up and monitoring periods, respectively, would be beneficial.

scholarly journals Health-related Quality of Life in long-term Prostate Cancer Survivors after Nerve-Sparing and Non-Nerve-Sparing Radical Prostatectomy – Results from the multiregional PROCAS study

2019 ◽  
Author(s):  
Salome Adam ◽  
Eva Martin-Diener ◽  
Bertrand Camey ◽  
Céline Egger Hayoz ◽  
Isabelle Konzelmann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sexual Activity ◽  
Symptom Burden ◽  
Nerve Sparing ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Eortc Qlq

Abstract Background: Nerve-sparing (NS) surgery was developed to improve postoperative sexual and potentially urological outcomes after radical prostatectomy (RP). However, it is largely unknown how NSRP affects health-related quality of life (HRQoL) including urinary and sexual outcomes in prostate cancer (PC) survivors 5-10 years after diagnosis in comparison to Non-NSRP. Methods: The study population included 382 stage pT2-T3N0M0 PC survivors 5-10 years post-diagnosis, who were identified from the multiregional Prostate Cancer Survivorship in Switzerland (PROCAS) study. Briefly, in 2017/2018, PC survivors were identified via six population-based cancer registries based in both German- and French-speaking Switzerland. HRQoL and PC-specific symptom burden was assessed using the EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires. Differences in HRQoL outcomes between survivors treated with NSRP (uni- & bilateral) and Non-NSRP were analysed with multivariable linear regression adjusted for age, years since diagnosis, cancer stage, comorbidities at diagnosis and further therapies, if appropriate. Multiple imputation was performed to minimize the bias due to missing data.Results: 5-10 years after diagnosis, PC survivors treated with NSRP and Non-NSRP reported similar symptom burden and comparable HRQoL function scores. The only significant differences were reported for sexual activity, whereas PC survivors who underwent NSRP reported statistically significant (p=0.031) higher sexual activity than those on Non-NSRP. NSRP and Non-NSRP reported similar scores for urinary symptoms and all other HRQoL outcomes. Conclusions: NSRP and Non-NSRP were generally associated with comparable long-term HRQoL outcomes, but NSRP was linked with significantly higher sexual activity scores than Non-NSRP. Our results support nerve-sparing techniques as an option to improve post-operative sexual but not urinary outcomes after RP in long-term PC survivors.

Thrombopoietin Receptor Agonists in Children with Immune Thrombocytopenia: A New Therapeutic Era

2020 ◽  
Vol 20 ◽  
Author(s):  
Giuseppe Lassandro ◽  
Valentina Palladino ◽  
Giovanni Carlo Del Vecchioa ◽  
Viviana Valeria Palmieri ◽  
Paola Carmela Corallo ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Treatment Options ◽  
Thrombopoietin Receptor Agonists ◽  
Receptor Agonists ◽  
Thrombopoietin Receptor ◽  
Related Quality ◽  
Health Related

Background and Objective: Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood. The management of ITP in children is controversial, requiring personalized assessment of patients and therapeutic choices. Thrombopoietin receptor agonists (TPO-RAs), eltrombopag and romiplostim, have been shown to be safety and effective for the treatment of pediatric ITP. The aim of our research is defining the role of thrombopoietin receptor agonists in the management of pediatric ITP. Method: This review focuses on the use of TPO-RAs in pediatric ITP, in randomized trials and in clinical routine, highlighting their key role in management of the disease. Results: Eltrombopag and romiplostim appear effective treatment options for children with ITP. Several clinical studies have assessed that the use of TPO-RAs increases platelet count, decreases bleeding symptoms and improves health-related quality of life. Moreover, TPO-RAs are well tolerated with minor side effects. Conclusion: Although TPO-RAs long term efficacy and safety still require further investigations, their use is gradually expanding in clinical practice of children with ITP.

Sign in / Sign up

Export Citation Format

Share Document