By Bart Scott, MD

2008-12-09

This year at ASH there are four separate oral sessions addressing health services and outcomes research. These sessions cover benign hematology, supportive care and methods, outcomes in stem cell transplantation, and patterns of care.

In the oral session on Benign Hematology, Dr. Nicole Kuderer and colleagues (abstract #172) presented a venous thromboembolism (VTE) risk model that predicts progression and overall mortality in cancer patients receiving chemotherapy. In multivariate analysis, a higher risk of VTE was associated with all-cause mortality. Prof. Ajay Kakkar and colleagues (abstract #171) examined the impact of surgery type and co-morbidities on prophylaxis for VTE. Patients undergoing major orthopedic surgeries were more likely to receive prophylaxis, whereas subjects undergoing urologic/gynecologic surgery were less likely to receive prophylaxis. Surgery type was the most important factor associated with the decision to provide prophylaxis for VTE.

A separate oral session covered supportive care and methods. Dr. Anja Magazin and colleagues (abstract #671) presented data regarding the influence of expectation-bias on the inconclusive results of randomized controlled trials in hematologic malignancies. Overall, the trials enrolled more patients than actually planned. But, the effect size was overestimated with a mean expected effect of 47 percent and an actual effect of 12 percent. The authors conclude that unrealistic expectations of treatment effects are a major factor for the large number of inconclusive results. Dr. Leah Kleinman and colleagues (abstract #668) presented data regarding an anemia impact measure for patients receiving chemotherapy. Among the subjects interviewed for the anemia impact measure, 83 percent rated tiredness as the most important symptom of anemia. The final anemia impact measure included a daily diary measuring symptoms such as tiredness, weakness, and exhaustion, as well as a weekly questionnaire measuring daily functions such as cognitive, emotional, and social/leisure activities.

In a session covering outcomes after stem cell transplantation (SCT), Dr. Can-Lan Sun and colleagues (abstract #741) presented data regarding the ethnic differences in the prevalence of anxiety, depression, and somatic distress in long-term post-transplant survivors. The risk ratio for depression was 1.99 and 3.13 for global distress in Hispanics compared to non-Hispanic Caucasians. The authors concluded that mental health problems are prevalent following SCT and that Hispanics appear to be at higher risk following SCT. Dr. F. Lennie Wong and colleagues (abstract #743) presented data regarding the decline in sexual functioning after SCT. In their analysis, gender appeared to modify the effect that irradiation had on sexual function. Interestingly, the degree of sexual dysfunction was worse in women than in men at all post-transplant time points. The authors concluded that more attention should be given to post-transplant sexual dysfunction and that a multidisciplinary approach is needed.

A separate oral session addressing patterns of care for hematologic diseases will be held today at 7:00 a.m., in Rooms 120-125 – North. Carla M. Van Bennekom, MPH, and colleagues (abstract #876) will report how newer agents for MDS have changed treatment patterns. Dr. Dianne Pulte and colleagues (abstract #877) will present data regarding the long-term survival of adolescents with hematologic malignancies. The authors will compare current survival trends with historical controls. Fiona Ryan, MPharm, and colleagues (abstract #879) will present data regarding a self-testing system for warfarin therapy. Additionally, Dr. Fausto Loberiza Jr. and colleagues (abstract #874) will present information regarding survival disparities in lymphoma patients by place of residence and treatment provider.

Health services and outcomes remains a vital component of hematologic research. As indicated above, several exciting advancements are being pursued that vary from developing new assessment models to easier methods to deliver therapy. Additionally, we are gaining a better understanding of how new therapies are incorporated into practice and the ultimate impact that these new therapies have on patient outcomes.

Dr. Scott indicated no relevant conflicts of interest.

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