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Teruaki Iwamoto - One of the best experts on this subject based on the ideXlab platform.
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Recognition and attitudes of Japanese Hematologists on sperm banking before chemotherapy: present status from nationwide questionnaire survey
International Journal of Clinical Oncology, 2019Co-Authors: Yasushi Yumura, Masahumi Kitazawa, Toshiyuki Kakinuma, Nao Suzuki, Seido Takae, Hiroshi Okada, Chie Watanabe, Tatsuya Suzuki, Akira Tsujimura, Teruaki IwamotoAbstract:Background Treatment advancements have improved young cancer patients’ survival rate considerably. Fertility preservation has become a very important tool in the prevention of treatment-induced gonadal toxicity. This study aimed to examine Hematologists’ awareness of its necessity and importance. Methods Questionnaires were mailed to the directors of 230 institutes that treated hematological malignancies in adults. The directors were asked to provide information regarding their institutes, collaboration with sperm banks, the number of patients treated per year, selection criteria for patients providing information, and their awareness of and attitudes toward sperm preservation. Results The response rate was 40.0%. Municipal and private hospitals treated patients significantly less frequently relative to university hospitals ( p = .002). Of the 92 participating hematology institutions, 17 included sperm banks and 69 collaborated with sperm banks in neighboring institutions. Many participants stated that sperm preservation should be performed before chemotherapy; however, only 38% provided sperm preservation information to all patients. Participants in facilities without sperm banks exhibited significantly lower levels of knowledge regarding sperm preservation, relative to those from institutions with sperm banks, and found discussing fertility preservation burdensome. This trend was identical to that observed in a survey conducted 10 years earlier. Conclusion Many Hematologists did not appear to possess sufficient knowledge regarding fertility preservation. Moreover, few institutions included sperm banks, and a considerable burden was exerted on Hematologists. The introduction of support systems is required to promote sperm preservation before cancer treatment.
Deirdra R. Terrell - One of the best experts on this subject based on the ideXlab platform.
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Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general Hematologist-oncologists
Journal of Thrombosis and Thrombolysis, 2018Co-Authors: Allyson M. Pishko, James N. George, Sara K. Vesely, Mudi Misgav, Adam Cuker, Douglas B. Cines, Deirdra R. TerrellAbstract:While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, Hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide Hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients. The survey described hypothetical patient scenarios and asked respondents to recommend a minimum platelet count for initiation of AP/AC therapy. We surveyed both Hematologists with an international reputation in treatment of ITP (n = 48) and also general Hematologist–oncologists in Oklahoma (n = 97). Response rates were 38/48 (79%) for the ITP specialists and 46/97 (47%) for general Hematologist–oncologists. Overall, recommended platelet thresholds for antithrombotic therapy were similar between ITP specialists and general Hematologist–oncologists. Although both groups recommended a minimum platelet count of 50 × 109/L for AP and AC therapy in most scenarios, there was great variability in individual practice patterns among respondents. This study highlights the need for studies of patients with ITP who require AP/AC therapy to provide high-quality evidence for establishing optimal management strategies.
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Management of Primary Immune Thrombocytopenia, 2012: A Survey of Oklahoma Hematologists-Oncologists
Blood, 2012Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract 1094 Introduction With the availability of multiple new agents, management of patients with primary immune thrombocytopenia (ITP) has changed substantially since the initial practice guideline for ITP was developed by the American Society of Hematology (ASH). To document current practice and to determine how current practice is related to recommendations of 2 recent guidelines for ITP, an International Consensus report (ICR), 2010, and an updated ASH guideline, 2011, we surveyed practicing Hematologists-oncologists in Oklahoma. Methods Separate surveys were developed for children and adults. Each survey had 3 clinical scenarios; each scenario had 5–7 management choices. Hematologists-oncologists were instructed to select 1 management choice. Questions were adapted from the clinical scenarios of the ASH guideline. Additionally, data were collected for [1] number of years in practice; [2] site of practice, (either University of Oklahoma Medical Center or community); and [3] the estimated number of patients with ITP seen each year. Oklahoma Hematologists-oncologists were identified by searching the Oklahoma Board of Medical Licensure and the Oklahoma Osteopathic Association websites for all active physicians certified in adult/pediatric hematology/oncology as of 12/31/2011. Exclusion criteria were: physicians whose careers were devoted to full-time research/administration. Data was collected between 1/31/2012–3/15/2012. Only the stronger grades of recommendations by the ICR and ASH guidelines were used for comparison to the Hematologists-oncologists9 responses. Comparison of treatment responses to the number of years in practice was selected a priori , because it was hypothesized that Hematologists-oncologists with fewer years in practice may more readily accept newer treatments while Hematologists-oncologists with more years in practice may prefer more traditional management. Chi-square or Fisher9s exact test were used to determine if treatment responses differed by number of years in practice. SAS version 9.2 was used; alpha was set at 0.05. Results All 13 (100%) Oklahoma pediatric Hematologists-oncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8,000/μL, and minor bleeding, 5 (38%) pediatric Hematologists-oncologists selected observation without drug treatment (recommended by both guidelines). Because of the small number of pediatric Hematologists-oncologists, no comparison of their responses to years in practice was performed. Eighty-three (82%) adult Hematologists-oncologists responded. For an adult with a platelet count of 9,000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by ASH guideline); 31 (37%) selected rituximab and 13 (16%) selected thrombopoietin (TPO)-receptor agonists (both recommended by ICR). There was not a statistically significant difference between the number of years in practice for those who selected splenectomy versus all other treatment options (p = 0.07). Discussion Although both recent guidelines recommended that children with no/mild bleeding may be managed with observation regardless of the platelet count, only 5 (38%) pediatric Hematologists-oncologists selected observation in this scenario. The practice guidelines have different recommendations for second-line treatment in adults: the ICR recommends TPO-receptor agonists and rituximab but not splenectomy; the ASH guideline recommends splenectomy but not TPO-receptor agonists or rituximab. For this clinical scenario, 39% of Hematologists-oncologists selected splenectomy, 37% selected rituximab and 16% selected TPO-agents. These different choices and recommendations reflect the changing clinical practice. Although not statistically significant, the Hematologists-oncologists who had been in practice for >20 years appeared to be more likely to select splenectomy (p=0.07), consistent with greater acceptance of newer treatments by younger Hematologists-oncologists. Although these data may not be generalizable, the high survey response rate provides confidence that these data accurately reflect the judgment, if not the actual practice, of Oklahoma Hematologists-oncologists. Conclusion These observations provide an estimate of actual current clinical practice for management of patients with ITP. Disclosures: Off Label Use: Rituximab for primary immune thrombocytopenia (ITP). George: Alexion, Inc.: Consultancy; Baxter, Inc.: Consultancy; Amgen, Inc.: Consultancy, PI for clinical trial involving romiplostim, PI for clinical trial involving romiplostim Other, Research Funding. Terrell: Amgen, Inc.: Consultancy; Baxter, Inc.: Consultancy.
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corticosteroid side effects and risk for bleeding in immune thrombocytopenic purpura patient and Hematologist perspectives
European Journal of Haematology, 2009Co-Authors: Jacqueline A. Guidry, James N. George, Sara K. Vesely, Shelia M. Kennison, Deirdra R. TerrellAbstract:Objectives: The purpose of this study was to examine Hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient’s risk for bleeding. The specific aim was to compare patient and Hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than Hematologists. Methods: We surveyed 80 patients in the Oklahoma ITP Registry and all 83 Hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results: Response rates were 80% (patients) and 71% (Hematologists). Responses of patients and Hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid side-effects, patients reported more frequent occurrence of severe symptoms than Hematologists (P < 0.05); physicians reported more frequent occurrence for one side-effect (P < 0.05). Conversely, 69% and 93% of Hematologists reported being very worried about serious bleeding when responding to two case scenarios describing patients with platelet counts of 10 000/μL and 5000/μL (P < 0.05), compared with only 16 (31%) of 51 patients whose lowest platelet count had been <10 000/μL. Conclusion: Awareness of the different opinions about corticosteroid side-effects and risk for bleeding between ITP patients and Hematologists may improve management decisions.
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Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and Hematologist perspectives.
European Journal of Haematology, 2009Co-Authors: Jacqueline A. Guidry, James N. George, Sara K. Vesely, Shelia M. Kennison, Deirdra R. TerrellAbstract:Objectives: The purpose of this study was to examine Hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient’s risk for bleeding. The specific aim was to compare patient and Hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than Hematologists. Methods: We surveyed 80 patients in the Oklahoma ITP Registry and all 83 Hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results: Response rates were 80% (patients) and 71% (Hematologists). Responses of patients and Hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid side-effects, patients reported more frequent occurrence of severe symptoms than Hematologists (P
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Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and Hematologist
2009Co-Authors: Jacqueline A. Guidry, James N. George, Sara K. Vesely, Shelia M. Kennison, Deirdra R. TerrellAbstract:Objectives: The purpose of this study was to examine Hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient’s risk for bleeding. The specific aim was to compare patient and Hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than Hematologists. Methods: We surveyed 80 patients in the Oklahoma ITP Registry and all 83 Hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results: Response rates were 80% (patients) and 71% (Hematologists). Responses of patients and Hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid sideeffects, patients reported more frequent occurrence of severe symptoms than Hematologists (P < 0.05); physicians reported more frequent occurrence for one side-effect (P < 0.05). Conversely, 69% and 93% of Hematologists reported being very worried about serious bleeding when responding to two case scenarios describing patients with platelet counts of 10 000 ⁄lL and 5000 ⁄l L( P < 0.05), compared with only 16 (31%) of 51 patients whose lowest platelet count had been
Yasushi Yumura - One of the best experts on this subject based on the ideXlab platform.
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Recognition and attitudes of Japanese Hematologists on sperm banking before chemotherapy: present status from nationwide questionnaire survey
International Journal of Clinical Oncology, 2019Co-Authors: Yasushi Yumura, Masahumi Kitazawa, Toshiyuki Kakinuma, Nao Suzuki, Seido Takae, Hiroshi Okada, Chie Watanabe, Tatsuya Suzuki, Akira Tsujimura, Teruaki IwamotoAbstract:Background Treatment advancements have improved young cancer patients’ survival rate considerably. Fertility preservation has become a very important tool in the prevention of treatment-induced gonadal toxicity. This study aimed to examine Hematologists’ awareness of its necessity and importance. Methods Questionnaires were mailed to the directors of 230 institutes that treated hematological malignancies in adults. The directors were asked to provide information regarding their institutes, collaboration with sperm banks, the number of patients treated per year, selection criteria for patients providing information, and their awareness of and attitudes toward sperm preservation. Results The response rate was 40.0%. Municipal and private hospitals treated patients significantly less frequently relative to university hospitals ( p = .002). Of the 92 participating hematology institutions, 17 included sperm banks and 69 collaborated with sperm banks in neighboring institutions. Many participants stated that sperm preservation should be performed before chemotherapy; however, only 38% provided sperm preservation information to all patients. Participants in facilities without sperm banks exhibited significantly lower levels of knowledge regarding sperm preservation, relative to those from institutions with sperm banks, and found discussing fertility preservation burdensome. This trend was identical to that observed in a survey conducted 10 years earlier. Conclusion Many Hematologists did not appear to possess sufficient knowledge regarding fertility preservation. Moreover, few institutions included sperm banks, and a considerable burden was exerted on Hematologists. The introduction of support systems is required to promote sperm preservation before cancer treatment.
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Recognition and attitudes of Japanese Hematologists on sperm banking before chemotherapy: present status from nationwide questionnaire survey
International Journal of Clinical Oncology, 2018Co-Authors: Yasushi Yumura, Masahumi Kitazawa, Toshiyuki Kakinuma, Seido Takae, Hiroshi Okada, Chie Watanabe, Tatsuya Suzuki, Akira Tsujimura, Nao SuzukiAbstract:Treatment advancements have improved young cancer patients’ survival rate considerably. Fertility preservation has become a very important tool in the prevention of treatment-induced gonadal toxicity. This study aimed to examine Hematologists’ awareness of its necessity and importance. Questionnaires were mailed to the directors of 230 institutes that treated hematological malignancies in adults. The directors were asked to provide information regarding their institutes, collaboration with sperm banks, the number of patients treated per year, selection criteria for patients providing information, and their awareness of and attitudes toward sperm preservation. The response rate was 40.0%. Municipal and private hospitals treated patients significantly less frequently relative to university hospitals (p = .002). Of the 92 participating hematology institutions, 17 included sperm banks and 69 collaborated with sperm banks in neighboring institutions. Many participants stated that sperm preservation should be performed before chemotherapy; however, only 38% provided sperm preservation information to all patients. Participants in facilities without sperm banks exhibited significantly lower levels of knowledge regarding sperm preservation, relative to those from institutions with sperm banks, and found discussing fertility preservation burdensome. This trend was identical to that observed in a survey conducted 10 years earlier. Many Hematologists did not appear to possess sufficient knowledge regarding fertility preservation. Moreover, few institutions included sperm banks, and a considerable burden was exerted on Hematologists. The introduction of support systems is required to promote sperm preservation before cancer treatment.
Dennis L Confer - One of the best experts on this subject based on the ideXlab platform.
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radiologic and nuclear events contingency planning for Hematologists oncologists
Blood, 2008Co-Authors: David M Weinstock, Cullen Case, Judith L Bader, Nelson J Chao, Norman C Coleman, Richard J Hatchett, Daniel J Weisdorf, Dennis L ConferAbstract:Untoward events involving radioactive material, either accidental or intentional, are potentially devastating. Hematologists and oncologists are uniquely suited to help manage radiation victims, as myelosuppression is a frequent complication of radiation exposure. In the aftermath of a large event, such as a nuclear detonation, there may be a national call for surge capacity that involves Hematologists/oncologists across the country in the disaster response. In preparation, the National Marrow Donor Program and American Society for Blood and Marrow Transplantation have established the Radiation Injury Treatment Network (RITN), a voluntary consortium of transplant centers, donor centers, and umbilical cord blood banks. RITN is partnered with the Office of the Assistant Secretary for Preparedness and Response in the United States Department of Health and Human Services to develop treatment guidelines, educate healthcare professionals, coordinate situation response, and provide comprehensive evaluation and care for radiation injury victims. We outline the current plans for event response and describe scenarios, including catastrophic events that would require extensive support from Hematologists/oncologists across the country. In addition, we highlight important reference resources and discuss current efforts to develop medical countermeasures against radiation toxicity. Practitioners and institutions across the country are encouraged to become involved and participate in the planning.
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Radiologic and nuclear events: contingency planning for Hematologists/oncologists
Blood, 2008Co-Authors: David M Weinstock, Cullen Case, Judith L Bader, Nelson J Chao, Richard J Hatchett, Daniel J Weisdorf, C. Norman Coleman, Dennis L ConferAbstract:Untoward events involving radioactive material, either accidental or intentional, are potentially devastating. Hematologists and oncologists are uniquely suited to help manage radiation victims, as myelosuppression is a frequent complication of radiation exposure. In the aftermath of a large event, such as a nuclear detonation, there may be a national call for surge capacity that involves Hematologists/oncologists across the country in the disaster response. In preparation, the National Marrow Donor Program and American Society for Blood and Marrow Transplantation have established the Radiation Injury Treatment Network (RITN), a voluntary consortium of transplant centers, donor centers, and umbilical cord blood banks. RITN is partnered with the Office of the Assistant Secretary for Preparedness and Response in the United States Department of Health and Human Services to develop treatment guidelines, educate healthcare professionals, coordinate situation response, and provide comprehensive evaluation and care for radiation injury victims. We outline the current plans for event response and describe scenarios, including catastrophic events that would require extensive support from Hematologists/oncologists across the country. In addition, we highlight important reference resources and discuss current efforts to develop medical countermeasures against radiation toxicity. Practitioners and institutions across the country are encouraged to become involved and participate in the planning.
James N. George - One of the best experts on this subject based on the ideXlab platform.
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Management of antithrombotic therapy in adults with immune thrombocytopenia (ITP): a survey of ITP specialists and general Hematologist-oncologists
Journal of Thrombosis and Thrombolysis, 2018Co-Authors: Allyson M. Pishko, James N. George, Sara K. Vesely, Mudi Misgav, Adam Cuker, Douglas B. Cines, Deirdra R. TerrellAbstract:While patients with immune thrombocytopenia (ITP) and low platelet counts are at risk for bleeding, they are not protected against arterial and venous thrombotic events. Frequently, Hematologists are asked to consult on a patient with ITP requiring an antiplatelet (AP) agent or anticoagulant (AC). No direct evidence exists to guide Hematologists in weighing the risk of thrombosis against the risk of bleeding in patients with ITP. Therefore, we performed a survey to determine the preferred management of AP/AC therapy in ITP patients. The survey described hypothetical patient scenarios and asked respondents to recommend a minimum platelet count for initiation of AP/AC therapy. We surveyed both Hematologists with an international reputation in treatment of ITP (n = 48) and also general Hematologist–oncologists in Oklahoma (n = 97). Response rates were 38/48 (79%) for the ITP specialists and 46/97 (47%) for general Hematologist–oncologists. Overall, recommended platelet thresholds for antithrombotic therapy were similar between ITP specialists and general Hematologist–oncologists. Although both groups recommended a minimum platelet count of 50 × 109/L for AP and AC therapy in most scenarios, there was great variability in individual practice patterns among respondents. This study highlights the need for studies of patients with ITP who require AP/AC therapy to provide high-quality evidence for establishing optimal management strategies.
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Management of Primary Immune Thrombocytopenia, 2012: A Survey of Oklahoma Hematologists-Oncologists
Blood, 2012Co-Authors: James N. George, Sara K. Vesely, Deirdra R. TerrellAbstract:Abstract 1094 Introduction With the availability of multiple new agents, management of patients with primary immune thrombocytopenia (ITP) has changed substantially since the initial practice guideline for ITP was developed by the American Society of Hematology (ASH). To document current practice and to determine how current practice is related to recommendations of 2 recent guidelines for ITP, an International Consensus report (ICR), 2010, and an updated ASH guideline, 2011, we surveyed practicing Hematologists-oncologists in Oklahoma. Methods Separate surveys were developed for children and adults. Each survey had 3 clinical scenarios; each scenario had 5–7 management choices. Hematologists-oncologists were instructed to select 1 management choice. Questions were adapted from the clinical scenarios of the ASH guideline. Additionally, data were collected for [1] number of years in practice; [2] site of practice, (either University of Oklahoma Medical Center or community); and [3] the estimated number of patients with ITP seen each year. Oklahoma Hematologists-oncologists were identified by searching the Oklahoma Board of Medical Licensure and the Oklahoma Osteopathic Association websites for all active physicians certified in adult/pediatric hematology/oncology as of 12/31/2011. Exclusion criteria were: physicians whose careers were devoted to full-time research/administration. Data was collected between 1/31/2012–3/15/2012. Only the stronger grades of recommendations by the ICR and ASH guidelines were used for comparison to the Hematologists-oncologists9 responses. Comparison of treatment responses to the number of years in practice was selected a priori , because it was hypothesized that Hematologists-oncologists with fewer years in practice may more readily accept newer treatments while Hematologists-oncologists with more years in practice may prefer more traditional management. Chi-square or Fisher9s exact test were used to determine if treatment responses differed by number of years in practice. SAS version 9.2 was used; alpha was set at 0.05. Results All 13 (100%) Oklahoma pediatric Hematologists-oncologists responded. For a child with a new diagnosis of ITP, a platelet count of 8,000/μL, and minor bleeding, 5 (38%) pediatric Hematologists-oncologists selected observation without drug treatment (recommended by both guidelines). Because of the small number of pediatric Hematologists-oncologists, no comparison of their responses to years in practice was performed. Eighty-three (82%) adult Hematologists-oncologists responded. For an adult with a platelet count of 9,000/μL who had failed to respond to initial treatment with corticosteroids and IVIg, 32 (39%) selected splenectomy (recommended by ASH guideline); 31 (37%) selected rituximab and 13 (16%) selected thrombopoietin (TPO)-receptor agonists (both recommended by ICR). There was not a statistically significant difference between the number of years in practice for those who selected splenectomy versus all other treatment options (p = 0.07). Discussion Although both recent guidelines recommended that children with no/mild bleeding may be managed with observation regardless of the platelet count, only 5 (38%) pediatric Hematologists-oncologists selected observation in this scenario. The practice guidelines have different recommendations for second-line treatment in adults: the ICR recommends TPO-receptor agonists and rituximab but not splenectomy; the ASH guideline recommends splenectomy but not TPO-receptor agonists or rituximab. For this clinical scenario, 39% of Hematologists-oncologists selected splenectomy, 37% selected rituximab and 16% selected TPO-agents. These different choices and recommendations reflect the changing clinical practice. Although not statistically significant, the Hematologists-oncologists who had been in practice for >20 years appeared to be more likely to select splenectomy (p=0.07), consistent with greater acceptance of newer treatments by younger Hematologists-oncologists. Although these data may not be generalizable, the high survey response rate provides confidence that these data accurately reflect the judgment, if not the actual practice, of Oklahoma Hematologists-oncologists. Conclusion These observations provide an estimate of actual current clinical practice for management of patients with ITP. Disclosures: Off Label Use: Rituximab for primary immune thrombocytopenia (ITP). George: Alexion, Inc.: Consultancy; Baxter, Inc.: Consultancy; Amgen, Inc.: Consultancy, PI for clinical trial involving romiplostim, PI for clinical trial involving romiplostim Other, Research Funding. Terrell: Amgen, Inc.: Consultancy; Baxter, Inc.: Consultancy.
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corticosteroid side effects and risk for bleeding in immune thrombocytopenic purpura patient and Hematologist perspectives
European Journal of Haematology, 2009Co-Authors: Jacqueline A. Guidry, James N. George, Sara K. Vesely, Shelia M. Kennison, Deirdra R. TerrellAbstract:Objectives: The purpose of this study was to examine Hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient’s risk for bleeding. The specific aim was to compare patient and Hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than Hematologists. Methods: We surveyed 80 patients in the Oklahoma ITP Registry and all 83 Hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results: Response rates were 80% (patients) and 71% (Hematologists). Responses of patients and Hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid side-effects, patients reported more frequent occurrence of severe symptoms than Hematologists (P < 0.05); physicians reported more frequent occurrence for one side-effect (P < 0.05). Conversely, 69% and 93% of Hematologists reported being very worried about serious bleeding when responding to two case scenarios describing patients with platelet counts of 10 000/μL and 5000/μL (P < 0.05), compared with only 16 (31%) of 51 patients whose lowest platelet count had been <10 000/μL. Conclusion: Awareness of the different opinions about corticosteroid side-effects and risk for bleeding between ITP patients and Hematologists may improve management decisions.
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Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and Hematologist perspectives.
European Journal of Haematology, 2009Co-Authors: Jacqueline A. Guidry, James N. George, Sara K. Vesely, Shelia M. Kennison, Deirdra R. TerrellAbstract:Objectives: The purpose of this study was to examine Hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient’s risk for bleeding. The specific aim was to compare patient and Hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than Hematologists. Methods: We surveyed 80 patients in the Oklahoma ITP Registry and all 83 Hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results: Response rates were 80% (patients) and 71% (Hematologists). Responses of patients and Hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid side-effects, patients reported more frequent occurrence of severe symptoms than Hematologists (P
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Corticosteroid side-effects and risk for bleeding in immune thrombocytopenic purpura: patient and Hematologist
2009Co-Authors: Jacqueline A. Guidry, James N. George, Sara K. Vesely, Shelia M. Kennison, Deirdra R. TerrellAbstract:Objectives: The purpose of this study was to examine Hematologist and patient perspectives about the side-effects of the corticosteroid treatment of immune thrombocytopenic purpura (ITP) and their perspectives about the patient’s risk for bleeding. The specific aim was to compare patient and Hematologist perspectives and, if a difference was documented, the implications of that difference. We hypothesized that patients with ITP may have more concern about corticosteroid side-effects and less concern about serious bleeding than Hematologists. Methods: We surveyed 80 patients in the Oklahoma ITP Registry and all 83 Hematologists in Oklahoma about the occurrence and severity of 18 corticosteroid side-effects and risks for serious bleeding. Results: Response rates were 80% (patients) and 71% (Hematologists). Responses of patients and Hematologists were significantly different from each other regarding both the frequency of severe corticosteroid side-effects and the risk of serious bleeding. For 13 of the 18 corticosteroid sideeffects, patients reported more frequent occurrence of severe symptoms than Hematologists (P < 0.05); physicians reported more frequent occurrence for one side-effect (P < 0.05). Conversely, 69% and 93% of Hematologists reported being very worried about serious bleeding when responding to two case scenarios describing patients with platelet counts of 10 000 ⁄lL and 5000 ⁄l L( P < 0.05), compared with only 16 (31%) of 51 patients whose lowest platelet count had been