EHA Library - The official digital education library of European Hematology Association (EHA)

THE SIMM STUDY: SURVEY OF INTEGRATIVE MEDICINE IN MYELOPROLIFERATIVE NEOPLASMS
Author(s): ,
Krisstina Gowin
Affiliations:
Hematology and Medical Oncology,Mayo Clinic Arizona,Phoenix,United States
,
Denise Millstine
Affiliations:
Integrative Medicine Program, Department of Medicine,Mayo Clinic Arizona,Phoenix,United States
,
Heidi Kosiorek
Affiliations:
Department of Biostatistics,Mayo Clinic Arizona,Phoenix,United States
,
Blake Langlais
Affiliations:
Department of Biostatistics,Mayo Clinic Arizona,Phoenix,United States
,
Jennifer Huberty
Affiliations:
School of Nutrition and Health Promotion,Arizona State University,Phoenix,United States
,
Ryan Eckert
Affiliations:
School of Nutrition and Health Promotion,Arizona State University,Phoenix,United States
Ruben Mesa
Affiliations:
Hematology,Mayo Clinic Arizona,Phoenix,United States
(Abstract release date: 05/18/17) EHA Library. gowin K. 06/24/17; 181792; S505
Krisstina gowin
Krisstina gowin
Contributions
Abstract

Abstract: S505

Type: Oral Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:00 - 17:15

Location: Room N109

Background
Pharmacologic therapy stabilizes hematologic counts and splenomegaly in myeloproliferative neoplasms (MPN), however only partial symptom improvement typically occurs. Evidenced-based integrative care may address this need, however data is limited in patients with MPNs. 

Aims
To investigate integrative therapy utilization association with symptom burden, quality of life, depression, and fatigue in MPN patients.

Methods
Patients were recruited via social media. Informed consent and online self-report surveys (Qualtrics) were completed capturing patient demographics, disease specific data, supportive care utilization, MPN symptom burden via MPN-SAF TSS, depression via Patient Health Questionnaire (PHQ)-9, fatigue via Brief Fatigue Inventory (BFI) Usual, and an overall quality of life (QOL) single question assessment. ANOVA, chi square tests, and Wilcoxon rank sum tests methods were applied.

Results
Patients: A total of 1087 patient surveys were consented. Of these, 858 had 10 or more responses. There were 338 essential thrombocytosis (ET), 188 myelofibrosis (MF), 315 polycythemia vera (PV), and 17 other. In MF: DIPSS risk categories included low (8%), Int-1 (19%), Int-2 (29%), high (12%), and unknown (32%).Symptom association:  Overall, patients had lower MPN related symptoms when participating in aerobic activity (p<0.001), massage (p=<0.001), yoga (p=0.02), strength training (p<0.001), breathing exercises (p=<0.001), and support groups (0.001). Overall quality of life was higher with aerobic activity (p=<0.001), massage (p=0.02), yoga (p=0.02), strength training (p=<0.001), breathing exercises (p=0.01), and support groups (p=0.001). Depression (PHQ-9 total >3 category) was lower in aerobic activity group (p=0.001), yoga (p=0.001), strength training (p=0.001), and meditation (p=0.2). Fatigue was lower in aerobic activity (p=<0.001), massage (p=0.04), strength training (p=<0.001), breathing exercises (p=<0.001), and support groups (p=0.001). In subgroup analysis, ET and PV patients had lower symptom burden (MPN-SAF TSS) with aerobic activity (p=<0.001, <0.001), massage (p= 0.01, 0.02), and strength training (p=0.03,0.02). Support groups were found to be associated with lower symptoms in ET patients (p=0.03). In MF, breathing exercises (p=<0.001) and support groups (p=0.03) were associated with lower symptom burden. See Table #1.

 
Overall
N = 858 
 
 
 
ET
N=338
PV
N=315
MF
N=188
 
MPN-SAF TSS
QOL
PHQ-2
BFI-
USUAL
MPN-SAF TSS
MPN-SAF
TSS
MPN-SAF TSS
Aerobic Activity
(Overall) N=442
<0.001
<0.001
0.001
<0.001
<0.001
<0.001
0.06
Massage
N=244
<0.001
0.02
0.94
0.04
0.01
0.02
0.14
Yoga
N=220
0.02
0.02
0.001
0.07
0.35
0.14
0.34
Nutrition
N=216
0.10
0.18
0.25
0.48
0.36
0.07
0.68
Strength training
N=204
<0.001
<0.001
0.001
<0.001
0.03
0.02
0.14
Acupuncture
N=166
0.18
0.08
0.18
0.63
0.20
0.90
0.14
Meditation
N=163
0.16
0.45
0.02
0.16
0.16
0.99
0.25
Breathing exercise
N=158
<0.001
0.01
0.12
<0.001
0.37
0.30
<0.001
Chiropractic
N=139
0.87
0.81
0.15
0.60
0.39
0.55
0.94
Support groups
N=124
0.001
0.001
0.15
0.001
0.03
0.08
0.03

Conclusion
Integrative therapies are associated with improved symptom burden, quality of life, depression, and fatigue in MPN patients. Interestingly, unique patterns were associated within MPN subtypes. Further studies are needed to understand the benefits of integrative therapies in MPN patients. 

 
 

Session topic: 35. Quality of life, palliative care, ethics and health economics

Keyword(s): Supportive care, Quality of Life, Myeloproliferative disorder

Abstract: S505

Type: Oral Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:00 - 17:15

Location: Room N109

Background
Pharmacologic therapy stabilizes hematologic counts and splenomegaly in myeloproliferative neoplasms (MPN), however only partial symptom improvement typically occurs. Evidenced-based integrative care may address this need, however data is limited in patients with MPNs. 

Aims
To investigate integrative therapy utilization association with symptom burden, quality of life, depression, and fatigue in MPN patients.

Methods
Patients were recruited via social media. Informed consent and online self-report surveys (Qualtrics) were completed capturing patient demographics, disease specific data, supportive care utilization, MPN symptom burden via MPN-SAF TSS, depression via Patient Health Questionnaire (PHQ)-9, fatigue via Brief Fatigue Inventory (BFI) Usual, and an overall quality of life (QOL) single question assessment. ANOVA, chi square tests, and Wilcoxon rank sum tests methods were applied.

Results
Patients: A total of 1087 patient surveys were consented. Of these, 858 had 10 or more responses. There were 338 essential thrombocytosis (ET), 188 myelofibrosis (MF), 315 polycythemia vera (PV), and 17 other. In MF: DIPSS risk categories included low (8%), Int-1 (19%), Int-2 (29%), high (12%), and unknown (32%).Symptom association:  Overall, patients had lower MPN related symptoms when participating in aerobic activity (p<0.001), massage (p=<0.001), yoga (p=0.02), strength training (p<0.001), breathing exercises (p=<0.001), and support groups (0.001). Overall quality of life was higher with aerobic activity (p=<0.001), massage (p=0.02), yoga (p=0.02), strength training (p=<0.001), breathing exercises (p=0.01), and support groups (p=0.001). Depression (PHQ-9 total >3 category) was lower in aerobic activity group (p=0.001), yoga (p=0.001), strength training (p=0.001), and meditation (p=0.2). Fatigue was lower in aerobic activity (p=<0.001), massage (p=0.04), strength training (p=<0.001), breathing exercises (p=<0.001), and support groups (p=0.001). In subgroup analysis, ET and PV patients had lower symptom burden (MPN-SAF TSS) with aerobic activity (p=<0.001, <0.001), massage (p= 0.01, 0.02), and strength training (p=0.03,0.02). Support groups were found to be associated with lower symptoms in ET patients (p=0.03). In MF, breathing exercises (p=<0.001) and support groups (p=0.03) were associated with lower symptom burden. See Table #1.

 
Overall
N = 858 
 
 
 
ET
N=338
PV
N=315
MF
N=188
 
MPN-SAF TSS
QOL
PHQ-2
BFI-
USUAL
MPN-SAF TSS
MPN-SAF
TSS
MPN-SAF TSS
Aerobic Activity
(Overall) N=442
<0.001
<0.001
0.001
<0.001
<0.001
<0.001
0.06
Massage
N=244
<0.001
0.02
0.94
0.04
0.01
0.02
0.14
Yoga
N=220
0.02
0.02
0.001
0.07
0.35
0.14
0.34
Nutrition
N=216
0.10
0.18
0.25
0.48
0.36
0.07
0.68
Strength training
N=204
<0.001
<0.001
0.001
<0.001
0.03
0.02
0.14
Acupuncture
N=166
0.18
0.08
0.18
0.63
0.20
0.90
0.14
Meditation
N=163
0.16
0.45
0.02
0.16
0.16
0.99
0.25
Breathing exercise
N=158
<0.001
0.01
0.12
<0.001
0.37
0.30
<0.001
Chiropractic
N=139
0.87
0.81
0.15
0.60
0.39
0.55
0.94
Support groups
N=124
0.001
0.001
0.15
0.001
0.03
0.08
0.03

Conclusion
Integrative therapies are associated with improved symptom burden, quality of life, depression, and fatigue in MPN patients. Interestingly, unique patterns were associated within MPN subtypes. Further studies are needed to understand the benefits of integrative therapies in MPN patients. 

 
 

Session topic: 35. Quality of life, palliative care, ethics and health economics

Keyword(s): Supportive care, Quality of Life, Myeloproliferative disorder

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