Incidence and reasons for discontinuation of first-line therapy in patients with multiple myeloma: results from a historical cohort, Brazil 2009-2020.

Multiple myeloma (MM) is an incurable hematological cancer requiring multiple lines of anti-myeloma regimens to promote disease remission and increase patient survival. The study assessed the incidence and reasons for discontinuation of first-line therapy in outpatients who started MM therapy in Belo Horizonte, Brazil from 2009 to 2020. A historical cohort study in which patients were followed from treatment initiation until discontinuation of first-line therapy. Discontinuation of first-line therapy was characterized as (i) discontinuation followed by a second-line therapy, and (ii) discontinuation that prevented patients from receiving a subsequent line of treatment. Non-parametric competing risk analysis with a 95% confidence interval estimated the cumulative incidences of discontinuation followed by a second-line therapy. The probability of discontinuation was compared according to selected variables using the Gray's test at a significance level of 5%. Approximately half of the participants (n = 260) were female and younger than 65 years. Discontinuation of first-line therapy followed by a second-line therapy accounted for 50.4% of the patients and occurred up to 30th month. The main reason for discontinuation not qualifying patients for receiving second-line therapy was to achieve a response to treatment. The maximum times for discontinuation not followed by a second-line therapy ranged from 12 to 20 months due to deaths or response to treatment. The probability of receiving second-line therapy was higher among patients initiating therapy in 2009-2014 and those not undergoing transplantation. In conclusion, discontinuation of first-line therapy followed by second-line treatment occurred as likely as the discontinuation not followed by a subsequent line.

Motivo de abandono del tratamiento desde la perspectiva del paciente con un trastorno de la conducta alimentaria / Reason for treatment abandonment from the perspective of the patient with an eating disorder

Los tratamientos psicológicos y farmacológicos para los trastornos de la conducta alimentaria comportan costes personales y sanitarios. En este trabajo estudiamos los diferentes motivos que pueden estar asociados al abandono en ambos tipos de tratamientos en pacientes diagnosticados con un trastorno de la conducta alimentaria, así como el tipo de abandono: abandono tras evaluar, abandono precoz y tardío. Por otro lado, analizamos si existe alguna relación entre el diagnóstico y el tipo de abandono. Se examinaron diversas características (edad, sexo, diagnóstico, motivos y tipos de abandono, y satisfacción respecto a la unidad de trastornos de la conducta alimentaria) en 212 pacientes atendidos en un servicio especializado en el tratamiento de trastornos de la conducta alimentaria durante un periodo de dos años. Nuestros datos apoyan la hipótesis de que el tipo de abandono de los tratamientos más frecuente es de tipo tardío, motivado por la mejoría del trastorno de la conducta alimentaria, mientras que no se verifica que exista relación alguna entre el diagnóstico y el tipo de abandono. Nuestros resultados indican que los motivos de abandono son heterogéneos. Se pueden establecer dos perfiles diferenciados de abandono; uno ligado a la mejoría y a los impedimentos físicos temporales, y otro relacionado con motivos diversos.

Psychological and pharmacological treatments for eating disorder involve personal and health costs. In this paper we study the various reasons that may be associated to abandonment in both types of treatments in patients diagnosed with a disorder of eating behavior and the kind of neglect: neglect after evaluation, early and late abandonment. On the other hand, we analyze whether there is any relationship between the diagnosis and the type of abandonment. Various characteristics (age, sex, diagnosis, motives and types of neglect, and satisfaction with the unit eating disorder) in 212 patients treated at a specialized service in the treatment of eating disorder were examined during a period of two years. Our data support the hypothesis that the rate of abandonment of the most common treatments is delayed type, motivated by the improvement of the disorder of eating behavior, while no verified that there is some relationship between the diagnosis and the type of abandonment. Our results indicate that the reasons for dropping out are heterogeneous. You can set two different profiles of dropouts, one linked to improvement and to temporary disability, and other related tovarious reasons