Browsing by Author "Cripe, Larry D."
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Item CNS involvement in AML at diagnosis is rare and does not affect response or survival: data from 11 ECOG-ACRIN trials(American Society of Hematology, 2021) Ganzel, Chezi; Lee, Ju-Whei; Fernandez, Hugo F.; Paietta, Elisabeth M.; Luger, Selina M.; Lazarus, Hillard M.; Cripe, Larry D.; Douer, Dan; Wiernik, Peter H.; Rowe, Jacob M.; Tallman, Martin S.; Litzow, Mark R.; Medicine, School of MedicineCentral nervous system (CNS) involvement in patients with newly diagnosed acute myeloid leukemia (AML) is rare, and systematic data regarding outcome are scarce. This retrospective study summarized data from 11 consecutive Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) clinical trials for patients with newly diagnosed AML. In all, 3240 patients with AML were analyzed, and 36 (1.11%) were found to have CNS involvement at diagnosis. The incidence of CNS disease among the 5 studies with per protocol mandatory lumbar puncture (LP) was similar to the incidence among studies in which LP was performed at the discretion of the investigator (0.86% vs 1.41%; P = .18). There was no significant difference in the rate of complete remission (CR) among patients with CNS involvement and those with other extramedullary disease (EMD) sites or those with no EMD (52.8% vs 59.3%-60%). The median overall survival (OS) for patients who were CNS positive, who had other EMD, or who had no EMD was 11.4, 11.3, and 12.7 months, respectively. There was no difference in OS among patients with CNS involvement, those with other EMD (hazard ratio [HR], 0.96; adjusted P = .84), and those with no EMD (HR, 1.19; adjusted P = .44). In conclusion, the reported incidence of CNS involvement in patients with newly diagnosed AML is low (1.1%), irrespective of whether an LP is mandatory or not. The presence of CNS disease at diagnosis in and of itself does not seem to portend a poor prognosis for achieving an initial CR or for OS.Item Combination of sorafenib, vorinostat and bortezomib for the treatment of poor-risk AML: report of two consecutive clinical trials(Elsevier, 2019-02) Sayar, Hamid; Cripe, Larry D.; Saliba, Antoine N.; Abu Zaid, Mohammad; Konig, Heiko; Boswell, H. Scott; Medicine, School of MedicineItem Discussions of Life Expectancy Moderate Relationships between Prognosis and Anxiety or Depression in Men with Advanced Cancer(2012-01) Cripe, Larry D.; Rawl, Susan M.; Schmidt, Karen K.; Tong, Yan; Monahan, Patrick O.; Rand, Kevin L.Purpose: Oncologists avoid prognostic discussions due to concerns about increasing patients' anxiety or depression. We sought to determine if perceived prognosis or extent of prognostic discussions predicted anxiety or depression and whether prognostic discussions moderated the relationship between prognosis and anxiety or depression. Methods: Men with advanced cancer and their oncologists estimated the likelihood of survival at 6 months and reported extent of prognostic discussions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Results: Men who died within 6 months reported higher scores on depression but not anxiety. Men who estimated a lower (10%–75%) likelihood of surviving at least 6 months were more depressed and anxious than men who estimated a higher (>90%) likelihood of survival. A similar relationship was seen with oncologists' prognostications. Men who reported having had full prognostic discussions with their oncologist had less depression compared with men who reported having had brief or no discussions. Men for whom the oncologists reported a full discussion had greater anxiety. The relationships between patient-perceived prognosis and depression or anxiety were moderated by extent of prognostic discussions as reported by the patient or oncologist, respectively. Conclusion: Full prognostic discussions are associated with less depression among men who perceive a poor prognosis. Anxiety is increased in men if the oncologists report a full discussion. Oncologists should engage in prognostic discussions but assess for increased anxiety to facilitate coping with advanced cancer.Item The impact of design on research teams in health services: A case study of the significance of the design artifact for interdisciplinary research and the generation of theoretical and applied lines of inquiry(John Benjamins, 2017-01-01) Sanematsu, Helen; Cripe, Larry D.; Herron School of Art and DesignThe development of patient communication tools in health services research often requires the skills of a designer who will give the tool its final, usable form. However, research teams frequently overlook the demands of implementation and focus instead on the delivery of content to the patient. In the study considered here, shared decision making in cancer treatment research was initiated by an interdisciplinary team without the participation of a designer. Once a designer began working on the team, the benefits she brought to the production of the designed artifact were evident. Design improved the team’s effectiveness through better communication, and allowed for further studies based on application and theory. Researchers responded positively to design and saw the potential for its application to a range of health research.Item Independent Prognostic Significance of Monosomy 17 and Impact of Karyotype Complexity in Monosomal Karyotype/Complex Karyotype Acute Myeloid Leukemia: Results from Four ECOG-ACRIN Prospective Therapeutic Trials(Elsevier, 2017-08) Strickland, Stephen A.; Sun, Zhuoxin; Ketterling, Rhett P.; Cherry, Athena M.; Cripe, Larry D.; Dewald, Gordon; Fernandez, Hugo; Hicks, Gary A.; Higgins, Rodney R.; Lazarus, Hillard M.; Litzow, Mark R.; Luger, Selina M.; Paietta, Elisabeth M.; Rowe, Jacob M.; Vance, Gail H.; Wiernik, Peter; Wiktor, Anne E.; Zhang, Yanming; Tallman, Martin S.; Department of Medicine, IU School of MedicineThe presence of a monosomal karyotype (MK+) and/or a complex karyotype (CK+) identifies subcategories of AML with poor prognosis. The prognostic significance of the most common monosomies (monosomy 5, monosomy 7, and monosomy 17) within MK+/CK+ AML is not well defined. We analyzed data from 1,592 AML patients age 17–93 years enrolled on ECOG-ACRIN therapeutic trials. The majority of MK+ patients (182/195; 93%) were MK+/CK+ with 87% (158/182) having ≥5 clonal abnormalities (CK≥ 5). MK+ patients with karyotype complexity ≤4 had a median overall survival (OS) of 0.4y compared to 1.0y for MK- with complexity ≤4 (p < 0.001), whereas no OS difference was seen in MK+ vs. MK- patients with CK≥ 5 (p = 0.82). Monosomy 5 (93%; 50/54) typically occurred within a highly complex karyotype and had no impact on OS (0.4y; p = 0.95). Monosomy 7 demonstrated no impact on OS in patients with CK≥ 5 (p = 0.39) or CK ≤ 4 (p = 0.44). Monosomy 17 appeared in 43% (68/158) of CK≥ 5 patients and demonstrated statistically significant worse OS (0.4y) compared to CK≥ 5 patients without monosomy 17 (0.5y; p = 0.012). Our data suggest that the prognostic impact of MK+ is limited to those with less complex karyotypes and that monosomy 17 may independently predict for worse survival in patients with AML.Item Integrative analysis identifies an older female-linked AML patient group with better risk in ECOG-ACRIN Cancer Research Group's clinical trial E3999(Springer Nature, 2022-09-23) Rapaport, Franck; Seier, Kenneth; Neelamraju, Yaseswini; Hassane, Duane; Baslan, Timour; Gildea, Daniel T.; Haddox, Samuel; Lee, Tak; Murdock, H. Moses; Sheridan, Caroline; Thurmond, Alexis; Wang, Ling; Carroll, Martin; Cripe, Larry D.; Fernandez, Hugo; Mason, Christopher E.; Paietta, Elisabeth; Roboz, Gail J.; Sun, Zhuoxin; Tallman, Martin S.; Zhang, Yanming; Gönen, Mithat; Levine, Ross; Melnick, Ari M.; Kleppe, Maria; Garrett-Bakelman, Francine E.; Medicine, School of MedicineItem Music Therapy Is Associated With Family Perception of More Spiritual Support and Decreased Breathing Problems in Cancer Patients Receiving Hospice Care(Elsevier, 2015-08) Burns, Debra S.; Perkins, Susan M.; Tong, Yan; Hilliard, Russell E.; Cripe, Larry D.; Department of Music & Arts Technology, IUPUIContext Music therapy is a common discretionary service offered within hospice; however, there are critical gaps in understanding the effects of music therapy on hospice quality indicators, such as family satisfaction with care. Objectives The purpose of this study was to examine whether music therapy affected family perception of patients' symptoms and family satisfaction with hospice care. Methods This was a retrospective, cross-sectional analysis of electronic medical records from 10,534 cancer patients cared for between 2006 and 2010 by a large national hospice. Logistic regression was used to estimate the effect of music therapy using propensity scores to adjust for non-random assignment. Results Overall, those receiving music therapy had higher odds of being female, having longer lengths of stay, and receiving more services other than music therapy, and lower odds of being married/partnered or receiving home care. Family satisfaction data were available for 1495 (14%) and were more likely available if the patient received music therapy (16% vs. 12%, P < 0.01). There were no differences in patient pain, anxiety, or overall satisfaction with care between those receiving music therapy vs. those not. Patients who received music therapy were more likely to report discussions about spirituality (odds ratio [OR] = 1.59, P = 0.01), had marginally less trouble breathing (OR = 0.77, P = 0.06), and were marginally more likely to receive the right amount of spiritual support (OR = 1.59, P = 0.06). Conclusion Music therapy was associated with perceptions of meaningful spiritual support and less trouble breathing. The results provide preliminary data for a prospective trial to optimize music therapy interventions for integration into clinical practice.Item “My Future is Now”: A Qualitative Study of Persons Living With Advanced Cancer(Sage, 2018) Cottingham, Ann H.; Cripe, Larry D.; Rand, Kevin L.; Frankel, Richard M.; Medicine, School of MedicineObjectives: Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients’ efforts to live in the present and plan for the future. Methods: Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion–crystallization, a qualitative research technique. Results: Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported. Significance of Results: These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) “What is important to you now, knowing that you will die sooner than you want or expected?” (2) “Tell me about yourself.” (3) “Tell me in your own words about your experience with cancer care and treatment.” (4) “What impact has your illness had on others?” In honoring patients’ lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients’ priorities for life.Item Physicians in Postgraduate Training Characteristics and Support of Palliative Sedation for Existential Distress(Sage, 2017-09) Cripe, Larry D.; Perkins, Susan M.; Cottingham, Ann; Tong, Yan; Kozak, Mary Ann; Mehta, Rakesh; Medicine, School of MedicineIntroduction: Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians’ in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients’ EOL care preferences. Methods: One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM. Predictors of PS-ED and PS-PP support were examined using binary and multinomial logistic regression. Results: Only 22.7% of residents were very supportive of PS-ED, and 82.0% were very supportive of PS-PP. Support for PS-PP or PS-ED did not correlate with levels of empathy, hope, optimism, or IRM; however, for residents with lower IRM, greater optimism was associated with greater PS-ED support. In contrast, among residents with higher IRM, optimism was not associated with PS-ED support. Conclusions: Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents’ supportiveness. The interaction between optimism and IRM suggests residents’ beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED.Item Prognostic effect of gender on outcome of treatment for adults with acute myeloid leukaemia(Wiley, 2021) Wiernik, Peter H.; Sun, Zhuoxin; Cripe, Larry D.; Rowe, Jacob M.; Fernandez, Hugo F.; Luger, Selina M.; Lazarus, Hillard M.; Paietta, Elisabeth M.; Tallman, Martin S.; Litzow, Mark R.; Medicine, School of MedicineThere are conflicting reports in the literature suggesting that one gender or the other has a better survival with acute myeloid leukaemia (AML). This study was done in an attempt to resolve the issue. The effect of gender was examined on 3,546 newly diagnosed patients with AML, including 548 patients with acute promyelocytic leukaemia (APL) enrolled in 10 multi-institutional treatment studies from March 1984 to November 2008. Kaplan-Meier estimates were used to estimate event-time distributions for survival and multivariate models were used to examine the gender effect after adjusting for multiple risk factors. P values were based on 2-sided tests. Non-APL female patients had a significantly better overall but not disease-free survival than males, irrespective of age, initial WBC count, or dose of daunorubicin. No differences were observed for obese or FLT3-ITD + patients. Female APL patients had a significantly better overall and disease-free survival than male APL patients, and differences in survival were greater for patients with t(15;17) + other cytogenetic abnormalities compared with those with t(15;17) only. Gender is an independent prognostic variable in patients with AML. Whether these survival differences are due to hormonal, genetic or pharmacokinetic differences between the sexes, or differential toxin exposure such as smoking is unknown. However, the former seems less likely since patient age did not influence the survival advantage for female patients.