Patients with polycythemia vera have worst impairment of quality of life among patients with newly diagnosed myeloproliferative neoplasms

Abelsson, Johanna; Andréasson, Björn; Samuelsson, Jan; Hultcrantz, Malin; Ejerblad, Elisabeth; Johansson, Björn; Emanuel, Robyn M.; Mesa, Ruben A.; Johansson, Peter

doi:10.3109/10428194.2013.766732

Cited by 49 publications

(53 citation statements)

References 28 publications

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“…MPN patients have been shown to have levels of fatigue far in excess of that of published norms (Brief fatigue index score of 4.9 vs. 2.2 out of 10, respectively) [4] but to date no other studies have compared the broad spectrum of MPN symptoms, evaluated by the MPN-SAF, with rates in the general population. Fatigue was the most commonly reported symptom among MPN-UK patients consistent with other reports in the literature [4,5,10,12,15,16]. Fatigue is a common symptom reported in clinical practice with 58% of patients in primary care reporting chronic fatigue [17].…”

Section: Discussionsupporting

confidence: 78%

Myeloproliferative neoplasm patient symptom burden and quality of life: Evidence of significant impairment compared to controls

Anderson¹,

James²,

Duncombe³

et al. 2015

American J Hematol

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The myeloproliferative neoplasms (MPN) including polycythaemia vera (PV), essential thrombocythaemia and primary myelofibrosis (PMF) are rare diseases contributing to significant morbidity. Symptom management is a prime treatment objective but current symptom assessment tools have not been validated compared to the general population. The MPN-symptom assessment form (MPN-SAF), a reliable and validated clinical tool to assess MPN symptom burden, was administered to MPN patients (n 5 106) and, for the first time, population controls (n 5 124) as part of a UK case-control study. Mean symptom scores were compared between patients and controls adjusting for potential confounders. Mean patient scores were compared to data collected by the Mayo Clinic, USA on 1,446 international MPN patients to determine patient group representativeness. MPN patients had significantly higher mean scores than controls for 25 of the 26 symptoms measured (P < 0.05); fatigue was the most common symptom (92.4% and 78.1%, respectively). Female MPN patients suffered worse symptom burden than male patients (P < 0.001) and substantially worse burden than female controls (P < 0.001). Compared to the Mayo clinic patients, MPN-UK patients reported similar symptom burden but lower satiety (P 5 0.046). Patients with PMF reported the worst symptom burden (88.3%); significantly higher than PV patients (P < 0.001). For the first time we report quality of life was worse in MPN-UK patients compared with controls (P < 0.001).

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Section: Discussionsupporting

confidence: 78%

Myeloproliferative neoplasm patient symptom burden and quality of life: Evidence of significant impairment compared to controls

Anderson¹,

James²,

Duncombe³

et al. 2015

American J Hematol

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“…2,3,5,6 We have previously reported that among patients with MF, the burden of constitutional symptoms is worse than that for other types of solid malignancies including breast cancer and is similar to that for patients with acute myeloid leukemia. 3 Of all MPN symptoms, fatigue stood apart as having the highest severity and prevalence for all MPN subtypes.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies of MPN-related fatigue indicate that it occurs in 81% 2 to 95% 3 of patients with MPNs and is the predominant symptom regardless of MPN subtype. [2][3][4][5][6][7] This fatigue reduces both physical and social functioning and substantially impairs quality of life. 2 Fatigue is a particular challenge for clinicians and patients due to its multifactorial nature.…”

Section: Introductionmentioning

confidence: 99%

Comprehensively understanding fatigue in patients with myeloproliferative neoplasms

Scherber

Kosiorek

Senyak

et al. 2015

Cancer

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BACKGROUND Patients with myeloproliferative neoplasms (MPNs) experience a high persistence, prevalence, and severity of fatigue. There is currently only limited information regarding factors that contribute to fatigue in patients with MPNs. METHODS A 70‐item, Internet‐based survey regarding fatigue was developed by MPN investigators and patients/advocates and hosted by the Mayo Clinic Survey Research Center. RESULTS Fatigue was found to be prevalent and severe among international survey respondents (1788 respondents). Higher body mass index (P<.001), current use of alcohol (P<.001), and current tobacco use (P = .0025) were found to be significantly associated with greater fatigue. Moderate/severe fatigue was present more frequently in those individuals who did not exercise compared with those who reported exercising at least once per week (P<.001). Medical comorbidities found to be significantly associated with greater fatigue included restless leg syndrome (P = .006), diabetes mellitus (P = .045), fibromyalgia (P < 0.001), chronic fatigue syndrome (P = .006), and chronic kidney disease (P = .02). Current use of antidepressants (P<.001), antihistamines (P = .0276), antianxiety medications (P = .0357), and prescription pain medications (P<.001) were found to be associated with worsened fatigue. Nearly 25% of respondents scored > 2 on the Patient Health Questionnaire, indicating a high probability of depression. Higher Brief Fatigue Inventory score, Myeloproliferative Neoplasm Total Symptom Score, and individual symptom items were all associated with a higher likelihood of depressive symptoms (P<.0001). CONCLUSIONS The management of fatigue should be multifactorial, with a comprehensive assessment and treatment plan to address all modifiable fatigue etiologies. Patients with MPNs likely have a higher prevalence of mood disturbances compared with the general population, suggesting the need to assess and intervene in this domain. Cancer 2016;122:477–485. © 2015 American Cancer Society.

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“…Other common aspects of the PV disease state, including blood hyperviscosity (Barbui et al , 2013) and splenomegaly (Mesa et al , 2007), may also play a role in the symptom profile of some patients. The overall PV‐related symptom burden, as measured by the MPN Symptom Assessment Form total symptom score (MPN‐SAF TSS), as well as the severity of individual symptoms, including fatigue (Emanuel et al , 2012; Abelsson et al , 2013) and itching (Siegel et al , 2013), have been associated with reduced quality of life in patients with PV.…”

mentioning

confidence: 99%

The efficacy and safety of continued hydroxycarbamide therapy versus switching to ruxolitinib in patients with polycythaemia vera: a randomized, double‐blind, double‐dummy, symptom study (RELIEF)

et al. 2016

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SummaryThe randomized, double‐blind, double‐dummy, phase 3b RELIEF trial evaluated polycythaemia vera (PV)‐related symptoms in patients who were well controlled with a stable dose of hydroxycarbamide (also termed hydroxyurea) but reported PV‐related symptoms. Patients were randomized 1:1 to ruxolitinib 10 mg BID (n = 54) or hydroxycarbamide (prerandomization dose/schedule; n = 56); crossover to ruxolitinib was permitted after Week 16. The primary endpoint, ≥50% improvement from baseline in myeloproliferative neoplasm ‐symptom assessment form total symptom score cytokine symptom cluster (TSS‐C; sum of tiredness, itching, muscle aches, night sweats, and sweats while awake) at Week 16, was achieved by 43·4% vs. 29·6% of ruxolitinib‐ and hydroxycarbamide‐treated patients, respectively (odds ratio, 1·82; 95% confidence interval, 0·82–4·04; P = 0·139). The primary endpoint was achieved by 34% of a subgroup who maintained their hydroxycarbamide dose from baseline to Weeks 13–16. In a post hoc analysis, the primary endpoint was achieved by more patients with stable screening‐to‐baseline TSS‐C scores (ratio ≤ 2) receiving ruxolitinib than hydroxycarbamide (47·4% vs. 25·0%; P = 0·0346). Ruxolitinib treatment after unblinding was associated with continued symptom score improvements. Adverse events were primarily grades 1/2 with no unexpected safety signals. Ruxolitinib was associated with a nonsignificant trend towards improved PV‐related symptoms versus hydroxycarbamide, although an unexpectedly large proportion of patients who maintained their hydroxycarbamide dose reported symptom improvement.

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Patients with polycythemia vera have worst impairment of quality of life among patients with newly diagnosed myeloproliferative neoplasms

Cited by 49 publications

References 28 publications

Myeloproliferative neoplasm patient symptom burden and quality of life: Evidence of significant impairment compared to controls

Myeloproliferative neoplasm patient symptom burden and quality of life: Evidence of significant impairment compared to controls

Comprehensively understanding fatigue in patients with myeloproliferative neoplasms

The efficacy and safety of continued hydroxycarbamide therapy versus switching to ruxolitinib in patients with polycythaemia vera: a randomized, double‐blind, double‐dummy, symptom study (RELIEF)

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