Preventive Screening in People with Multiple Sclerosis

Barrett, Megan Weigel; Roberts, Brian R.

doi:10.7224/1537-2073-12.4.168

Cited by 6 publications

(4 citation statements)

References 22 publications

(42 reference statements)

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“…Health-care access was ascertained using patient-reported information through completion of surveys by patients in private and academic MS centers. 10 It is reassuring that their observations were generally comparable with the present data.…”

Section: Discussionsupporting

confidence: 80%

“…This is consistent with other literature identifying many barriers to preventive care among disabled women, most of which are based on challenges associated with accessibility. 10,18 For example, a recent study looking at barriers and facilitators related to breast cancer screening in patients with MS reported that more than 80% of women who have not received annual mammograms had mobility impairment. 19 These patients were also more likely to report additional barriers to screening, such as transportation issues, inaccessibility within the facility, difficulty with positioning in the mammogram machine, and barriers related to health-care providers, such as negative attitudes and a lack of referrals.…”

Section: Discussionmentioning

confidence: 99%

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Access to Preventive Health Care in Severely Disabled Women with Multiple Sclerosis

Dobos

Healy²,

Houtchens³

2015

International Journal of MS Care

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Background: Nonambulatory patients may be at risk for poor access to preventive health screening. Few studies have reported on this access in severely disabled women with multiple sclerosis (MS). We sought to describe preventive medical care in the most disabled women with MS and to identify factors that may influence access to care. Methods: Patient records from the Partners MS Center database were reviewed. Women with Expanded Disability Status Scale scores of 7 or greater were selected. Proportions of patients with preventive-care visits were compared with 2012 Centers for Disease Control and Prevention (CDC) guidelines and normative data. Logistic regression was used to assess demographic and disease effects on receiving services. Results: Forty-eight percent of patients had annual mammograms versus 72% of healthy women and the CDC target of 81%; 41.8% had Papanicolaou smears within 3 years compared with 82% of healthy women and the target of 93%; and 61.2% aged 50 years and older ever had a colonoscopy compared with the target of 70%. Younger age predicted lower rates of colonoscopy (P < .002) and mammography (P < .004), and shorter disease duration predicted lower rates of mammography (P < .004). Obesity was associated with a lower likelihood of colonoscopy (P = .007) and bone density screening (P = .02). Conclusions: Women with severe MS disability are vulnerable to significantly decreased access to preventive care. The influence of patient and physician factors and the possible consequent delays in cancer diagnosis should be further clarified.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Access to Preventive Health Care in Severely Disabled Women with Multiple Sclerosis

Dobos

Healy²,

Houtchens³

2015

International Journal of MS Care

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“…Managed care may also be able to use these findings to identify patients who may benefit from interventions. Some patients with MS may not be receiving the recommended preventive care services, 28 and some of the comorbid conditions prevalent in patients with MS may be prevented with proper screenings or better managed with additional patient counseling. 29 Care of patients with MS is optimized with a comprehensive care approach, 30 and the increased complexity from comorbidities reinforces the importance of integrated care.…”

Section: Discussionmentioning

confidence: 99%

Comorbidity in US patients with multiple sclerosis

Edwards¹,

Munsell²,

Menzin³

et al. 2018

PROM

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ObjectiveTo assess the trends in the prevalence of comorbidities in US patients with multiple sclerosis (MS), and the association of demographic characteristics with the presence of comorbidities.Study designA retrospective analysis was conducted from a sample of 5 million patients from the IMS Health Real World Data Adjudicated Claims – US database.MethodsComorbidity in patients with MS was assessed by year (2006–2014), and logistic regression models evaluated the association of age, sex, and region with select comorbidities.ResultsThe most common comorbidities from 2006 to 2014 were hyperlipidemia and hypertension (25.9%–29.7% of patients within an individual year), followed by gastrointestinal disease (18.4%–21.2% of patients) and thyroid disease (12.9%–17.1% of patients). The proportion with a claim for hyperlipidemia increased from 2006 to 2009, was stable from 2009 to 2011, and then declined from 2011 to 2014. The proportion with a claim for hypertension generally increased from 2006 to 2013, then declined from 2013 to 2014. The proportion with a claim for gastrointestinal disease, thyroid disease, and anxiety generally increased from 2006 to 2014. Claims for comorbidities were statistically significantly more likely among older age groups (p<0.05), with the exception of anxiety and alcohol abuse, which were statistically significantly less likely among older age groups. Claims for gastrointestinal disease (OR=0.75), thyroid disease (OR=0.36), chronic lung disease (OR=0.76), arthritis (OR=0.71), anxiety (OR=0.63), and depression (OR=0.69) were statistically significantly less likely among males versus females (all p<0.05). Claims for hyperlipidemia (OR=1.39), hypertension (OR=1.25), diabetes (OR=1.31), and alcohol abuse (OR=2.41) were significantly more likely among males (p<0.05). Many comorbidity claims were statistically significantly more likely in the Northeast and South compared with the Midwest and West.ConclusionThis study provides select comorbidity claims estimates in US patients with MS, and thus highlights the importance of comprehensive patient care approaches.

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“…Cancer Ensure appropriate cancer screening per guidelines, e.g., mammogram, cervical cancer screening, colonoscopy (95). Women with disabilities, including MS, are less likely to get screening (possibly due to clinician biases and more burdensome medical care) (70).…”

Section: Comprehensive Carementioning

confidence: 99%

Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

et al. 2021

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Over two thirds of all individuals who develop multiple sclerosis (MS) will be women prior to the age of menopause. Further, an estimated 30% of the current MS population consists of peri- or postmenopausal women. The presence of MS does not appear to influence age of menopausal onset. In clinical practice, symptoms of MS and menopause can frequently overlap, including disturbances in cognition, mood, sleep, and bladder function, which can create challenges in ascertaining the likely cause of symptoms to be treated. A holistic and comprehensive approach to address these common physical and psychological changes is often suggested to patients during menopause. Although some studies have suggested that women with MS experience reduced relapse rates and increased disability progression post menopause, the data are not consistent enough for firm conclusions to be drawn. Mechanisms through which postmenopausal women with MS may experience disability progression include neuroinflammation and neurodegeneration from age-associated phenomena such as immunosenescence and inflammaging. Additional effects are likely to result from reduced levels of estrogen, which affects MS disease course. Following early retrospective studies of women with MS receiving steroid hormones, more recent interventional trials of exogenous hormone use, albeit as oral contraceptive, have provided some indications of potential benefit on MS outcomes. This review summarizes current research on the effects of menopause in women with MS, including the psychological impact and symptoms of menopause on disease worsening, and the treatment options. Finally, we highlight the need for more inclusion of MS patients from underrepresented racial and geographic groups in clinical trials, including among menopausal women.

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Preventive Screening in People with Multiple Sclerosis

Cited by 6 publications

References 22 publications

Access to Preventive Health Care in Severely Disabled Women with Multiple Sclerosis

Access to Preventive Health Care in Severely Disabled Women with Multiple Sclerosis

Comorbidity in US patients with multiple sclerosis

Effects of Menopause in Women With Multiple Sclerosis: An Evidence-Based Review

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