Prevalence and Risk Factors for Opioid-Related Complications in Patients with Myeloproliferative Neoplasms: An International Survey of 502 Patients By the MPN Quality of Life Study Group

Abstract Introduction: Myeloproliferative Neoplasm (MPN) patients encounter debilitating pain syndromes as a result of their disorder. Opioids are frequently employed in cancer-related pain but have been increasingly recognized for their risk profiles including accidental overdose, addiction and death. With many MPN patients facing near-normal life expectancies, chronicity of opioid use may increase the risk of adverse events. In this survey, we evaluated the prevalence of MPN opioid use, risk factors for negative outcomes and compared the features of this population to MPN patients not receiving opioid therapy. Methods: This study was performed by the MPN Quality of Life Study Group. A survey was designed by a team of MPN investigators experienced with MPN symptomatology. Patients completed the MPN-10, a 10 item survey of MPN symptoms completed on a 0 (absent) to 10 (worst imaginable) scale (Blood. 2011 Jul 14;118(2):401-8). Other surveyed tools included the Opioid Risk Tool (ORT) as well as DSMV criteria for Opioid Use Disorder (OUD). The survey was posted on high-traffic MPN-related webpages focused on patient education and advocacy (MPN Forum, MPN Net, MPN Research Foundation, MPN Voice)for a total of 28 days. Patients currently receiving opioids were compared to patients not receiving opioids and statistical significance was defined as p<0.05. Results Demographics A total of 416 patients completed the survey and were compared by active opioids use (n=69) vs. no active opioid use (n=347). Patients described a history of myelofibrosis (MF, 28.8%), polycythemia vera (PV, 44.2%) and essential thrombocythemia (ET, 26.9%). Most MPNs were diagnosed between 1-3 years ago (22.2%), 3-10 years ago (35.0%) or >10 years ago (30.4%). Patients were furthermore of expected mean age (60.7), primarily female (75.0%) and from the United States (66.6%). Few patients had a history of transformation to acute leukemia (0.5%), severe bleeding (12.3%) or blood clot (26.5%). Mean individual symptom scores and prevalences were 3.0 and 65.6% for abdominal discomfort and 3.3 and 59.4% for bone pain, respectively, indicating a low to moderate symptom burden. Patients Receiving Opioid Therapy Patients on opioid therapy (n=69) displayed a number of high risk features for adverse outcomes including a personal history of substance abuse (20.2%), respiratory disease (33%) and mental health disorders (60.1%). By DSMV criteria, 5.9% of opioid patients scored 'mild' and 2.9% scored 'moderate' for OUD (total 8.8%), consistent with prevalence in the general population. Approximately 24.6% of opioid-using patients scored moderate to high risk on the ORT but despite this, did not appear more likely to meet criteria for OUD (p=0.81). Palliative care and pain management were involved in only 34.3% of patients and side effects of opioids were discussed in only 70.1% of all cases. Opioid vs. Non-Opioid Patients Compared to patients not receiving opioid therapy, patients currently on opioid treatment were more likely to describe more frequent and/or more severe abdominal discomfort (88.4% vs. 61.0%, p<0.001; mean 5.0 vs. 2.6, p<0.001), bone pain (87.0% vs. 53.9%, p<0.001; mean 5.6 vs. 2.4, p<0.001), unintentional weight loss (41.2% vs. 21.4%, p=0.001), inactivity (94.2% vs. 71.5%, p<0.001), early satiety (84.1% vs. 58.2%, p<0.001), and impaired quality of life (mean 4.9 vs. 6.6, p<0.001). They were also more likely to describe regularly taking pain medications (85.5% vs. 34.5%, p<0.001) as well as attempt non-pharmacological treatments to manage symptoms (Figure 1). Despite more aggressive pain treatment approaches, only 42% of opioid patients reported satisfaction with their current pain plan vs. 62.2% of patients not receiving opioid therapy. Conclusions: MPN patients face significant symptom burden despite often limited reduction in life expectancy. Patients furthermore demonstrate a high prevalence of risk factors for opioid-related complications including overdose and substance misuse. Despite aggressive pain regimens, opioid patients are less likely to voice adequate symptom control or satisfaction with their pain treatment plans. Providers should be cognizant of opioid-related complications and consider subspecialty pain management referrals or adaptation of the JCO Clinical Practice Guidelines for Management of Chronic Pain in Survivors of Adult Cancers (J Clin Oncol. 2016 Sep 20;34(27):3325-45). Disclosures Scherber: Orphan Pharmaceuticals: Honoraria; Incyte: Consultancy. Palmer:Novartis: Research Funding. Dueck:Phytogine: Employment; Pfizer: Honoraria; Bayer: Employment. Mesa:Gilead: Research Funding; Novartis: Consultancy; CTI: Research Funding; Galena: Consultancy; Incyte: Research Funding; Promedior: Research Funding; Ariad: Consultancy; Celgene: Research Funding.

Download Full-text

Addressing the Adequacy of Current MPN Pain Management Strategies: An International Survey of 502 Patients By the MPN Quality of Life Study Group

Blood ◽

10.1182/blood-2018-99-115095 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4298-4298

Author(s):

Holly L. Geyer ◽

Robyn M. Scherber ◽

Gina Mazza ◽

Blake T. Langlais ◽

Ruben A. Mesa ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Pain Management ◽

Research Funding ◽

Bone Pain ◽

Abdominal Discomfort ◽

Study Group ◽

Life Study ◽

History Of

Abstract Introduction: MPN-related pain, including abdominal discomfort (53.2%), and bone pain (48.5%), is a prevalent complaint within the disorder and is associated with impaired patient quality of life, reduction in most functional domains and overall poor prognosis. Non-targeted treatments for MPN disorders have been previously shown to provide little symptomatic relief for MPN pain. To date, little is known about patient viewpoints on MPN pain, its relationship to other chronic pain syndromes and the impact of pharmacologic and non-pharmacologic pain therapies. In this study, we performed an international survey of MPN patients to better understand the prevalence and management of MPN pain. Methods: This study was performed by the MPN Quality of Life Study Group. A survey was designed by a team of MPN investigators experienced with MPN symptomatology. Survey content included the Barriers Questionnaire II (BQII), a 27-item survey validated to assess patient belief barriers to optimal management of cancer pain measured on a 0 (do not agree at all) to 5 (agree very much) scale (Pain. 2002 Oct;99(3):385-96.). Patients also completed the MPN-10, a 10-item survey of MPN symptoms completed on a 0 (absent) to 10 (worst imaginable) scale (Blood. 2011 Jul 14;118(2):401-8). The survey was posted on high-traffic MPN-related webpages focused on patient education and advocacy (MPN Forum, MPN Net, MPN Research Foundation, MPN Voice) for a total of 28 days. Survey questions evaluated patient demographics, pain histories, current and prior treatment strategies, as well as satisfaction with and barriers to available treatment options. Results: Demographics A total of 502 MPN patients (MF 26.9%, PV 44.2%, ET 28.9%) completed the survey. Patients were of expected mean age (60.5 years) and primarily female (74.9%). Most were from the United States (66.7%) and primarily English speaking (92.2%). Patients described being diagnosed with their MPN 3 to 10 years (35.4%) or >10 years ago (30.8%). Splenic enlargement was vocalized by 36.5% of patients and few patients had had a known history of blood clots (25.4%), severe bleeding (13.3%), conversion to acute leukemia (0.4%) or prior bone marrow transplant (1.4%). Patients described a treatment history of a variety of MPN therapies including aspirin (82.7%), hydroxyurea (60.6%), phlebotomy (40.6%), ruxolitinib (25.9%), interferon (18.5%), anagrelide (17.3%), active clinical trial (5.0%) and radiation treatment (0.4%). Pain Severity, Prevalence and Treatments Among surveyed patients, the MPN-10 mean was 28.3. Mean individual symptom scores and prevalence were 3.1 and 65.6% for abdominal discomfort and 3.0 and 60.4% for bone pain, respectively indicating a low to moderate symptom burden. Most patients had no prior history of chronic pain prior to their MPN diagnosis (47.1%), with chronic abdominal pain and chronic bone/muscle pain noted prior to MPN development in 5.6% and 20.8% of patients, respectively. Most patients felt that their chronic pain has either stayed the same (26.2%), worsened (28.3%) or significantly worsened (14.5%) since their MPN diagnosis. Many patients found pharmacologic and non-pharmacological therapies efficacious for individual pain symptoms, and 42.1% described regularly taking medication to control their pain (Table 1). Barriers to Pain Management Overall, 42.3% of MPN patients reported being unsatisfied with their current pain management plan. Despite this, only 43.5% of patients stated that their MPN providers discussed pain during office visits. Palliative Care (3.1%) and Pain Management (7.3%) were infrequently engaged. On the BQII, patients described being confident that cancer can cause pain (mean 4.2, SD 1.1) but did not necessarily expect to have pain following their MPN diagnosis (mean 2.2, SD 1.8). Conclusion Chronic pain (abdominal, bone) is a prevalent and undermanaged feature of MPN disorders. Chronic non-MPN pain is further complicated by the development of the disorder. Many MPN patients lack understanding on its prevalence and furthermore feel ill-equipped to manage it. Patients have, however, found symptomatic benefit from various pharmacological and non-pharmacological treatment modalities that require further exploration. Results from this study suggest MPN patients should be assessed regularly for pain and offered early referral to specialized services for evaluation, source identification and treatment. Table 1. Table 1. Disclosures Scherber: Incyte: Consultancy; Orphan Pharmaceuticals: Honoraria. Mesa:Ariad: Consultancy; Galena: Consultancy; CTI: Research Funding; Incyte: Research Funding; Promedior: Research Funding; Gilead: Research Funding; Novartis: Consultancy; Celgene: Research Funding. Dueck:Bayer: Employment; Pfizer: Honoraria; Phytogine: Employment. Palmer:Novartis: Research Funding.

Download Full-text

Risk factors associated with peripheral neuropathy among diabetic individuals: a case control study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20210236 ◽

2021 ◽

Vol 8 (2) ◽

pp. 768

Author(s):

Christa Kingston ◽

Aravindan J. ◽

Srikumar Walsalam

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Diabetic Neuropathy ◽

Case Control Study ◽

Case Control ◽

Diabetic Patients ◽

Factors Associated ◽

History Of ◽

Control Study

Background: Diabetic neuropathy is one among the most common complication in diabetes mellitus. Diabetic peripheral neuropathy hinders the quality of life causing morbidity and mortality. The purpose of this study was to find the risk factors associated with diabetic neuropathy.Methods: This case control study involved 100 diabetic patients attending the Dohnavur fellowship hospital, Dohnavur from October 2019 to March 2020. Sociodemographic profile and diabetic characteristics of the study group were obtained and analysed. Diagnosis of Diabetic Neuropathy was done by using the diagnostic method proposed by American Diabetic Association.Results: Of the total study population with mean age 59.43 years, 63% had family history of diabetes. Almost 70% had poor diabetic control. Statistically significant relationships were found between neuropathy and duration of diabetes, glycaemic control, history of hypertension, monofilament test and pinprick sensation.Conclusions: In this study, glycemic control, dyslipidemia and hypertension were modifiable risk factors for diabetic neuropathy. Early interventional programs to sensitize diabetics on these factors could improve the quality of life of Diabetic patients.

Download Full-text

A Standardized Equation Model of Quality of Life in Myeloproliferative Neoplasms

Blood ◽

10.1182/blood-2019-126803 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2181-2181

Author(s):

Robyn M. Scherber ◽

Martin M. Goros ◽

Jonathan Gelfond ◽

Amylou C. Dueck ◽

Sarah F Christensen ◽

...

Keyword(s):

Quality Of Life ◽

Research Funding ◽

Structural Equation ◽

Online Survey ◽

Myeloproliferative Neoplasms ◽

Linear Regression Analysis ◽

Symptom Burden ◽

Equation Model ◽

Nccn Guidelines

Background: Quality of life (QOL) is predictive of survival in many malignancy types, including myeloproliferative neoplasms (MPNs; Scherber 2017, Sloan 2012, Montazeri 2009, Nilsson 2017). We have previously characterized that an association exists between symptom burden and QOL among MPN patients, but due to the disease specificity of symptoms, symptoms rather than QOL remains a key therapeutic endpoint (Scherber 2017, NCCN Guidelines). Despite these advancements, our understanding of the extent that different patient and disease characteristics, including symptoms, contribute to overall QOL has remained elusive. In this analysis, we utilized information from a large survey of MPN patients to develop a model of QOL that establishes the degree that individual variables contribute to QOL, including psychosocial variables, comorbidities, and MPN disease symptoms. Methods: The FATIGUE survey of MPN patients (Scherber 2016) investigated self-reported symptoms using the MPN10 (Scherber 2012), depression utilizing the Profile of Mood States-Brief (POMS-B, McNair 1971), Patient Health Questionnaire (PHQ-2, Kroenke 2003) and Mental Health Inventory (MHI-5, Berwick 1991), and QOL utilizing a single numeric analog scale (range 0-10) regarding overall quality of life. Linear regression analysis was utilized to establish the relationship between individual symptoms and QOL, and a structural equation model (SEM) was used to identify complex relationships among patient demographics, behavioral factors, comorbidities, and QOL. Results: A total of 914 patients from the online survey lived in the USA and provided data for this analysis. Average age was 62 with 67% of patients being female and the mean BMI was 25. Education varied across middle school or high school education (22%), undergraduate or college degree (44%), masters (26%), to doctorate (8%). 43% of respondents were employed. Fatigue (β coefficient 0.23, p<0.001), inactivity (β 0.21, p<0.001), concentration difficulties (β 0.13, p<0.001), sad mood (β 0.18, p<0.001), and night sweats (β 0.05, p=0.03) showed statistically significant impact on QOL. SEM Model: We developed the SEM model in Figure 1. Out of all variables analyzed, MPN total symptom burden demonstrated the strongest association with (β 0.89) with QOL, followed by depression (β 0.76). Comorbidities, including COPD and renal issues, age, and body mass index abnormalities had some impact on symptoms (all β <0.40), but did not demonstrate a significant impact on QOL. Comparative Fit Index (CFI) was 0.905 and root mean square error of approximation (RMSEA) was 0.051 (0.048, 0.054) indicating good fit. Conclusions: Previous clinical trials of JAK inhibition have targeted improvement in symptoms as a key endpoint, and ultimately demonstrated improvements in overall survival. The mechanism of this survival benefit has not been fully explored. This analysis suggests that symptoms and mood are strongly associated and potentially a major contributor to QOL among MPN patients, whereas other major comorbidities and age are not as strongly correlated. Efforts are underway to analyze more comprehensive datasets to better understand the role of other variables, including marriage status and financial concerns, on QOL. Disclosures Scherber: Blueprint: Other: Ad board; Incyte: Consultancy; Gilead: Consultancy. Hasselbalch:Novartis: Research Funding; AOP Orphan Pharmaceuticals: Other: Data monitoring board. Mesa:Baxalta: Consultancy; LaJolla: Consultancy; Genentech: Consultancy; Celgene Corporation: Research Funding; Samus: Research Funding; AbbVie: Research Funding; NS Pharma: Research Funding; Novartis: Consultancy, Honoraria, Other: travel, accommodations, expenses; CTI: Research Funding; Galena Biopharma: Consultancy; Pfizer: Research Funding; Incyte: Other: travel, accommodations, expenses, Research Funding; Genotech: Research Funding; AOP Orphan Pharmaceuticals: Honoraria, Other: travel, accommodations, expenses; PharmaEssentia: Research Funding; Gilead Sciences: Research Funding; Promedior: Research Funding; Shire: Honoraria; Sierra Oncology: Consultancy.

Download Full-text

Risk Factors and Quality of Life of Lung Cancer Survivors in Lahore, Pakistan

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i1831317 ◽

2021 ◽

pp. 68-71

Author(s):

Rehan Ahmad Khan Sherwani ◽

Sajjad Ali Gill ◽

Saba Younus ◽

Sana Saeed ◽

Nadia Saeed ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Lung Cancer ◽

Family History ◽

Cancer Patients ◽

Environmental History ◽

Well Being ◽

Lung Cancer Patients ◽

History Of

Introduction: The objectives of this study is to determine the risk factors of lung cancer were patients and investigate the quality of life of lung cancer survivors. The occupational, smoking, personal, environmental and family history of the survivors are investigated. The well-being of the survivors with physical and social norms not were also studied. Methods: Risk factors and quality of life from a sample of 50 lung cancer patients investigated through a self-administered questionnaire after getting consent from the hospital management and the patients. All the analysis has been done in SPSS 21. Results: Most of the lung cancer patients were male smokers with a strong history of smoking, and more than half of the respondents inhaled while smoking cigarettes. The significant risk factors among non-smokers are occupational history, personal history, environmental history, and family history. The impact of environmental history with smoking history is observed in lung cancer patients. The physical well-being of the patients is considerably affected by the disease and the pain in their daily activities. Conclusion: Smoking remained the leading risk factor of lung cancer patients followed by radon. However, family history is found statistically significant in the prevalence of lung cancer. Authorities should draw and implement some guiding rules to control smoking, radon, and air pollution, particularly in residential areas.

Download Full-text

Patient-Reported Outcomes (PRO) Data from Patients (Pts) with Essential Thrombocythemia (ET) Enrolled in the MOST Study

Blood ◽

10.1182/blood-2019-124527 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1665-1665

Author(s):

Ellen K. Ritchie ◽

Anas Al-Janadi ◽

Philomena Colucci ◽

Patricia Kalafut ◽

Dilan Paranagama ◽

...

Keyword(s):

Quality Of Life ◽

Global Health ◽

Research Funding ◽

Symptom Burden ◽

Advisory Board ◽

Employment Equity ◽

Scale Scores ◽

Equity Ownership ◽

Eortc Qlq

Introduction: ET is a chronic myeloproliferative neoplasm (MPN) characterized by thrombocytosis and an increased risk for thrombotic and hemorrhagic events. ET can be associated with substantial symptom burden, impaired quality of life (QoL), and reduced survival. PRO data pertaining to the impact of ET on QoL and symptom burden in these pts are limited. The ongoing Myelofibrosis and Essential Thrombocythemia Observational STudy (MOST) was designed to collect data about the demographics, disease burden, PROs, and management of pts with ET or myelofibrosis (MF) in clinical practices throughout the United States. This analysis describes PROs from pts with ET enrolled in MOST. Methods: MOST is a longitudinal, multicenter, noninterventional, prospective, observational study (NCT02953704). Eligible adults with ET were ≥60 years of age, had a history of thrombotic events, or were receiving ET-directed therapy. PROs were collected in conjunction with usual-care visits approximately every 6 months over a planned observation period of 36 months. Patient-reported symptom burden was assessed with the disease-specific MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS), composed of 10 items (fatigue, early satiety, abdominal discomfort, inactivity, concentration problems, night sweats, itching, bone pain, fever [>100oF], weight loss). The MPN-SAF numbness/tingling item was also included in the questionnaire but was not included in the TSS calculation. Symptom severity was graded from 0 (absent) to 10 (worst imaginable), with a possible TSS ranging from 0 to 100. Health-related QoL was evaluated with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30 v3.0), composed of 5 functional scales, 3 symptom scales, 6 additional single-symptom items, and a global health/QoL scale. For functional and global health/QoL scales, higher scores indicate higher functioning and better global health/QoL, respectively. For symptom scales/items, higher scores indicate greater symptom burden. High-risk pts and low-risk pts receiving ET-directed therapy (excluding aspirin only) with baseline PRO data were included in this analysis. Data were summarized with descriptive statistics. Results: The MOST study enrolled 1234 pts with ET between Nov 29, 2016 and March 29, 2019 at 124 sites. Of these pts, 794 qualified for this analysis (data cut-off date, June 17, 2019); median age was 70 (range, 19-93) years, 80% were ≥60 years of age, 68% were women, 90% were white, 42% were working full or part-time, and 4% had a documented family history of MF, ET, or polycythemia vera. The majority of pts (87%) had high-risk ET. At enrollment, 768 pts completed the MPN-SAF. Mean (SD) TSS was 17.1 (15.6); 33% of pts had TSS ≥20. Women had higher mean (SD) TSS than men (18.5 [15.8] vs 14.2 [14.9]) and had higher mean individual symptom scores, except for weight loss and fever. The highest mean (SD) individual symptom scores were fatigue (3.4 [2.7]), numbness/tingling (2.3 [3.0]), inactivity (2.3 [2.8]), and early satiety (2.3 [2.7]) (Fig A). The most frequently reported severe symptoms (ie, score ≥7) were fatigue (17% [127/746]), numbness/tingling (14% [107/767]), and inactivity (11% [86/762]). At enrollment, 794 pts completed the EORTC QLQ-C30. The highest mean (SD) symptom scale scores (score ≥15) were fatigue (29.6 [25.8]), insomnia (28.6 [30.6]), pain (22.1 [27.9]), dyspnea (17.2 [25.5]), and constipation (15.7 [25.2]) (Fig B). The mean (SD) global health status/QoL score was 72.7 (21.9); functional scores ranged from 79.9 (21.9) for emotional functioning to 85.2 (24.1) for social functioning (Fig C). The average functional scale scores and symptom scale scores indicate higher functioning and less symptom burden, respectively, in men vs women. Conclusion: Pts with ET experienced a high symptom burden; fatigue was the most common and highest in severity. Symptom burden and quality of life scores in the current study were similar to prior reports (Emanuel J Clin Oncol 2012; Scherber Blood 2011). Women reported higher symptom burden than men in both the MPN-SAF and EORTC QLQ-30. Of note, numbness/tingling, which is not included in the MPN-SAF TSS calculation, was one of the most frequently reported severe symptoms for pts with ET in MOST. Future analyses from this trial will continue to increase understanding of the symptom burden and its impact on QoL in pts with ET. Disclosures Ritchie: Celgene, Incyte, Novartis, Pfizer: Consultancy; Genentech: Other: Advisory board; Tolero: Other: Advisory board; Pfizer: Other: Advisory board, travel support; agios: Other: Advisory board; Celgene: Other: Advisory board; Jazz Pharmaceuticals: Research Funding; Celgene, Novartis: Other: travel support; AStella, Bristol-Myers Squibb, Novartis, NS Pharma, Pfizer: Research Funding; Ariad, Celgene, Incyte, Novartis: Speakers Bureau. Al-Janadi:Incyte: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding; Celgene: Honoraria, Other: Travel, Accommodations, Expenses, Research Funding, Speakers Bureau; Genentech/Abbvie: Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; Genentech/Roche: Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; Gilead Sciences: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses; Sandoz-Novartis: Consultancy, Honoraria; Alexion Pharmaceuticals: Consultancy, Honoraria, Other: Travel, Accommodation, Expenses, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses, Research Funding, Speakers Bureau; MEI Pharma: Research Funding; Seattle Genetics: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses. Colucci:Incyte: Employment, Equity Ownership. Kalafut:Incyte: Employment, Equity Ownership. Paranagama:Incyte: Employment, Equity Ownership. Mesa:Genotech: Research Funding; Promedior: Research Funding; Sierra Onc: Consultancy; Celgene: Research Funding; AbbVie: Research Funding; Novartis: Consultancy; La Jolla Pharma: Consultancy; CTI Biopharma: Research Funding; Samus: Research Funding; Incyte: Research Funding.

Download Full-text

Abstract 138: Characterizing Depressed Symptoms in Younger Women and Men Who Experienced an Acute Myocardial Infarction: Insights from the VIRGO Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.138 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Kim Smolderen ◽

Kelly Strait ◽

Dreyer Rachel ◽

Gail D’Onofrio ◽

Shengfan Zhou ◽

...

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Cardiovascular Risk ◽

Health Status ◽

Symptom Burden ◽

Prior History ◽

Younger Women ◽

History Of ◽

History Of Depression

Background: This study aimed to determine the prevalence of the depressive symptom burden among younger men and women, and to better characterize those experiencing depressive symptoms in the weeks leading up to their AMI. Method: The VIRGO study enrolled 3,572 AMI patients (2:1 ratio for women: men; 67.1% women) between 2008 and 2012 (103 US hospitals, 24 in Spain and 3 in Australia) at their index AMI admission. The PHQ-9 (clinically relevant depressive symptoms = PHQ-9 scores ≥10) was administered to assess patients’ depressive symptoms. Demographic, socio-economic, cardiovascular risk, AMI risk factor, perceived stress (PSS-14), and health status information (Seattle Angina Questionnaire [SAQ], EQ-5D) was obtained through patient interviews during the index hospitalization and medical chart abstraction. Information about history of depression was also documented through interviews. Results: A total of 886 (39%) women experienced clinically relevant depressive symptoms vs. 245 (22%) men (P<0.0001). Overall, about half (n=1141, 48%) of women reported a prior history of depression vs. 1 in 4 in men (n=280, 24%) (P<0.0001). Women had higher rates of somatic depressive symptoms (10% vs. 6% in men), as well as a combination of cognitive and somatic symptoms of depression (23% vs. 11% in men) (P<0.0001). High levels of stress (mean score 32±8 vs. 21±8 for men; 34±8 vs. 23±8 for women on PSS-14) and low quality of life scores (mean SAQ Quality of Life score 50±22 vs. 63±21 for men; 45±25 vs. 61±22 for women) were noted among depressed patients, regardless of their gender (all P-values <0.0001 for depressed vs. non-depressed). In both women and men, depression was more prevalent among patients with a lower socio-economic profile (e.g. lower education, uninsured), among those with cardiovascular risk factors (e.g. diabetes, smoking). As compared with men, women had a 2.28-increased odds of experiencing depressive symptoms. This relationship persisted after adjusting for demographic, socio-economic, cardiovascular and AMI risk factors, and health status (OR=1.64; 95%CI 1.36, 1.98). Conclusions: A high depressive symptom burden and prior history of depression was observed among younger women admitted with AMI. Regardless of gender, depression affected those with a lower socio-economic status and cardiovascular risk factors; it was also accompanied with high levels of stress and worse health status. Targeted interventions and preventive strategies should consider addressing this high burden of depressive symptoms among younger depressed AMI patients.

Download Full-text

Back pain in pregnancy among office workers: risk factors and its impact on quality of life

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2017-0037 ◽

2017 ◽

Vol 32 (3) ◽

Author(s):

Beng Kwang Ng ◽

Mardiana Kipli ◽

Abdul Kadir Abdul Karim ◽

Suhaila Shohaimi ◽

Nur Azurah Abdul Ghani ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Back Pain ◽

Pregnant Women ◽

Social Life ◽

Functional Limitation ◽

Personal Care ◽

History Of ◽

In Pregnancy

AbstractBackgroundBack pain is a common presenting complaint during pregnancy and it is often being considered as part of the pregnancy process. The purpose of the study is to investigate the prevalence of back pain in pregnancy, risk factors and its impact on the quality of life in pregnant women.Materials and methodsThree hundred and fifty-eight pregnant women who attended the antenatal clinic in Universiti Kebangsaan Malaysia (UKM) Medical Centre were recruited in this cross-sectional study from October 2011 until April 2012. The back pain was further classified into lumbar pain and posterior pelvic pain. The severity of back pain was assessed using visual analoque scale (VAS) and the functional limitation was assessed using the Oswestry Disability Questionnaire (ODQ).ResultThe prevalence of back pain in pregnancy was 84.6%. Occupation and previous history of back pain were associated with back pain in pregnancy. In terms of functional limitation disability, total ODQ score was statistically significant correlate with severity of pain (VAS score). Personal care, sitting, standing, sex life and social life were significantly affected.ConclusionThe risk factors for back pain in pregnancy were type of occupation and history of back pain. The higher VAS score, the more ODQ will be affected. Personal care, sitting, standing, sex life and social life were significantly affected.

Download Full-text

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

BMC Palliative Care ◽

10.1186/s12904-021-00735-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sondos Zayed ◽

Pencilla Lang ◽

Lucas C. Mendez ◽

Nancy Read ◽

Jinka Sathya ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Head And Neck Cancer ◽

Head And Neck ◽

Randomized Clinical Trial ◽

Multimodal Analgesia ◽

Opioid Therapy ◽

Opioid Analgesia ◽

Opioid Use

Abstract Background Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients. Methods In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain. Discussion This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT. Trial registration ClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.

Download Full-text

Female Urinary Incontinence: Prevalence and Impact on the Quality of Life of Gynaecological Clinic Attendees in Lagos, Nigeria

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v13i2.21909 ◽

2018 ◽

Vol 13 (2) ◽

Author(s):

FM Akinlusi ◽

TA Ottun ◽

YA Oshodi

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Urinary Incontinence ◽

Cross Sectional Study ◽

University Teaching ◽

State University ◽

Health Seeking ◽

Cross Sectional ◽

History Of

Aims: To determine the prevalence of urinary incontinence (UI); risk factors; impact on quality of life and symptom specific health seeking behaviour. Methods: A cross-sectional study of 395 women attending gynaecological clinic of the Lagos State University Teaching Hospital. UI was defined as the complaint of any involuntary leakage of urine in the previous six months. Socio-demographic characteristics, obstetrics, gynaecological, medical and surgical risk factors, impact on daily activities and treatment history were assessed. Univariate, bivariate and multivariable analyses were performed. Results: Participants age ranged from 25-67 years with a mean of 38.81 ± 10.1. Prevalence of UI was 32.9%. Urge UI occurred in 18.0% of all respondents while the prevalence of stress and mixed incontinence was 7.3% and 7.6% respectively. Independent risk factors for urinary incontinence were age (OR= 0.49, 95%;CI = 0.26-0.92), higher body mass index (OR = 1.92; 95% CI =1.53-3.00) and history of constipation(OR = 2.11; 95% CI =1.30 - 3.43). About47%of those with UI admitted to having negative feelings such as despair, anxiety and depression while 45% had a cumulative moderate to severe affectation of their quality of life in all domains. Despite these, only 27.7% sought help. Conclusions: Despite thesubstantial impact of UI on the quality of life, majority do not seek help. Addressing modifiable risks factors, improving treatment seeking behaviour by correction of misconceptions and elimination of stigma will go a long way in reducing the prevalence of UI.

Download Full-text

What Do Patients Think about Palliative Care? a National Survey of Hematopoietic Stem Cell Transplant Recipients

Blood ◽

10.1182/blood-2021-149766 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2968-2968

Author(s):

Areej El-Jawahri ◽

Christa Meyer ◽

Lih-Wen Mau ◽

Deborah Mattila ◽

Linda J Burns ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Stem Cell ◽

Hematopoietic Stem Cell ◽

Research Funding ◽

Symptom Burden ◽

Advisory Board ◽

Hematopoietic Stem ◽

Limited Knowledge

Abstract Background: Palliative care (PC) benefits patients with cancer and those undergoing hematopoietic stem cell transplantation (HSCT), but remains under-utilized in HSCT. While transplant physicians have substantial concerns regarding how patients perceive PC, studies examining HSCT recipients' perceptions of PC are lacking. Methods: Between 11/2020-4/2021, the CIBMTR Survey Research Group conducted a multi-site cross-sectional survey of adult autologous and allogeneic HSCT recipients at 11 transplant centers in the United States who were 3-12 months post-transplant to assess their experience, knowledge, and perceptions of PC. Using validated questionnaires, we assessed patients' familiarity with PC, knowledge and perception of PC, unmet PC needs, quality of life, and symptom burden. We computed a composite score of patients' perceptions of PC (mean = 48.8, SD = 12.2). We used a generalized linear regression model to examine factors associated with patients' perceptions of PC. Results: Of 359 potentially eligible patients, 250 (69.6%) enrolled in the study and 249 were eligible for analysis. Median participant age was 58.1 years (IQR 16.6). Most were white (85.9%), non-Hispanic or Latino (95.2%), and male (53.0%). Overall, 63.1% underwent autologous HSCT. The most common diagnoses were multiple myeloma (42.2%), lymphoma (22.1%), leukemia (16.9%), and MDS/MPN (12.4%). Overall, 44.2% (110/249) of patients reported limited knowledge about PC and 51.0% (127/249) endorsed being familiar with PC. Most patients stated that when they hear the term PC, they feel hopeful (54%), and reassured (50%) while a minority reported feeling scared (21%), stressed (22%), or depressed (15%) [Figure 1]. Most endorsed that when a PC referral is suggested for them, they think their doctor really cares about what is happening to them (83%), and only 7% of patients stated that when a PC referral is suggested, they think their doctor has given up on them [Figure 2]. In multivariate analyses, patients who were more knowledgeable about PC were more likely to have a positive perception of PC (B = 7.54, SE=1.61, P < 0.001) compared to those who had less knowledge about PC. Patients with postgraduate education were more likely to have a negative perception of PC (B = -5.55, SE=2.60, P = 0.034) compared to those with high school education or less. Patients' demographics, HSCT type, diagnosis, unmet PC needs, quality of life, and symptom burden were not statistically significantly associated with their perceptions of PC. Conclusions: A substantial proportion of HSCT recipients report limited knowledge and familiarity with PC. Most patients reported positive perceptions of PC, and those who were more knowledgeable about PC were more likely to have positive perceptions of PC. These data do not support transplant physicians' concerns about how patients perceive PC and underscore the need for future interventions to further educate patients about PC to overcome barriers to PC utilization in HSCT. Figure 1 Figure 1. Disclosures Burns: Astellas Pharma Inc.: Research Funding; Medac GmbH: Research Funding; Sanofi: Research Funding; OncoImmune: Research Funding; Fate: Research Funding; Bristol Meyers Squibb: Research Funding; PrioThera: Research Funding; Kyowa Kirin International: Research Funding. Murthy: CRISPR Therapeutics: Research Funding. LeBlanc: Amgen: Consultancy, Other: travel; Pfizer: Consultancy, Other: Advisory Board; AstraZeneca: Consultancy, Honoraria, Other: Advisory board, Research Funding; Flatiron: Consultancy, Other: Advisory board; Agios: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; BMS/Celgene: Consultancy, Honoraria, Other: Travel fees, Research Funding, Speakers Bureau; Daiichi-Sankyo: Consultancy, Honoraria, Other: Advisory board; AbbVie: Consultancy, Honoraria, Other: Advisory board; Travel fees, Speakers Bureau; Helsinn: Consultancy, Research Funding; Duke University: Research Funding; Jazz Pharmaceuticals: Research Funding; UpToDate: Patents & Royalties; NINR/NIH: Research Funding; CareVive: Consultancy, Other, Research Funding; Otsuka: Consultancy, Honoraria, Other; American Cancer Society: Research Funding; Seattle Genetics: Consultancy, Other: Advisory board, Research Funding; Astellas: Consultancy, Honoraria, Other: Advisory board; Heron: Consultancy, Honoraria, Other: advisory board.

Download Full-text