RESUMEN
Steroid refractory acute graft-versus-host-disease of the gut is a serious complication associated with high mortality after allogeneic stem cell transplantation. Treatment options are limited and not predictably effective. We describe the treatment of steroid-refractory acute graft-versus-host-disease with vedolizumab, an antibody directed against integrin α4ß7, in 6 patients. All patients responded, and 4 of 6 patients are alive with a median follow-up of 10 months.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Integrinas/efectos de los fármacos , Enfermedades Intestinales/tratamiento farmacológico , Adulto , Femenino , Fármacos Gastrointestinales/uso terapéutico , Enfermedad Injerto contra Huésped/patología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Terapia Recuperativa/métodos , Esteroides/uso terapéutico , Trasplante Homólogo , Resultado del TratamientoRESUMEN
OBJECTIVE: To examine the effects of a computer-assisted, interactive tailored patient assessment (ITPA) tool in oncology practice on: documented patient care, symptom distress, and patients' need for symptom management support during treatment and rehabilitation. DESIGN AND METHODS: For this repeated measures clinical trial at a university hospital in Norway, 145 patients starting treatment for leukemia or lymphoma were randomly assigned to either an intervention (n=75) or control group (n=70). Both groups used the ITPA for symptom assessments prior to inpatient and outpatient visits for up to one year. The assessment summary, which displayed patients' self-reported symptoms, problems, and distress in rank-order of the patient's need for support, was provided to physicians and nurses in the intervention group only but not in the control group. RESULTS: Significantly more symptoms were addressed in the intervention group patient charts versus those of the control group. Symptom distress in the intervention group decreased significantly over time in 11 (58%) of 19 symptom/problem categories versus 2 (10%) for the control group. Need for symptom management support over time also decreased significantly more for the intervention group than the control group in 13 (68%) symptom categories. CONCLUSION: This is the first study to show that an ITPA used in an interdisciplinary oncology practice can significantly improve patient-centered care and patient outcomes, including reduced symptom distress and reduced need for symptom management support.
Asunto(s)
Leucemia/terapia , Linfoma/terapia , Calidad de Vida , Apoyo Social , Terapia Asistida por Computador , Interfaz Usuario-Computador , Adulto , Depresión/prevención & control , Humanos , Leucemia/enfermería , Leucemia/psicología , Modelos Lineales , Linfoma/enfermería , Linfoma/psicología , Noruega , Atención Dirigida al Paciente , Método Simple CiegoRESUMEN
We compared the performance of a computerized symptom assessment tool called Choice in terms of number of symptoms and time needed for 92 cancer patients with two other standard methods: interview and questionnaire. Choice outperformed interviews in number and precision of reported symptoms, and did better than questionnaires in focusing on bothersome symptoms. There were high correlations between Choice and questionnaires. Interface and symptom structure play an important role for adequately eliciting patients' symptoms.