Financial Toxicity, Time Toxicity, and Quality of Life in Multiple Myeloma.

BACKGROUND: Patients with multiple myeloma (MM) may be on therapy for years, which can lead to financial toxicity (FinTox) or time toxicity (TimeTox). The prevalence, predictors, and quality of life (QOL) impacts of FinTox and TimeTox during different phases of MM treatment have not been characterized. PATIENTS AND METHODS: We conducted a single-center cross-sectional survey of patients with MM who had undergone transplantation. FinTox+ was defined as a COST-FACIT score <23, TimeTox+ as MM-related interactions (including phone calls) ≥1x weekly or ≥1x monthly in-person among far-residing patients, QOL using PROMIS Global Health, and functional status using patient-reported Karnofsky performance status (KPS). RESULTS: Of 252 patients, 22% and 40% met FinTox+ and TimeTox+ criteria respectively. Respective FinTox+ and TimeTox+ proportions were 22%/37% for patients on maintenance, 22%/82% with active therapy, and 20%/14% with observation. FinTox+ predictors included annual income (P < .01) and out-of-pocket costs (P < .01). TimeTox+ predictors included disease status (P < .001), caregiver status (P = .01), far-residing status (P < .001), and out-of-pocket costs (P = .03). FinTox+ was associated with a clinically meaningful decrease in mental QOL, while TimeTox+ patients were more likely to have KPS ≤ 80. CONCLUSIONS: In our large study, monetary status but not disease status predicted FinTox. Over a third of patients on maintenance reported TimeTox. FinTox+ was associated with decreased mental health, while TimeTox+ was associated with worse performance status. These two toxicities may negatively impact patient wellbeing, and studies of strategies to mitigate their impact are in development.

Targeted Radiation Delivery before Haploidentical HCT for High-risk Leukemia or MDS Patients Yields Long-term Survivors.

PURPOSE: Hematopoietic cell transplantation (HCT) has curative potential for myeloid malignancies, though many patients cannot tolerate myeloablative conditioning with high-dose chemotherapy alone or with total-body irradiation (TBI). Here we report long-term outcomes from a phase I/II study using iodine-131 (131I)-anti-CD45 antibody BC8 combined with nonmyeloablative conditioning prior to HLA-haploidentical HCT in adults with high-risk relapsed/ refractory acute myeloid or lymphoid leukemia (AML or ALL), or myelodysplastic syndrome (MDS; ClinicalTrials.gov, NCT00589316). PATIENTS AND METHODS: Patients received a tracer diagnostic dose before a therapeutic infusion of 131I-anti-CD45 to deliver escalating doses (12-26 Gy) to the dose-limiting organ. Patients subsequently received fludarabine, cyclophosphamide (CY), and 2 Gy TBI conditioning before haploidentical marrow HCT. GVHD prophylaxis was posttransplant CY plus tacrolimus and mycophenolate mofetil. RESULTS: Twenty-five patients (20 with AML, 4 ALL and 1 high-risk MDS) were treated; 8 had ≥ 5% blasts by morphology (range 9%-20%), and 7 had previously failed HCT. All 25 patients achieved a morphologic remission 28 days after HCT, with only 2 patients showing minimal residual disease (0.002-1.8%) by flow cytometry. Median time to engraftment was 15 days for neutrophils and 23 days for platelets. Point estimates for overall survival and progression-free survival were 40% and 32% at 1 year, and 24% at 2 years, respectively. Point estimates of relapse and nonrelapse mortality at 1 year were 56% and 12%, respectively. CONCLUSIONS: 131I-anti-CD45 radioimmunotherapy prior to haploidentical HCT is feasible and can be curative in some patients, including those with disease, without additional toxicity.

Realistic effort action plans (REAP) for exercise among underactive and inactive university students: A randomized trial.

Objective: The efficacy of effort appraisal exercise action plans was tested among underactive and inactive university students (N = 221). Methods: Students were randomized across three conditions (information, action planning, or realistic effort action planning (REAP)) and participated in psychoeducational small-group sessions. Students returned after a three-week pedometer tracking period and at two and six months to assess self-reported exercise. Results: Greater three-week step averages were observed for the action planning and REAP conditions compared to the information condition. The information condition showed small-sized exercise increases at two and six months (d = .26, d = .35, ps < .05); the action planning condition showed a small-sized increase at six months (d = . 36, p < 05); and the REAP condition showed medium-sized increases at two and six months (d = .40, d = . 46, ps < .05). Conclusions: The findings provide initial evidence showing exercise action plans for college students might be improved with explicit appraisals of prior effort and persistence.

The effects of puberty on associations between mood/personality factors and disordered eating symptoms in girls.

OBJECTIVE: Negative and positive urgency, anxiety, and depressive symptoms are significant factors of disordered eating (DE) symptoms in early adolescence through young adulthood. However, it is unclear how puberty-a critical developmental milestone that is associated with increased risk for DE symptoms-affects the relationship between these factors and DE symptoms, given that the role of pubertal status has rarely been considered in relation to these associations. Thus, the present study examined whether puberty moderates associations between mood/personality factors and DE in pre-adolescent and adolescent girls. METHOD: Participants included 981 girls (aged 8-16 years) from the Michigan State University Twin Registry. Mood/personality factors, pubertal status, and DE were assessed with self-report questionnaires. RESULTS: Puberty significantly moderated associations between several factors (negative urgency, positive urgency, trait anxiety, depressive symptoms) and the cognitive symptoms of DE (e.g., shape/weight concerns, body dissatisfaction). Associations between mood/personality factors and cognitive DE were stronger in girls with more advanced pubertal status. By contrast, no significant moderation effects were detected for mood/personality-dysregulated eating (e.g., binge eating, emotional eating) associations. DISCUSSION: Findings identify pubertal development as an important moderator of mood/personality-DE symptom associations, especially for cognitive DE symptoms that are known to predict the later onset of clinical pathology.

Development and Validation of a Machine Learning Model to Estimate Bacterial Sepsis Among Immunocompromised Recipients of Stem Cell Transplant.

Importance: Sepsis disproportionately affects recipients of allogeneic hematopoietic cell transplant (allo-HCT), and timely detection is crucial. However, the atypical presentation of sepsis within this population makes detection challenging, and existing clinical sepsis tools have limited prognostic value among this high-risk population. Objective: To develop a full risk factor (demographic, transplant, clinical, and laboratory factors) and clinical factor-specific automated bacterial sepsis decision support tool for recipients of allo-HCT with potential bloodstream infections (PBIs). Design, Setting, and Participants: This prognostic study used data from adult recipients of allo-HCT transplanted at the Fred Hutchinson Cancer Research Center, Seattle, Washington, between June 2010 and June 2019 randomly divided into 70% modeling and 30% validation data sets. Tools were developed using the area under the curve (AUC) optimized SuperLearner, and their performance was compared with existing clinical sepsis tools: National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS), using the validation data set. Data were analyzed between January and October of 2020. Main Outcomes and Measures: The primary outcome was high-sepsis risk bacteremia (culture confirmed gram-negative species, Staphylococcus aureus, or Streptococcus spp bacteremia), and the secondary outcomes were 10- and 28-day mortality. Tool discrimination and calibration were examined using accuracy metrics and expected vs observed probabilities. Results: Between June 2010 and June 2019, 1943 recipients of allo-HCT received their first transplant, and 1594 recipients (median [interquartile range] age at transplant, 54 [43-63] years; 911 [57.2%] men; 1242 individuals [77.9%] identifying as White) experienced at least 1 PBI. Of 8131 observed PBIs, 238 (2.9%) were high-sepsis risk bacteremia. Compared with high-sepsis risk bacteremia, the full decision support tool had the highest AUC (0.85; 95% CI, 0.81-0.89), followed by the clinical factor-specific tool (0.72; 95% CI, 0.66-0.78). SIRS had the highest AUC of existing tools (0.64; 95% CI, 0.57-0.71). The full decision support tool had the highest AUCs for PBIs identified in inpatient (0.82; 95% CI, 0.76-0.89) and outpatient (0.82; 95% CI, 0.75-0.89) settings and for 10-day (0.85; 95% CI, 0.79-0.91) and 28-day (0.80; 95% CI, 0.75-0.84) mortality. Conclusions and Relevance: These findings suggest that compared with existing tools and the clinical factor-specific tool, the full decision support tool had superior prognostic accuracy for the primary (high-sepsis risk bacteremia) and secondary (short-term mortality) outcomes in inpatient and outpatient settings. If used at the time of culture collection, the full decision support tool may inform more timely sepsis detection among recipients of allo-HCT.

Convergence in maternal and child reports of impulsivity, depressive symptoms, and trait anxiety, and their predictive utility for binge-eating behaviors.

OBJECTIVE: Early detection of binge-eating (BE) behaviors and their risk factors is associated with better outcomes. A multi-informant approach for assessing BE psychopathology and risk factors has been emphasized to increase the probability and accuracy of early detection. Impulsivity (particularly negative and positive urgency), trait anxiety, and depressive symptoms are associated with BE behaviors. The present study examined maternal-child convergence of reports of child BE, impulsivity, trait anxiety, and depressive symptoms and examined the predictive power of maternal reports for child-reported BE behaviors. METHOD: Participants included 927 female twins (aged 8-16 years) and 468 mothers from the Michigan State University Twin Registry. Risk factors and BE were assessed with self-report questionnaires. RESULTS: Intraclass correlation coefficients showed fair-to-moderate inter-rater agreement (ICCs = .31-.41) between maternal and child reports of risk factors and low-to-fair agreement for BE (ICCs = .05-.29). Controlling for the effects of age, pubertal status, body mass index, and family relatedness, multilevel models showed that maternal reports of child impulsivity, anxiety, and depressive symptoms did not add predictive power above and beyond child reports. DISCUSSION: Results call into question the utility and practical implications of using maternal reports to supplement child reports for BE and its risk factors.

Stress as a potential moderator of ovarian hormone influences on binge eating in women.

Previous research has demonstrated significant associations between increased levels of ovarian hormones and increased rates of binge eating (BE) in women. However, whereas all women experience fluctuations in ovarian hormones across the menstrual cycle, not all women binge eat in response to these fluctuations, suggesting that other factors must contribute. Stress is one potential contributing factor. Specifically, it may be that hormone-BE associations are stronger in women who experience high levels of stress, particularly as stress has been shown to be a precipitant to BE episodes in women. To date, no studies have directly examined stress as a moderator of hormone-BE associations, but indirect data (that is, associations between BE and stress and between ovarian hormones and stress) could provide initial clues about moderating effects. Given the above, the purpose of this narrative review was to evaluate these indirect data and their promise for understanding the role of stress in hormone-BE associations. Studies examining associations between all three phenotypes (that is, ovarian hormones, stress, and BE) in animals and humans were reviewed to provide the most thorough and up-to-date review of the literature on the potential moderating effects of stress on ovarian hormone-BE associations. Overall, current evidence suggests that associations between hormones and BE may be stronger in women with high stress levels, possibly via altered hypothalamic-pituitary-adrenal axis response to stress and increased sensitivity to and altered effects of ovarian hormones during stress. Additional studies are necessary to directly examine stress as a moderator of ovarian hormone-BE associations and identify the mechanisms underlying these effects.

Testing a brief motivational-interviewing educational commitment module for at-risk college drinkers: A randomized trial.

BACKGROUND: The goal of the present study was to test the drink and harm reduction effects of a novel educational commitment (EC) module as a complement to a standard brief MI protocol (i.e., the Brief Alcohol Screening and Intervention for College Students; BASICS, Dimeff, Baer, Kivlahan, & Marlatt, 1999). METHODS: Using a randomized trial design, 180 university students were assigned to one of three conditions: Information, BASICS, or BASICS+EC. Participants completed an alcohol consumption interview and measures of alcohol-related problems, partying decision-making, subjective student role investment, and self-control-related traits at baseline and at two- and nine-month follow-ups. RESULTS: Linear models showed significant condition effects for two-month and nine-month drink quantity, but not for alcohol problems/consequences. Secondary outcome analyses showed significant condition effects for two-month high-risk high-reward partying decision-making and nine-month conscientiousness. Somewhat larger-sized decreases in consumption were observed at two months for the BASICS+EC condition compared to the BASICS condition, although these differences were not present at nine months. CONCLUSIONS: The differential efficacy between the BASICS and BASICS+EC conditions compared to the Information condition reinforces the utility of in-person feedback modalities as more intensive indicated prevention strategies for at-risk college drinkers. The limited differential efficacy for BASICS+EC compared to BASICS suggests a brief MI module for the academic/vocational aspects of the student role is not associated with greater long-term drink and harm reduction. Future research should examine more intensive educational commitment modalities, the utility of on-going academic goal and action feedback, and mechanisms of differential efficacy across intervention groups.

School Investment, Drinking Motives, and High-Risk, High-Reward Partying Decisions Mediate the Relationship Between Trait Self-Control and Alcohol Consumption Among College Drinkers.

OBJECTIVE: Research has shown trait self-control, neuroticism, and coping and enhancement drinking motives to be predictors of alcohol consumption among college students. Recent research also provides evidence for the effects of role investment and role-based alcohol consumption-decision making (i.e., partying decisions). The goal of the present study was to clarify the organization and contributions of these multifarious influences on college student drinking. METHOD: College students (N = 355; 51.8% female) with a heterogeneous prevalence of alcohol dependence completed measures of trait self-control; neuroticism; coping and enhancement drinking motives; subjective college student role investment, satisfaction, and stress; role-based partying scenarios; and a typical weekly alcohol consumption interview. Internal and comparative fit indices for alternative path models were evaluated and bootstrapping procedures were used to examine indirect effects. RESULTS: Modeling results favored a more stratified organization, where (a) the association between trait self-control and consumption was mediated by drinking motives and partying decisions, (b) the association between neuroticism and consumption was mediated by coping motives, and (c) the association between role investment and consumption was mediated by partying decisions. The associations between motives and consumption were not mediated by partying decisions. CONCLUSIONS: The results provide support for disinhibitory and distress pathways to college student drinking, where impulsive and anxious students are more likely to drink excessively because of more frequent mood-affecting drinking goals, less academic involvement, and/or more frequent decisions to attend parties where negative academic consequences are likely but where perceived rewarding alcohol-related and social features are present.

Testing Theory of Planned Behavior and Neo-Socioanalytic Theory models of trait activity, industriousness, exercise social cognitions, exercise intentions, and physical activity in a representative U.S. sample.

Prior research identified assorted relations between trait and social cognition models of personality and engagement in physical activity. Using a representative U.S. sample (N = 957), the goal of the present study was to test two alternative structural models of the relationships among the extraversion-related facet of activity, the conscientiousness-related facet of industriousness, social cognitions from the Theory of Planned Behavior (perceived behavioral control, affective attitudes, subjective norms, intentions), Social Cognitive Theory (self-efficacy, outcome expectancies), and the Transtheoretical Model (behavioral processes of change), and engagement in physical activity. Path analyses with bootstrapping procedures were used to model direct and indirect effects of trait and social cognition constructs on physical activity through two distinct frameworks - the Theory of Planned Behavior and Neo-Socioanalytic Theory. While both models showed good internal fit, comparative model information criteria showed the Theory-of-Planned-Behavior-informed model provided a better fit. In the model, social cognitions fully mediated the relationships from the activity facet and industriousness to intentions for and engagement in physical activity, such that the relationships were primarily maintained by positive affective evaluations, positive expected outcomes, and confidence in overcoming barriers related to physical activity engagement. The resultant model - termed the Disposition-Belief-Motivation model- is proposed as a useful framework for organizing and integrating personality trait facets and social cognitions from various theoretical perspectives to investigate the expression of health-related behaviors, such as physical activity. Moreover, the results are discussed in terms of extending the application of the Disposition-Belief-Motivation model to longitudinal and intervention designs for physical activity engagement.

Physicians' adherence to acute coronary syndrome prescribing guidelines in Vietnamese hospital practice: a cross-sectional study.

OBJECTIVES: To determine the extent of physicians' adherence to prescribing guidelines for acute coronary syndrome in Vietnamese hospitals. METHODS: Retrospective cross-sectional study of medical records of all patients with ACS admitted to two public hospitals in Ho Chi Minh City, Vietnam, from January to December 2013. Percentages of eligible patients receiving guideline-recommended medications were determined. Factors associated with non-adherence were identified using multivariate logistic regression. RESULTS: Overall, 711 medical records were reviewed and 284 patients fulfilled inclusion criteria (mean age 64 years; 69.4% male). Of those patients eligible for treatment, aspirin was prescribed for 97.9% at arrival and 96.3% at discharge; dual antiplatelet therapy was prescribed for 92.3% at arrival and 91.7% at discharge; loading doses were prescribed for 79.5% (aspirin) and 55.8% (clopidogrel); beta blockers were prescribed for 58.7% at arrival and 76.7% at discharge; angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were prescribed for 89.1% at arrival or discharge; and statins were prescribed for 94.1% at arrival and 90.7% at discharge. Patients undergoing an invasive procedure were more likely to receive guideline-recommended medications at discharge: dual antiplatelet therapy (OR 3.77; 95% CI 1.23-11.52), beta blocker (OR 3.95; 95% CI 1.86-8.40) and ACEI/ARB (OR 4.01; 95% CI 1.30-12.41). Ninety of the excluded patients were discharged without completing treatment. CONCLUSIONS: In general, physicians closely adhered to ACS prescribing guidelines in Vietnamese hospital practice. Prescribing of beta blockers and clopidogrel loading doses was probably suboptimal. Why patients do not complete treatment needs to be investigated.

Openness, neuroticism, conscientiousness, and family health and aging concerns interact in the prediction of health-related Internet searches in a representative U.S. sample.

Recent estimates suggest 60% of the U.S. adult population uses the Internet to find health-related information. The goal of the present study was to model health-related Internet searches as a function of an interdependent system of personality adaptation in the context of recent health and aging-related concerns. Assessments of background factors, Big Five personality traits, past-month health and aging-related concerns, and the frequency of past-month health-related Internet searches (via Google, Yahoo, AOL, Bing, or some other search engine) were obtained from a representative U.S. sample (N = 1,015). Controlling for background factors, regression analyses showed more frequent health-related Internet searches were predicted by a drive for exploration and investigation (high openness), as well as alarm sensitivity (high openness and high neuroticism) and an anticipatory inclination (high openness and high conscientiousness) in the context of recent problems with aging parents and recent health concerns for a family member. Consistent with interdependent models of personality adaptation, as well as prior evidence for "surrogate" health-related Internet searches, the results suggest a personality process model of search behavior that is partially dependent upon dispositional levels of exploration, emotional stability, control, and health and aging concerns for family members.