ABSTRACT
INTRODUCTION: Anesthesiologists and intensive care specialists are considered to be an extremely vulnerable group of medical specialists, more susceptible to professional stress in the context of the COVID-19 pandemic. OBJECTIVE: We aimed to study the severity of professional burnout syndrome (PB), quality of life (QoL) issues and psychological burben in anesthesiologists and intensive care specialists working in a multi-field hospital, as well as to determine the risk factors for PB in these specialists. MATERIALS AND METHODS: Physicians completed the online survey questionnaire including MBI, WHOQOL-BREF and HADS for assessment of PB, QoL and anxiety and depression, respectively, as well as the checklists with general questions related to COVID-19. Pairwise or multiple comparisons as well as correlation and regression analyses were performed within the statistical analysis. RESULTS: The online survey involved 101 physicians (mean age 38.3 ± 9.8 years, 54.5% — females). During the pandemic, 68.3% of specialists worked in the red zone. It was demonstrated that the PB syndrome or its signs were observed 2 years after the start of the pandemic in 75% of specialists — in 27% it was formed, and in 48% its signs were revealed. Decreased levels of the main QoL domains, physical, psychological and social well-being, were observed in 1/3 of physicians. About one third of specialists had borderline or increased levels of anxiety/depression. Working in the red zone during pandemic and elevated levels of depression increase the probability of PB, and a high level of social well-being decreases it. CONCLUSIONS: For the prevention of the PB development of screening examinations are recommended on the regular basis to reveal those specialists who are at high risk of PB. The results obtained may be used to develop evidence-based practical recommendations for the prevention of PB syndrome and psychosocial disorders in anesthesiologists and intensive care specialists. © 2023, Practical Medicine Publishing House LLC. All rights reserved.
ABSTRACT
Background: Comprehensive evaluation of new treatment regimens in RRMM patients both from physician's and patients' perspective is worthwhile. Aims: We aimed to evaluate clinical and patient-reported outcomes during IRd treatment as ≥ 2nd line in RRMM patients in a multicenter real-world evidence study. Methods: Adult patients with RRMM who have been assigned IRd as ≥2nd line treatment were enrolled in 18 centers of Russian Federation from April 2019 till May 2020. Treatment response was evaluated by IMWG 2011 criteria. For assessment of adverse events (AEs) NCI CTCAE v. 4.0 was used. Patients filled out RAND SF-36 and ESAS-R questionnaires at baseline, at 1 and 3 mos, and thereafter every 3 mos till 18 mos after IRd treatment onset. Statistical analysis of patient-reported outcomes was conducted using GEE with adjustment to age, gender and baseline quality of life (QoL). Duration of response (DOR), progression-free (PFS) and overall survival (OS) from the start of IRd treatment were evaluated using Kaplan-Meyer method. Results: In total, 40 patients with RRMM were enrolled into the study: median age - 64 years (range, 33-80), 35% males. Durie-Salmon stage at study entry: II/III - 40/60%, ECOG status 0/1 - 70%, 2/3 - 30%. Median time since initial MM diagnosis - 55 mos (range, 2.0-99.0). Median number of lines of prior therapy - 3 (range, 1-7). Comorbidities were revealed in 65% patients;median Charlson Comorbidity index - 2 (range, 0-5);95% patients had bone complications. The median duration of IRd treatment - 7.5 mos (IQR, 3.9-18.0). Two-thirds of the patients (28/39) responded to therapy. The overall response rate was 46.2% (95%CI: 30.6-61.8), median DOR - 16.3 mos (95%CI: 15.4-17.3). Among them 3 patients achieved complete response, 1 - stringent complete response, 2 - very good partial response, 12 - partial response. Ten patients had minor response. Clinical benefit rate - 71.8% (95%CI: 57.7-85.9). Six patients (15.4%) had stable disease and 4 (10.3%) progressed upon therapy. Median PFS was 10.6 mos (95%CI: 6.3-16.3). During the entire period of the study 5 deaths were registered: 3 were related to progression, 2 - because of COVID-19. Median OS was not reached. One-year OS rate was 85.2% (95%CI: 71.0-99.0). AEs were revealed in 55% patients: grades 1-2 AEs - 15 patients;grades 3-4 AEs - 7 patients;SAEs - 3 patients (neurological toxicity, gastric bleeding, hypotension and diarrhea). Baseline QoL was dramatically impaired by the majority of SF- 36 scales;42% patients experienced severe/critical QoL impairment. At baseline all the patients experienced symptoms;85% with moderate-to severe symptoms (≥4 scores on the scale from 0 to 10). The most prevalent and severe symptoms were tiredness (98%), drowsiness (90%), pain (82%) and shortness of breath (80%). During IRd treatment QoL was stable or improved. Physical and role physical functioning, general health, vitality and mental health significantly improved as compared to baseline (GEE, p<0.05). Twice increase of Integral QoL Index was observed - 0.27 at baseline vs 0.48 at 18 mos (p<0.05). Severity of pain, tiredness and nausea meaningfully decreased during IRd treatment as compared to baseline (GEE, p<0.05). Total ESAS-R score decreased by 10 points at 18 mos of therapy as compared to baseline - 31 vs 21 (GEE, p<0.05). Summary/Conclusion: In summary, results obtained in a real-world evidence study confirmed RCTs data that IRd regimen is an effective treatment in RRMM patients. This treatment is accompanied with definite improvement of QoL. Our results demonstrate benefits of IRd, both from physician's and patient's perspective.