Survey of Patients Referred to a University Cancer Center for Benign Hematology: Quality Measures and Patient Understanding

Khimani, Farhad; Curley, Brendan F.; Almubarak, Mohammed

doi:10.1200/jop.2014.001543

Cited by 12 publications

(12 citation statements)

References 6 publications

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“…Patients with MGUS may experience psychological distress similar to that experienced by those with MM, and the identification of cancer precursor states must be accompanied by a discussion of the utility of follow-up in individual patients. 38-42 Promising efforts that evaluate MGUS screening and continuous follow-up before clinical manifestation of MM are under way in a long-term, prospective, three-armed randomized trial (iStopMM). 43 Such long-term efforts highlight the utility of predictive tools such as the one developed here.…”

Section: Discussionmentioning

confidence: 99%

Computational Model of Progression to Multiple Myeloma Identifies Optimum Screening Strategies

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Ferlic

Galla

et al. 2018

JCO Clinical Cancer Informatics

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PurposeRecent advances have uncovered therapeutic interventions that might reduce the risk of progression of premalignant diagnoses, such as monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). It remains unclear how to best screen populations at risk and how to evaluate the ability of these interventions to reduce disease prevalence and mortality at the population level. To address these questions, we developed a computational modeling framework.Materials and MethodsWe used individual-based computational modeling of MGUS incidence and progression across a population of diverse individuals to determine best screening strategies in terms of screening start, intervals, and risk-group specificity. Inputs were life tables, MGUS incidence, and baseline MM survival. We measured MM-specific mortality and MM prevalence after MGUS detection from simulations and mathematic modeling predictions.ResultsOur framework is applicable to a wide spectrum of screening and intervention scenarios, including variation of the baseline MGUS to MM progression rate and evolving MGUS, in which progression increases over time. Given the currently available point estimate of progression risk reduction to 61% risk, starting screening at age 55 years and performing follow-up screening every 6 years reduced total MM prevalence by 19%. The same reduction could be achieved with starting screening at age 65 years and performing follow-up screening every 2 years. A 40% progression risk reduction per patient with MGUS per year would reduce MM-specific mortality by 40%. Specifically, screening onset age and screening frequency can change disease prevalence, and progression risk reduction changes both prevalence and disease-specific mortality. Screening would generally be favorable in high-risk individuals.ConclusionScreening efforts should focus on specifically identified groups with high lifetime risk of MGUS, for which screening benefits can be significant. Screening low-risk individuals with MGUS would require improved preventions.

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Section: Discussionmentioning

confidence: 99%

Computational Model of Progression to Multiple Myeloma Identifies Optimum Screening Strategies

Altrock

Ferlic

Galla

et al. 2018

JCO Clinical Cancer Informatics

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“…2,4,5 Patients with MGUS progress to multiple myeloma at a rate of approximately 1% annually, 6,7 yet despite the relatively low risk of progression, patients with MGUS undergo clinical follow up every 6-12 months for signs of disease progression. [8][9][10] There are no population-based screening recommendations for MGUS detection, primarily due to a lack of treatment for MGUS and the relatively low probability of subsequent development of multiple myeloma. 6,7 However, patients may experience high levels of stress after a diagnosis of MGUS, [8][9][10] which could result in changes in healthcare services utilization.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Differences in Hospital, Emergency Room and Outpatient Visits Among Adults With and Without Monoclonal Gammopathy of Undetermined Significance

et al. 2022

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Introduction This study evaluated the impact of receiving a monoclonal gammopathy of undetermined significance (MGUS) diagnosis on healthcare utilization from patients at a community-based multispecialty provider organization. Methods A cohort of patients with MGUS (n = 429) were matched on sex, age, and length of enrollment to a cohort of patients without MGUS (n = 1286). Healthcare utilization was assessed: 1-12 months before, 1 month before and after, and 1-12 months after diagnosis/index date. Multivariable conditional Poisson models compared change in utilization of each service in patients with and without MGUS. Results During the 2 months around diagnosis/index date, the rates of emergency room, hospital and outpatient visits were higher for patients with MGUS than patients without MGUS. In the year before MGUS diagnosis, the association was still elevated, although attenuated. Conclusion Understanding the care of MGUS patients is important given that multiple myeloma patients with a pre-existing MGUS diagnosis may have a better prognosis.

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“…While there is no negative impact of these unnecessary patient referrals on the quality of care and patient outcome, these false positives can result in the ineffective use of medical resources, and undue anxiety and stress for the patient. 6 Overa ® , a second-generation multivariate index assay, was developed to improve the specificity of OVA1. 7 Overa was derived from the serum concentrations of APO-A1, TRF, CA125, Human Epididymis Protein 4 (HE4) and follicle-stimulating hormone (FSH).…”

mentioning

confidence: 99%

A reflex testing protocol using two multivariate index assays improves the risk assessment for ovarian cancer in patients with an adnexal mass

Bullock

2023

Intl J Gynecology & Obste

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Objectives Patients with adnexal masses suspicious for malignancy benefit from referral to oncology specialists during presurgical assessment of the mass. OVA1 is a multivariate assay using a five‐biomarker panel which offers high overall and early‐stage sensitivity. However, OVA1 has a high false‐positive rate for benign masses. Overa, a second‐generation multivariate index assay was developed to reduce the false‐positive rate. The aim of the present study was to use Overa as a reflex for OVA1 and increase specificity. Methods OVA1 cut‐off scores were established to place patients into three categories: low, intermediate, and high cancer risk. Samples with intermediate‐risk OVA1 scores were reflexed to the Overa and defined as high or low risk. This protocol was tested with 1035 prospectively collected serum samples and validated with an independent prospectively collected sample set (N = 207). Results Thirty‐five per cent (359) of samples had intermediate OVA1 scores. Reflexing these to Overa eliminated 58% of the false‐positives and improved the overall specificity from 50% to 72%. This finding was confirmed in the independent dataset, in which the specificity increased from 56% to 73%. Conclusions Reflexing samples with intermediate OVA1 scores significantly decreases the false‐positive rate, thereby reducing unnecessary surgical referrals.

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Survey of Patients Referred to a University Cancer Center for Benign Hematology: Quality Measures and Patient Understanding

Abstract: Referral to outpatient clinics in a cancer center for benign hematologic diseases seems to increase psychological stress and anxiety among patients, who may perceive that they are being referred for evaluation of a cancer diagnosis.

Cited by 12 publications

References 6 publications

Computational Model of Progression to Multiple Myeloma Identifies Optimum Screening Strategies

Computational Model of Progression to Multiple Myeloma Identifies Optimum Screening Strategies

Differences in Hospital, Emergency Room and Outpatient Visits Among Adults With and Without Monoclonal Gammopathy of Undetermined Significance

A reflex testing protocol using two multivariate index assays improves the risk assessment for ovarian cancer in patients with an adnexal mass

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