Patient-Reported Disease Burden and Age: Results from a National Patient Advocacy Survey of Patients with Chronic Lymphocytic Leukemia, Diffuse Large B-Cell Lymphoma and Follicular Lymphoma

Introduction: Evaluation of patients' psychosocial burden related to their cancer and its treatment is important for shared decision making by patients and their healthcare team. We aimed to better understand the impact of age on this burden as reported by patients with chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma (FL) using data from a large US patient advocacy survey. Methods: We developed a survey to understand patients' perceptions of disease burden and impact on physical and emotional health. The survey was designed through consultation with medical experts, patient advocacy organizations and research team members. Concept elicitation and cognitive pretesting were conducted with patients to inform the survey content. The survey was administered electronically to patients with CLL, DLBCL, or FL who had received either initial or subsequent treatment within the past year. The survey consisted of categorical Likert options that quantified the impact of disease on physical function, sleep, cognition, work, emotional health and quality of life (QoL). The survey data were analyzed descriptively by patients' reported age: 60 years or older versus less than 60 years. Results: The survey was completed by 424 patients who were associated with The Leukemia & Lymphoma Society and/or the Lymphoma Research Foundation (309 patients with CLL, 59 patients with DLBCL and 69 patients with FL). Respondents had a mean age of 66 years (range: 22-95 with five patients electing not to report their age), 79% were 60 years or older, and 51% were female. A greater proportion of younger patients (<60 years) reported negative impact of the disease on various aspects of their lives as compared with older patients. Negative impact on emotional health, on personal relationships and on overall health-related QoL, as well as worry about disease returning or getting worse are highlighted in the following Table. Physical impacts of diseases were also reported in a greater proportion of younger patients versus older patients, specifically in reports of nausea, pain, appetite, sleep patterns, concentration and multi-tasking. Additionally, 95% of patients overall, regardless of age, agreed that delaying disease progression was important to them. Conclusions: Evaluation of disease burden is important as patients and healthcare providers are empowered to take more active roles in shared decision making for treatments that are aligned with patients' concerns and priorities. While patients with CLL, DLBCL, and FL report substantial disease burden, the negative impact of disease was reported in a greater proportion of younger patients (<60 years) than in older patients (≥60 years). Differences in patient-reported disease burden based on age and other patient circumstances should be explored as potential key concerns of patients for education of the clinical community. Disclosures Dawson: Roche/Genentech: Equity Ownership; Genentech: Employment. Price:RTI Health Solutions (RTI-HS): Employment. Sae-Hau:Genentech: Other: The Leukemia & Lymphoma Society received funding from Genentech to participate in this research and also receives programmatic funding from Genentech.. Weiss:Genentech: Other: The Leukemia & Lymphoma Society received funding from Genentech to participate in this research and also receives programmatic funding from Genentech.. Mange:Research Triangle Institute d/b/a RTI Health Solutions: Employment. Mansfield:RTI Health Solutions (RTI-HS): Employment. Comenencia-Ortiz:Genentech, Inc.: Employment. Masaquel:Roche: Equity Ownership; Genentech: Employment. Ravelo:Genentech: Employment, Equity Ownership.

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What Are Patients' Preferences and Satisfaction Regarding Modes of Administration for the Treatment of Chronic Lymphocytic Leukemia (CLL), Diffuse Large B-Cell Lymphoma (DLBCL), and Follicular Lymphoma (FL)?

Blood ◽

10.1182/blood-2018-99-115327 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5897-5897

Author(s):

Mark Price ◽

Arliene Ravelo ◽

Elisa Weiss ◽

Peggy Ann Torney ◽

Victor Gonzalez ◽

...

Keyword(s):

Decision Making ◽

Patient Satisfaction ◽

Research Funding ◽

Emotional Health ◽

B Cell Lymphoma ◽

Treatment Schedule ◽

Treatment Pathways ◽

Patient Reported ◽

Equity Ownership ◽

The Impact

Abstract OBJECTIVES: In recent years, there has been an increase in the number of treatments with different administration modes for patients with CLL, DLBCL, and FL, providing patients with options that were previously unavailable. However, there is a dearth of quantitative evidence for how patients make decisions when choosing treatments and on patients' opinions regarding the burden of disease, treatment, and satisfaction with processes involved in treatment. We developed a survey to understand patient experiences, preferences, and factors that contribute to decision making. This study aims to quantify patient-reported information via standard survey items with categorical Likert options that measure aspects of satisfaction with patients' most recent treatment. Additionally, patient preferences for various modes of treatment administration will be measured through direct assessment. METHODS: To design the survey, a rigorous approach consisting of consultation with medical experts, patient advocacy organizations, and research team members was undertaken. Additionally, concept elicitation and cognitive pretesting with patients yielded important attributes to measure, including satisfaction with and preference for various aspects of treatment, treatment schedule and burden, travel time, work productivity and caregiver impact. A particular focus was given to the impact of disease and treatment on health-related quality of life. Specific topics in this category included impact on energy levels, sleep, concentration, emotional health, personal relationships, anxiety and uncertainty, and optimism about future health status. RESULTS: The draft survey questionnaire was developed and pretested in semistructured interviews with patients (n = 14). Four patients with CLL, 5 patients with DLBCL, and 6 patients with FL were interviewed. Eight patients were male and 6 were female, and mean patient age was 59 (range: 33-74). Interview results suggested that patients experience a significant time burden related to the treatment of their disease. All survey items (including those addressing preferences for treatments based on duration and level of satisfaction with various time and resource dependent treatment characteristics) were refined during the interviews. The final survey is currently being administered online to patients who are associated with The Leukemia & Lymphoma Society and The Lymphoma Research Foundation. We anticipate surveying 500 patients, with results ready for the 2018 American Society of Hematology Annual Meeting. CONCLUSIONS: Evaluations of patient satisfaction, preferences, and priorities are increasingly important as patients are enabled to take more active roles in decision-making for their treatment pathways. Our present study will yield necessary data on important treatment attributes among patients with CLL, DLBCL, and FL. A large-scale evaluation of patient satisfaction and preferences can be used for education of the clinical and broader medical community in a landscape that includes several new therapies. Disclosures Price: Genentech: Consultancy. Ravelo:Genentech: Employment. Weiss:Genentech: Research Funding. Torney:Genentech: Research Funding. Gonzalez:Genentech: Research Funding. Sae-Hau:Genentech: Research Funding. Mansfield:Takeda Pharmaceuticals International Co: Consultancy; Genentech: Consultancy. Comenencia-Ortiz:Genentech: Employment. Cunanan:Genentech: Consultancy. Masaquel:Roche: Equity Ownership; Genentech: Employment, Equity Ownership. Dawson:Genentech: Employment.

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Systemic Mastocytosis Patient Experience from Mast Cell Connect, the First Patient-Reported Registry for Mastocytosis

Blood ◽

10.1182/blood.v128.22.4783.4783 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4783-4783 ◽

Cited By ~ 3

Author(s):

Philina Lee ◽

Tracy I. George ◽

Hongliang Shi ◽

Erica K. Evans ◽

Teghpal Singh ◽

...

Keyword(s):

Clinical Trials ◽

Mast Cell ◽

Research Funding ◽

Disease Burden ◽

Systemic Mastocytosis ◽

Employment Equity ◽

New Therapies ◽

Patient Reported ◽

Equity Ownership ◽

The Impact

Abstract Background: Systemic mastocytosis (SM) is a rare mast cell disorder associated with a range of debilitating symptoms and a shortage of effective treatment options. Little is known about the impact of the disease from the patients' perspective. Systematically characterizing the natural history of SM and its impact on patients will facilitate the development of new therapies. Registries that engage patients have proven valuable in other rare diseases by expanding knowledge of current treatment approaches, evaluating disease burden and accelerating clinical trials. Methods: Mast Cell Connect (NCT02620254, www.mastcellconnect.org) is an observational database that captures demographic, socioeconomic and disease information from patients with mastocytosis. It is the first patient-reported registry for mastocytosis to our knowledge. Key objectives are to improve collective understanding of the disease burden on patients and to facilitate development of new therapies by increasing participation in clinical trials. Enrollment is "site-agnostic" as participants register and take surveys on a secure online portal. Since many US patients are seen outside large clinical centers, this enables broader participation and collection of real-world data. Inclusion criteria are a diagnosis of SM or cutaneous mastocytosis (CM). Diagnoses are self-reported and participants are asked to provide medical reports that will be used to confirm diagnoses in the future. Informed consent is required to join this IRB-approved study. Results: Mast Cell Connect opened on December 1, 2015. As of May 31, 2016, 166 participants had registered, of whom 157 had responded to the online survey. Of the 153 participants who reported their diagnosis, 107 had SM and 38 had CM. Those who reported a diagnosis of SM were categorized as SM participants if they also reported other diagnoses. The current analyses are based on data provided by the 107 SM participants. Of the 107 SM participants, 60 (56%) had Indolent SM (ISM), 8 (7%) had Smoldering SM (SSM), 10 (9%) had Advanced SM (AdvSM, defined as aggressive SM, SM with an associated hematological neoplasm, and Mast Cell Leukemia) and 29 (27%) did not know their subtype. Median age was 50 years (range 4-77). More females participated (74%) than males (26%). Median time from symptom-onset to diagnosis was 7 years. Participants saw a median of 3 specialists prior to diagnosis, most frequently dermatology (67%), allergy/immunology (67%), hematology/oncology (63%) and general practitioner/internal medicine (63%). Specialists diagnosing SM most often included dermatology (36%), allergy/immunology (25%) and hematology/oncology (23%). AdvSM participants were typically diagnosed by hematology/oncology (70%). The medications taken most often at the time of survey were anti-histamines (85% H1 blockers, 72% H2 blockers), leukotriene inhibitors (38%) and cromolyn sodium (33%). Agents to reduce mast cell burden were taken less often (imatinib: 7%, interferon-α: 2%, hydroxyurea: 1% and investigational agents: 1%). Symptoms reported as moderately to severely bothersome included: fatigue (69%), difficulty concentrating (63%), abdominal pain (55%), pain in other locations (53%), difficulty sleeping (53%), itching (46%), diarrhea (45%), bloating (43%), nausea (42%), headache (40%), skin changes (40%), anxiety (39%) and flushing (37%). Participants reported being limited in work or other daily activities "quite a bit" to "very much" in 47% of ISM, 43% of SSM, and 70% of AdvSM cases. Participants' physical condition or medical treatment interfered with their family life "quite a bit" or "very much" in 59% of ISM, 43% of SSM, and 80% of AdvSM cases. Conclusions: Over 160 participants joined Mast Cell Connect in the first 6 months, indicating the mastocytosis community, including The Mastocytosis Society, is highly motivated to participate in research. SM participants reported a diagnostic odyssey, seeing multiple specialists over a median of 7 years prior to diagnosis. Despite frequent use of symptom-directed medications, symptom burden remains substantial and considerably impacts quality of life. Novel therapies targeting the underlying disease are needed. Establishing US centers of excellence may hasten the time to diagnosis. Continued collaboration between researchers, patient advocates and industry is needed to advance the care of patients with SM. Disclosures Lee: Blueprint Medicines: Employment, Equity Ownership. George:Allakos: Research Funding; Novartis: Consultancy; Blueprint Medicines: Consultancy; Allakos: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Seattle Genetics: Consultancy, Research Funding; Incyte: Consultancy; GLG: Consultancy; Wiley Blackwell: Consultancy; American Registry of Pathology: Patents & Royalties; Wolters Kluwer: Patents & Royalties; UpToDate: Patents & Royalties. Shi:Blueprint Medicines: Employment, Equity Ownership. Evans:Blueprint Medicines: Employment, Equity Ownership. Singh:Blueprint Medicines: Employment, Equity Ownership. Boral:Blueprint Medicines: Employment, Equity Ownership. Rangel Miller:PatientCrossroads: Employment, Equity Ownership.

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Effect of Instructing Care Program Through Group Discussion on the Quality of Life of the Parents of the Children Afflicted With Leukemia

Global Journal of Health Science ◽

10.5539/gjhs.v8n5p197 ◽

2015 ◽

Vol 8 (5) ◽

pp. 197 ◽

Cited By ~ 3

Author(s):

Fariba Asadi Noughabi ◽

Daryoush Iranpoor ◽

Hadi Yousefi ◽

Hakimeh Abrakht ◽

Fatemeh Ghani Dehkordi

Keyword(s):

Quality Of Life ◽

Negative Impact ◽

Emotional Health ◽

Group Discussion ◽

Bodily Pain ◽

Care Program ◽

Role Of Parents ◽

The Impact ◽

Taking Care

PURPOSE: Children long-term involvement with cancer may have a negative impact on the quality of life their parents. Design and implementation of training programs for parents whose children have been diagnosed with leukemia, as the primary caregivers of children, will have a special significance and can contribute to better taking care of such children. The main purpose of the present study was to examine the impact of conducting group discussion, as care program training, on the quality of life parents whose children were suffering from leukemia.METHODS: This quasi-experimental before-after intervention study encompassed two groups of parents (in total 41) of leukemia children. To collect data, a demographic questionnaire and the shortened version of SF-36 questionnaire were used to determine the quality of life of parents. Both groups completed the quality of life questionnaires before and two months after the intervention.RESULTS: Comparison of the parents’ quality of life mean scores, obtained before and two months after training, showed that promotion in 6 domains of bodily pain, general health, emotional health, role limitation due to emotional problems, social functioning, and vitality were occurred. (P <0.05)CONCLUSIONS: Considering the important role of parents in taking care of children suffering from leukemia, introduction of care program training can be a positive step to help these parents and empower them to manage their children’s problems more systematically and will ultimately lead to improved quality of life of parents.

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Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19556 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19556-e19556

Author(s):

Kitsada Wudhikarn ◽

Radhika Bansal ◽

Arushi Khurana ◽

Matthew Hathcock ◽

Michael Ruff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Older Patients ◽

Clinical Course ◽

International Prognostic Index ◽

Age Groups ◽

Central Nervous System Involvement ◽

Microvascular Disease ◽

B Cell Lymphoma ◽

Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

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The impact of a time target on older patients attending the emergency department

Emergency Medicine Journal ◽

10.1136/emj.2010.103150.05 ◽

2010 ◽

Vol 27 (Suppl 1) ◽

pp. A2.1-A2

Author(s):

Sue Mason

Keyword(s):

Emergency Department ◽

Older Patients ◽

Age Groups ◽

Unintended Consequences ◽

Older Patient ◽

Younger Patients ◽

Patient Level ◽

Level Data ◽

Younger Age ◽

The Impact

IntroductionThe 4 h emergency standard for English acute trusts was introduced in 2003 and became full established by 2008 at 98% for all Emergency Department (ED) patients to be seen and discharged. This study examined the impact of the target for older patients attending departments.MethodsRoutine patient level data was received from 15 English EDs representing 774 095 individual patient attendances during May and June for 2003 to 2006. The data were used to determine the distribution of the total time spent in the EDs. Attendances were compared for older patients (65 years and above) with younger age groups.ResultsA total of 145 596 attendances were for patients aged 65+ years (18.9%). Across each year analysed, these older patients have a significantly longer median total time in the ED than those younger than 65 years (162 min vs 103 min, p<0.001). In addition, older patients are significantly more likely to leave the emergency department in the last 20 min prior to 4 h (12.4% vs 5.2% in those <65 years, p<0.001). This proportion is growing year on year in both the admitted and discharged categories of patients. Finally, older patients are significantly more likely to breach the 4-h than their younger counterparts (16.6% vs 6.3%, p<0.001).ConclusionsThere are some unintended consequences of introducing the 4 h target in UK emergency departments. While the target has reduced overall time in departments, the older patient appears to be disadvantaged relative to younger patients. Older patients are more likely to be ‘rushed through’ to other unmonitored areas of the hospital just prior to the target or to breach the target altogether. This finding calls in to question the benefits that the target is conveying for individual patients, and especially the most vulnerable in society.

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Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study

BMJ Open ◽

10.1136/bmjopen-2018-027199 ◽

2019 ◽

Vol 9 (4) ◽

pp. e027199

Author(s):

Tomas Jernberg ◽

Daniel Lindholm ◽

Lars Pål Hasvold ◽

Bodil Svennblad ◽

Johan Bodegård ◽

...

Keyword(s):

Heart Disease ◽

Relative Risk ◽

Ischaemic Heart Disease ◽

Lower Risk ◽

Older Patients ◽

Cox Model ◽

Younger Patients ◽

Linear Association ◽

The Impact ◽

First Time

ObjectivesTo compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD).DesignCohort study linking morbidity, mortality and medication data from Swedish national registries.ParticipantsFirst-time users of GLD during 2007–2016.OutcomesPredicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled.Results260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD—prior MI and 22 550 (9%) had IHD+MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (±prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (<60 years) patients had a relative greater risk compared with older patients.ConclusionsT2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.

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SUN-LB102 Development of a Conceptual Model to Present the Impacts of Obesity on Physical Functioning

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2058 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jiat Ling Poon ◽

Chris Marshall ◽

Chloe Johnson ◽

Hannah Pegram ◽

Maile Hunter ◽

...

Keyword(s):

Conceptual Model ◽

Physical Functioning ◽

Content Validity ◽

Clinical Studies ◽

Negative Impact ◽

The United States ◽

Overweight And Obesity ◽

Spontaneous Reports ◽

Patient Reported ◽

The Impact

Abstract Background. Obesity is a chronic disease with a significant negative impact on health-related quality of life (HRQoL) and specifically, physical functioning, including the ability to complete activities of daily living (ADLs). Weight loss based on lifestyle management (e.g. diet, exercise), surgery, and pharmacotherapy can improve physical functioning; however, there is a need for further qualitative research to support the content validity of patient-reported outcome (PRO) measures for use in clinical studies of obesity and thus inform regulatory decision-making. Objective. To explore the impacts of obesity on physical functioning and develop a conceptual model (a visual representation of the concepts of importance and relevance to the experience of living with obesity) to ultimately support the content validity of PRO measures.Methods. Qualitative semi-structured interviews were conducted in the United States with individuals who have overweight and obesity (Body Mass Index [BMI] ≥ 27.0 kg/m2) with a history of at least one unsuccessful dietary effort to lose body weight. Recruitment quotas targeted a sample with diverse demographic and clinical characteristics, including participants with and without diabetes. Experienced qualitative interviewers used open-ended questions to elicit spontaneous reports of the impact of obesity on individuals’ daily lives, and specific probing questions to explore impacts on physical functioning. Interviews were audio-recorded, transcribed and analyzed using thematic techniques. Results. A total of 33 participants were interviewed (mean BMI of 37.6 kg/m2 [27.4 kg/m2 to 56.6 kg/m2]; mean age of 45 years [19 to 81 years]). The sample included a mix of races (Caucasian: n=12, 36%), education completed (high school: n=17, 51%) and split of gender (female: n=16, 48%). During development of the conceptual model, two separate domains were identified to group the reported impacts on physical functioning: ‘Mobility/Movement’ and ‘ADLs’. The most frequently reported impacts related to Mobility/Movement were ‘running’ (n=31/33, 94%), ‘bending’ (n=27/33, 82%), ‘walking’ (n=26/33, 79%), ‘difficulty standing for prolonged periods’ (n=22/33, 67%), and ‘lifting’ (n=19/33, 58%). All participants reported effects on some aspect of physical functioning, which were often characterized in terms of their direct impact on ADLs such as ‘household chores’ (n=21/33, 64%). Conclusions. The conceptual model will serve as a basis to identify fit-for-purpose PRO measures with strong content validity to evaluate the impact of anti-obesity therapies on physical functioning in future clinical studies. Obesity has a consistent and significant impact on physical functioning, leading to limitations in various aspects of mobility and affecting an individual’s ability to carry out specific daily activities.

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The prevalence of depressive and anxiety symptoms and their associations with quality of life among clinically stable older patients with psychiatric disorders during the COVID-19 pandemic

Translational Psychiatry ◽

10.1038/s41398-021-01196-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Wen Li ◽

Na Zhao ◽

Xiaona Yan ◽

Siyun Zou ◽

Huan Wang ◽

...

Keyword(s):

Quality Of Life ◽

Psychiatric Disorders ◽

Older Patients ◽

Negative Impact ◽

Anxiety Symptoms ◽

Poor Adherence ◽

Adherence To Treatment ◽

Negatively Associated ◽

The Impact

AbstractThe impact of the COVID-19 pandemic on clinically stable older patients with psychiatric disorders is unclear. This study examined the prevalence of depressive and anxiety symptoms, and their associations with quality of life (QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. This was a multicenter, cross-sectional study. Depressive and anxiety symptoms, insomnia, pain, and QOL were assessed with standardized instruments. A total of 1063 patients were included. The prevalence of depressive and anxiety symptoms, and combined depressive and anxiety symptoms were 62.3% (95%CI = 59.4–65.2%), 52.4% (95%CI = 49.3–55.4%), and 45.9% (95%CI = 42.9–48.9%), respectively. Patients with depressive and anxiety symptoms had significantly lower QOL than those without (P < 0.01). Binary logistic regression analyses revealed that having depressive symptoms was positively associated with more severe insomnia (OR = 1.29, P < 0.01) and pain (OR = 1.14, P < 0.01), and was negatively associated with other psychiatric diagnoses (except for major depressive disorder, schizophrenia, and organic mental disorder; OR = 0.50, P < 0.01), while having anxiety symptoms was positively associated with severe physical diseases (OR = 1.57, P = 0.02), poor adherence to treatment (OR = 1.50, P < 0.01), and more severe insomnia (OR = 1.15, P < 0.01) and pain (OR = 1.11, P < 0.01). Having combined depression and anxiety symptoms was positively associated with poor adherence to treatment (OR = 1.42, P = 0.02) and more severe insomnia (OR = 1.19, P < 0.01) and pain (OR = 1.15, P < 0.01), and was negatively associated with the diagnosis of schizophrenia (OR = 0.50, P = 0.04) and others (OR = 0.53, P < 0.01). Depressive and anxiety symptoms were common in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Considering the negative impact of these symptoms on QOL, regular screening and appropriate treatment are recommended for this population.

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Compound Sarcopenia in Hospitalized Patients with Cirrhosis Worsens Outcomes with Increasing Age

Nutrients ◽

10.3390/nu13020659 ◽

2021 ◽

Vol 13 (2) ◽

pp. 659

Author(s):

Nicole Welch ◽

Amy Attaway ◽

Annette Bellar ◽

Hayder Alkhafaji ◽

Adil Vural ◽

...

Keyword(s):

Chronic Diseases ◽

Older Patients ◽

Hospitalized Patients ◽

Muscle Loss ◽

Term Care ◽

Old Patients ◽

Younger Patients ◽

Age Related ◽

Number Of Patients ◽

The Impact

Background: There are limited data on outcomes of older patients with chronic diseases. Skeletal muscle loss of aging (primary sarcopenia) has been extensively studied but the impact of secondary sarcopenia of chronic disease is not as well evaluated. Older patients with chronic diseases have both primary and secondary sarcopenia that we term compound sarcopenia. We evaluated the clinical impact of compound sarcopenia in hospitalized patients with cirrhosis given the increasing number of patients and high prevalence of sarcopenia in these patients. Design: The Nationwide Inpatients Sample (NIS) database (years 2010–2014) was analyzed to study older patients with cirrhosis. Since there is no universal hospital diagnosis code for “muscle loss”, we used a comprehensive array of codes for “muscle loss phenotype” in the international classification of diseases-9 (ICD-9). A randomly selected 2% sample of hospitalized general medical population (GMP) and inpatients with cirrhosis were stratified into 3 age groups based on age-related changes in muscle mass. In-hospital mortality, length of stay (LoS), cost of hospitalization (CoH), comorbidities and discharge disposition were analyzed. Results. Of 517,605 hospitalizations for GMP and 106,835 hospitalizations for treatment of cirrhosis or a cirrhosis-related complication, 207,266 (40.4%) GMP and 29,018 (27.7%) patients with cirrhosis were >65 years old, respectively. Muscle loss phenotype in both GMP and inpatients with cirrhosis 51–65 years old and >65 years old was significantly (p < 0.001 for all) associated with higher mortality, LoS, and CoH compared to those ≤50 years old. Patients >65 years old with cirrhosis and muscle loss phenotype had higher mortality (adjusted OR: 1.06, 95% CI [1.04, 1.08] and CoH (adjusted odds ratio (OR): 1.10, 95% confidence interval (CI) [1.04, 1.08])) when compared to >65 years old GMP with muscle loss phenotype. Muscle loss in younger patients with cirrhosis (≤50 years old) was associated with worse outcomes compared to GMP >65 years old. Non-home discharges (nursing, skilled, long-term care) were more frequent with increasing age to a greater extent in patients with cirrhosis with muscle loss phenotype for each age stratum. Conclusion: Muscle loss is more frequent in older patients with cirrhosis than younger patients with cirrhosis and older GMP. Younger patients with cirrhosis had clinical outcomes similar to those of older GMP, suggesting an accelerated senescence in cirrhosis. Compound sarcopenia in older patients with cirrhosis is associated with higher inpatient mortality, increased LoS, and CoH compared to GMP with sarcopenia.

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Uptake of adjuvant chemotherapy for colon cancer in older and younger patients in the Irish population.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.478 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 478-478

Author(s):

Seamus Coyle ◽

Zia Rehman ◽

Chalen Lee ◽

Sandra Deady ◽

Harry Comber ◽

...

Keyword(s):

Colon Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Adjuvant Therapy ◽

Older Patients ◽

The Elderly ◽

Stage Ii ◽

Stage Iii ◽

Younger Patients ◽

The Impact

478 Background: Colon cancer is predominantly a disease of the elderly, with recent evidence supporting the use of adjuvant chemotherapy in the older population. However, it remains unclear to what degree such patients are receiving adjuvant therapy in clinical practice. We examined uptake of adjuvantchemotherapy and it’s impact on survival in older patients with stage II and stage III colon cancer in a national cohort. Methods: Using the National cancer Registry of Ireland, we identified 3,486 patients with stage II and III colon cancer who were treated with curative resection from 2004-2009. Clinopathological features and chemotherapy use were compared between those ≥70 years and those < 70 years. Results: A total of 2,026 patients with stage II disease were identified, 56% male and 60% ≥ 70 years. T3 tumors accounted for 81%, T4 19% and 89% were grade 2/3. Adjuvant chemotherapy was utilized in 10% and 40% of ≥ 70 and <70 years, respectively (p<0.0001). A benefit for chemotherapy over observation alone was seen in both the older [HR 0.36; 95% CI 0.36 – 0.68; p <0.0001] and younger patient groups [HR 0.43; 95% CI 0.2701 - 0.6881; p<0.0004]. Of 1,460 patients with stage III disease, 51% were ≥ 70 years, 54% male. 34% of older and 83% of younger patients received adjuvant therapy (p<0.0001). A similar magnitude of benefit from chemotherapy compared to observation was seen in patients ≥ 70 years [HR 0.30; 95% CI 0.29 - 0.45 ; p <0.0001] and <70 years [HR 0.22 95%CI 0.1 – 0.2; p<0.0001] with stage III disease. Conclusions: Adoption of adjuvant chemotherapy appears to be associated with significant survival benefit in older patients (age ≥ 70 years), however, is still underutilized in clinical practice. The impact of sociodemographic and clinicopathological features as potential drivers of treatment decisions in a cohort of this population will be reported.

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