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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">Commentary</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Article</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-11-22T13:00:00.000">November 22, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Balancing Life and Myeloma: A Patient-Centered Approach</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Balancing Life and Myeloma: A Patient-Centered Approach" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="Balancing Life and Myeloma: A Patient-Centered Approach" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2"></p><p class="pb-2">In our ongoing discussion with Don M. Benson, MD, PHD, The Ohio State University Comprehensive Cancer Center, who moderated the <a target="_blank" href="https://www.ajmc.com/compendium/multiple-myeloma">multiple myeloma</a> panel discussion at our recent Institute for Value-Based Medicine<sup class="text-inherit">®</sup> event in Cleveland, Ohio, he explains what are his top priorities for his patients throughout their treatment journey for multiple myeloma and how caring for them is a true partnership.</p><p class="pb-2"></p><p class="pb-2">As a hematologist-oncologist, Benson has cared for patients at James Cancer Hospital for 22 years, where he strives to enable his patients to live as long and as well as possible, he explains in this clip.</p><p class="pb-2"></p><p class="pb-2">“We make it work,” he says, “and that's amazing because, again, we didn't do that 20 years ago."</p><p class="pb-2"></p><p class="pb-2"><em>The transcript has been lightly edited for clarity.</em></p><p class="pb-2"></p><p class="pb-2"><strong><span style="text-decoration:underline">Transcript</span></strong></p><p class="pb-2"></p><p class="pb-2"><strong>What factors should guide the choice between traditional transplant options and newer immunotherapy approaches for newly diagnosed or relapsed disease?</strong></p><p class="pb-2"></p><p class="pb-2">When I meet somebody with myeloma, my goal is for them to live as long as possible and as well as possible. Leaving the complexities aside for a second, the principal goal of induction treatment is to alleviate suffering, get symptoms under control, get the disease in remission. I tell my patients, we're going to play offense, we're going to take the ball. We're playing offense, and the goal is a complete remission. The goal is to get you back to life before you heard those words that you have myeloma.</p><p class="pb-2"></p><p class="pb-2">We’re blessed. We can achieve that now for the vast majority of people within a few months.The challenge really isn't getting the disease under control nowadays, it's doing it in a way to minimize toxicities, minimize side effects, even down to things like time. How long are you in the clinic? How long are you away from your life? These are things that we never would have thought of 20 years ago. So I think starting with principles and then moving forward, once the disease is in remission.</p><p class="pb-2"></p><p class="pb-2">We talk a little bit about this shared decision-making model of, we have a panoply of options available. What makes sense for you with your myeloma right now? Realizing that that answer might be different 2 years from now or 5 years from now. But what can we do right now to stay on our true north, that I want you to live as long as possible and as well as possible. And for some people, that's a transplant.For some people, that's maybe a CAR [chimeric antigen receptor] T cell. For some people, that might be stopping treatment and just taking a maintenance drug.</p><p class="pb-2"></p><p class="pb-2"><strong>What strategies can be implemented to support caregivers and enhance patient engagement throughout this journey?</strong></p><p class="pb-2"></p><p class="pb-2">I can speak to my perspective at a referral center that the vast majority of people with myeloma are receiving care in community settings. Oftentimes, when we get involved at a referral center, at an academic center, there's potentially a question about transplant eligibility, about eligibility for a BiTE [bispecific T-cell engager] or a CAR T cell. But just as often, these are referrals that are like grassroots referrals, and it's often an adult child who's driving care.It's not the patient who's maybe 75 or 80 years old, it's an adult child who's gotten on the internet, who's going to support groups, who's done his or her homework, and is saying, “Mom, I really think it's worth the drive to this center. Not that we are unhappy with our care, not that we disagree with our care, but this is a rare cancer. Maybe it would make sense to have somebody look at your case and meet you once, who does it for a living, who sees it every day.”</p><p class="pb-2"></p><p class="pb-2">And I'm all about that. I think that's so important. Myeloma is a rare cancer, and I think the more that—the patient, obviously—but the patient's family, their loved ones, and most often it's the adult children—it's actually usually the oldest daughter for what it's worth, who's taking time off work, who's finding childcare, who's making sacrifices to make sure mom or dad is getting the best care possible. And I see that as a partnership, and I truly see it as a shared decision-making model, because things that we would do for one person… I've had patients come in and say, “I got 400 acres of corn I have to harvest.” And I've had other people come in and say, “We have nonrefundable tickets for a cruise around Greece.”</p><p class="pb-2"></p><p class="pb-2">And so we make it work. 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=30 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=30" decoding="async" data-nimg="fill" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div class="w-full flex-wrap text-center text-sm mt-4 font-light no-underline text-white"></div></a></div></div><div class="relative block sm:hidden"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/edentulism-may-heighten-sleep-apnea-risk?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d8405a2a194a2c5f871d2c521ca31d0ec29d29bc-1200x738.jpg?fit=crop&auto=format" alt="Tooth loss | Image Credit: © valiantsin-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 23rd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/edentulism-may-heighten-sleep-apnea-risk?utm_source=www.ajmc.com&utm_medium=relatedContent">Edentulism May Heighten Sleep Apnea Risk</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/edentulism-may-heighten-sleep-apnea-risk?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A systematic review has found a potential link between edentulism and sleep apnea risk, although the authors said differences in study designs prohibited a meta-analysis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a7faacd2fa8e7c7c69fd4060f3c1a5f5d28f148c-5369x3558.jpg?fit=crop&auto=format" alt="Blood testing - angellodeco - stok.adobe.com.jpg" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent">A Case for Iron Deficiency as a Marker of Inequality in Care Access and Treatment</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Iron deficiency represents more than a medical condition; it is a reflection of persistent health disparities, according to an editorial published in The Lancet Haematology.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e16c42f428ff1dae499535cfedd861067c30dce4-4096x4096.jpg?fit=crop&auto=format" alt="Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Cutie - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent">COVID-19 Infection Raises Myasthenia Gravis Exacerbation Risk, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kimberly-rath-pharmd">Kimberly Rath, PharmD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study shows that COVID-19 infection significantly increases the risk of exacerbation in patients with myasthenia gravis (MG). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645.png?fit=crop&auto=format" alt="Elevating Value in Cancer Care With Innovations, Accessibility, Equity" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent">Elevating Value in Cancer Care With Innovations, Accessibility, Equity</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the IVBM Regional event in Denver, Colorado.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/edentulism-may-heighten-sleep-apnea-risk?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/d8405a2a194a2c5f871d2c521ca31d0ec29d29bc-1200x738.jpg?fit=crop&auto=format" alt="Tooth loss | Image Credit: © valiantsin-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 23rd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/edentulism-may-heighten-sleep-apnea-risk?utm_source=www.ajmc.com&utm_medium=relatedContent">Edentulism May Heighten Sleep Apnea Risk</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/jared-kaltwasser">Jared Kaltwasser</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/edentulism-may-heighten-sleep-apnea-risk?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A systematic review has found a potential link between edentulism and sleep apnea risk, although the authors said differences in study designs prohibited a meta-analysis.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a7faacd2fa8e7c7c69fd4060f3c1a5f5d28f148c-5369x3558.jpg?fit=crop&auto=format" alt="Blood testing - angellodeco - stok.adobe.com.jpg" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent">A Case for Iron Deficiency as a Marker of Inequality in Care Access and Treatment</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Iron deficiency represents more than a medical condition; it is a reflection of persistent health disparities, according to an editorial published in The Lancet Haematology.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e16c42f428ff1dae499535cfedd861067c30dce4-4096x4096.jpg?fit=crop&auto=format" alt="Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Cutie - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent">COVID-19 Infection Raises Myasthenia Gravis Exacerbation Risk, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kimberly-rath-pharmd">Kimberly Rath, PharmD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study shows that COVID-19 infection significantly increases the risk of exacerbation in patients with myasthenia gravis (MG). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645.png?fit=crop&auto=format" alt="Elevating Value in Cancer Care With Innovations, Accessibility, Equity" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent">Elevating Value in Cancer Care With Innovations, Accessibility, Equity</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the IVBM Regional event in Denver, Colorado.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Balancing Life and Myeloma: A Patient-Centered Approach","datePublished":"2024-11-22T13:00:00.000Z","dateModified":"2024-11-22T16:24:13Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/6c4eacfe9c992d1f7ea48bbb7606ade7b9a0b9cf-1920x1080.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/balancing-life-and-myeloma-a-patient-centered-approach"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"multiple myeloma,shared decision-making,patient-centered care","articleBody":"\n\n\n\nIn our ongoing discussion with Don M. Benson, MD, PHD, The Ohio State University Comprehensive Cancer Center, who moderated the multiple myeloma panel discussion at our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains what are his top priorities for his patients throughout their treatment journey for multiple myeloma and how caring for them is a true partnership.\n\n\n\nAs a hematologist-oncologist, Benson has cared for patients at James Cancer Hospital for 22 years, where he strives to enable his patients to live as long and as well as possible, he explains in this clip.\n\n\n\n“We make it work,” he says, “and that's amazing because, again, we didn't do that 20 years ago.\"\n\n\n\nThe transcript has been lightly edited for clarity.\n\n\n\nTranscript\n\n\n\nWhat factors should guide the choice between traditional transplant options and newer immunotherapy approaches for newly diagnosed or relapsed disease?\n\n\n\nWhen I meet somebody with myeloma, my goal is for them to live as long as possible and as well as possible. Leaving the complexities aside for a second, the principal goal of induction treatment is to alleviate suffering, get symptoms under control, get the disease in remission. I tell my patients, we're going to play offense, we're going to take the ball. We're playing offense, and the goal is a complete remission. The goal is to get you back to life before you heard those words that you have myeloma.\n\n\n\nWe’re blessed. We can achieve that now for the vast majority of people within a few months.The challenge really isn't getting the disease under control nowadays, it's doing it in a way to minimize toxicities, minimize side effects, even down to things like time. How long are you in the clinic? How long are you away from your life? These are things that we never would have thought of 20 years ago. So I think starting with principles and then moving forward, once the disease is in remission.\n\n\n\nWe talk a little bit about this shared decision-making model of, we have a panoply of options available. What makes sense for you with your myeloma right now? Realizing that that answer might be different 2 years from now or 5 years from now. But what can we do right now to stay on our true north, that I want you to live as long as possible and as well as possible. And for some people, that's a transplant.For some people, that's maybe a CAR [chimeric antigen receptor] T cell. For some people, that might be stopping treatment and just taking a maintenance drug.\n\n\n\nWhat strategies can be implemented to support caregivers and enhance patient engagement throughout this journey?\n\n\n\nI can speak to my perspective at a referral center that the vast majority of people with myeloma are receiving care in community settings. Oftentimes, when we get involved at a referral center, at an academic center, there's potentially a question about transplant eligibility, about eligibility for a BiTE [bispecific T-cell engager] or a CAR T cell. But just as often, these are referrals that are like grassroots referrals, and it's often an adult child who's driving care.It's not the patient who's maybe 75 or 80 years old, it's an adult child who's gotten on the internet, who's going to support groups, who's done his or her homework, and is saying, “Mom, I really think it's worth the drive to this center. Not that we are unhappy with our care, not that we disagree with our care, but this is a rare cancer. Maybe it would make sense to have somebody look at your case and meet you once, who does it for a living, who sees it every day.”\n\n\n\nAnd I'm all about that. I think that's so important. Myeloma is a rare cancer, and I think the more that—the patient, obviously—but the patient's family, their loved ones, and most often it's the adult children—it's actually usually the oldest daughter for what it's worth, who's taking time off work, who's finding childcare, who's making sacrifices to make sure mom or dad is getting the best care possible. And I see that as a partnership, and I truly see it as a shared decision-making model, because things that we would do for one person… I've had patients come in and say, “I got 400 acres of corn I have to harvest.” And I've had other people come in and say, “We have nonrefundable tickets for a cruise around Greece.”\n\n\n\nAnd so we make it work. And that's amazing because, again, we didn't do that 20 years ago.","description":"In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.","author":[{"@type":"Person","name":"Maggie L. Shaw"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class=" mx-auto flex"><div class="bg-[#00598D] xl:w-[70%] w-[70%] py-12 pl-auto"><div class="xxl:w-[75%] w-[90%] ml-auto"><div><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span 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Leaving the complexities aside for a second, the principal goal of induction treatment is to alleviate suffering, get symptoms under control, get the disease in remission. I tell my patients, we're going to play offense, we're going to take the ball. We're playing offense, and the goal is a complete remission. The goal is to get you back to life before you heard those words that you have myeloma.","_key":"98a12fa87f160","_type":"span"}],"_type":"block"},{"_key":"b87ccab950ce","markDefs":[],"children":[{"text":"","_key":"e5122cc087dd0","_type":"span","marks":[]}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block","style":"normal"},{"upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"marks":[],"text":"We’re blessed. 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A ","_key":"587cbe20ec100"},{"_key":"587cbe20ec101","_type":"span","marks":["91332f5ba54c"],"text":"study published in 2022"},{"text":" found that the high rate of undiagnosed OSA is tied to a lack of coordination of care, negative perceptions about the disease, and a belief among patients that their OSA symptoms are not serious enough to warrant medical care.","_key":"587cbe20ec102","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"2","_key":"d5852708fdf2"}],"_type":"block","style":"normal","_key":"9cd0ed4366ab"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5ddd8c54d0af0"}],"_type":"block","style":"normal","_key":"e829bdbc87cb"},{"_type":"block","style":"normal","_key":"aaa1a9748b76","markDefs":[],"children":[{"text":"The authors noted that although most sleep-related disorders are treated by medical doctors, some sleep issues can be related to the dental field.","_key":"755ca50e64540","_type":"span","marks":[]}]},{"_key":"06055f5802e7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7ffaf14223590"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"930e7aa3248f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Oral care may be influenced by OSA and there have already been studies concerning the association of OSA with increased prevalence of periodontal disease, as well as with tooth wear, orofacial pain, and xerostomia,” they wrote.","_key":"2e3bc463941d0"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"950bd8a228040"}],"_type":"block","style":"normal","_key":"7211c654edda","markDefs":[]},{"disableTextWrap":false,"widthP":35,"alt":"Tooth loss | Image Credit: © valiantsin-stock.adobe.com","imgcaption":[{"_type":"block","style":"normal","_key":"2274b7d17f47","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Explaining their findings, the authors of this study noted that although most sleep-related disorders are treated by medical doctors, some sleep issues can be related to the dental field. | Image Credit: © valiantsin-stock.adobe.com","_key":"064dc2d83b5a0"}]}],"asset":{"_ref":"image-d8405a2a194a2c5f871d2c521ca31d0ec29d29bc-1200x738-jpg","_type":"reference"},"alignment":"Right","_type":"figure","disableLightBox":true,"_key":"19ab91cdb8bb"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The link between edentulism and OSA has been studied for a number of years, in part because complete tooth loss has already been associated with diseases including periodontitis, oral cancer, and trauma, they noted. Moreover, the loss of teeth can spark anatomical changes affecting the size and function of the upper airway.","_key":"aefd8b1a9f610"}],"_type":"block","style":"normal","_key":"8c8b6f8657f1"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"539a9cd6f1550"}],"_type":"block","style":"normal","_key":"ff1adb42426d"},{"style":"normal","_key":"d0c3f5637115","markDefs":[],"children":[{"marks":[],"text":"“Changes that are also frequently observed include loss of the vertical dimension of occlusion, mandibular rotation, and reduction of the lower face height,” they wrote. “Increased collapsibility of the pharynx can act as a causal factor for OSA.”","_key":"4d17b4fe5fcd0","_type":"span"}],"_type":"block"},{"_type":"block","style":"normal","_key":"5e9fc41d7b1c","markDefs":[],"children":[{"text":"","_key":"082349298fc00","_type":"span","marks":[]}]},{"_type":"block","style":"normal","_key":"705b5175718f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"They wanted to better understand what the existing scientific literature says about links between OSA and edentulism, and see what conclusions—if any—could be drawn, so they searched a number of scientific databases for relevant studies investigating potential links between OSA and edentulism. They found 23 such studies, published between from 1999 to 2023, all of which were clinical studies and 6 of which were randomized controlled trials.","_key":"ec4726a420040"}]},{"children":[{"text":"","_key":"e834297069ac0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"ea63d03014e5","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The studies were unanimous in concluding that there is an association between edentulism and OSA, the authors found. They suggest that Apnea-Hypopnea Index scores were 2 to 3 times higher in people with edentulism than people with teeth. However, the authors cautioned that there were relatively few data directly comparing edentulous and dentate patients, which they said indicates a need for more research into the question. They also said differences in study methods, OSA diagnostic tools, and outcome criteria made it impossible to do a meta-analysis.","_key":"1f0847d503150"}],"_type":"block","style":"normal","_key":"c5c180d5f2e5"},{"style":"normal","_key":"f7531c4f1f7b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d19cb9a41d950"}],"_type":"block"},{"_key":"602bdf3a65bd","markDefs":[{"_key":"35f2bb436b66","nofollow":true,"blank":true,"_type":"link","href":"https://dentjods.sums.ac.ir/article_48879.html"}],"children":[{"_type":"span","marks":[],"text":"Another question that has been evaluated is the impact of dentures on OSA risk. The existing research is inconclusive, they noted, with some studies suggesting that dentures can increase the risk of OSA and other studies finding that dentures decrease the risk. A ","_key":"abec7bf6b6970"},{"text":"more recent study","_key":"abec7bf6b6971","_type":"span","marks":["35f2bb436b66"]},{"marks":[],"text":" that looked specifically at implant-supported mandibular dentures, however, found they can improve airway space and symptoms in people with mild to moderate OSA.","_key":"abec7bf6b6972","_type":"span"},{"_type":"span","marks":["superscript"],"text":"3","_key":"ebc2975378e6"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"04cb188be8e6","markDefs":[],"children":[{"_key":"e293351702310","_type":"span","marks":[],"text":""}]},{"children":[{"_type":"span","marks":[],"text":"The authors said the data show a “plausible” association between edentulism and OSA, which they said underscores the importance of prosthodontic management and the prevention of tooth loss.","_key":"70e7e788832b0"}],"_type":"block","style":"normal","_key":"4066ffa1fb1b","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"65c9689ec36e0","_type":"span"}],"_type":"block","style":"normal","_key":"73dfa0ac768e"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“However, clinical data are limited and heterogenous, so more clinical studies should be encouraged for more robust conclusions,” they wrote.","_key":"8dc157f6bf5a0"}],"_type":"block","style":"normal","_key":"afd2f29abf1f"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2c0e07b996950"}],"_type":"block","style":"normal","_key":"77ca49258627"},{"_key":"e974d605f021","markDefs":[],"children":[{"text":"References","_key":"e90434645a9d0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_key":"b5b6f290f58e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Pachiou A, Roulias P, Steiropoulos P, Halazonetis DJ, Kourtis S. Association of edentulism and obstructive sleep apnea: a systematic review. ","_key":"e30ad513e5250"},{"_key":"e30ad513e5251","_type":"span","marks":["em"],"text":"J Prosthodont"},{"_type":"span","marks":[],"text":". Published online November 13, 2024. doi:10.1111/jopr.13981","_key":"e30ad513e5252"}],"_type":"block","style":"normal"},{"_key":"ddfa4413b9a6","markDefs":[],"children":[{"_key":"551a72c715b20","_type":"span","marks":[],"text":"2. Ye L, Li W, Willis DG. Facilitators and barriers to getting obstructive sleep apnea diagnosed: perspectives from patients and their partners. "},{"_type":"span","marks":["em"],"text":"J Clin Sleep Med","_key":"551a72c715b21"},{"marks":[],"text":". 2022;18(3):835-841. doi:10.5664/jcsm.9738","_key":"551a72c715b22","_type":"span"}],"_type":"block","style":"normal"},{"_key":"81bb9c8d0104","markDefs":[],"children":[{"_type":"span","marks":[],"text":"3. Krishnamurthy P, Maheswari U, Mohamed K. Effect of prosthetic rehabilitation on airway space in edentulous patients with obstructive sleep apnea- a preliminary observational study. ","_key":"39685a5c77cd0"},{"_type":"span","marks":["em"],"text":"J Dent (Shiraz)","_key":"39685a5c77cd1"},{"_type":"span","marks":[],"text":". 2023;24(4):382-388. doi:10.30476/dentjods.2022.95716.1886","_key":"39685a5c77cd2"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"6560e444aa6f0"}],"_type":"block","style":"normal","_key":"a2eab0b1ce27","markDefs":[]}],"gptSummary":"A systematic review highlights a potential link between edentulism and obstructive sleep apnea (OSA), suggesting anatomical changes from tooth loss may increase OSA risk. The review found unanimous agreement among 23 studies, though data comparing edentulous and dentate patients are limited. The impact of dentures on OSA risk remains inconclusive, with some studies indicating increased risk and others suggesting improvement in airway space. 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A recent study published in ","_key":"a09cfc1c8a140","_type":"span","marks":[]},{"marks":["em"],"text":"Blood Advances","_key":"a09cfc1c8a141","_type":"span"},{"_type":"span","marks":[],"text":" analyzed data from 13,084 patients in the United States with laboratory-confirmed iron deficiency.","_key":"a09cfc1c8a142"},{"text":"2","_key":"828b516e1a0d","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" It was found that 58% of patients did not resolve their deficiency within 3 years of diagnosis, even with repeated ferritin testing. For those who did see improvement, the median time to resolution was nearly 2 years.","_key":"bd46393f6d9a"}],"_type":"block","style":"normal","_key":"cc4b29bc8cbb"},{"style":"normal","_key":"2f990b646e2b","markDefs":[],"children":[{"text":"","_key":"aba3a485c4ce","_type":"span","marks":[]}],"_type":"block"},{"_type":"block","style":"normal","_key":"2d55ba5b754c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Understanding the effects of iron deficiency separate from anemia can be complex.","_key":"e1d472ec43750"},{"marks":["superscript"],"text":"1","_key":"0372013b0f93","_type":"span"},{"marks":[],"text":" However, those with iron deficiency often experience symptoms like fatigue, weakness, intolerance to exercise, and cognitive difficulties. The implications are even more significant for pregnant individuals, as iron deficiency has been associated with adverse neurodevelopmental outcomes in infants.","_key":"1c3fc5b6e5f7","_type":"span"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"b084d12699350"}],"_type":"block","style":"normal","_key":"cea5fa013bf4","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The quality-of-life impact is significant, yet historical diagnostic practices often fail to capture the condition. Current evidence suggests that a ferritin level of 30 µg/L or less is sensitive and specific for diagnosing absolute iron deficiency. However, some experts advocate using a threshold of 50 µg/L to better identify affected individuals, the article acknowledged. Functional iron deficiency, marked by an inability to utilize stored iron due to underlying inflammatory conditions such as chronic kidney disease, requires different diagnostic approaches, including measuring transferrin saturation.","_key":"5a6918b5ce960"}],"_type":"block","style":"normal","_key":"43e8892b332a"},{"_key":"c00da1714f6f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d4f247c6d13e"}],"_type":"block","style":"normal"},{"style":"h3","_key":"1894f045d6c0","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Disproportionate Burden and Barriers to Treatment","_key":"7cd19df54a6e"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"Recent data highlight significant disparities in the prevalence of iron deficiency. A study conducted in September 2024 estimated that 14% of adults in the US experience absolute iron deficiency, while 15% are affected by functional iron deficiency. Among women aged 18 to 50 years, the prevalence of absolute iron deficiency is particularly concerning, reaching 34% (95% CI, 31-37), whereas functional iron deficiency is more commonly observed in older women and men across all age groups. ","_key":"a5e90e95b0860"}],"_type":"block","style":"normal","_key":"0d9a723e1fe5","markDefs":[]},{"_type":"block","style":"normal","_key":"4eca6c79991b","markDefs":[],"children":[{"_key":"8a9684626765","_type":"span","marks":[],"text":""}]},{"markDefs":[{"_type":"link","href":"https://www.ajmc.com/compendium/rareblood","_key":"f35e7cfdde91","nofollow":false,"blank":true}],"children":[{"_type":"span","marks":[],"text":"Factors such as menstruation and pregnancy place women and girls at a higher risk for absolute iron deficiency, specifically when factoring in the under-detected possibility of ","_key":"2eb8cbc2f3dd"},{"_key":"d2c947804e85","_type":"span","marks":["f35e7cfdde91"],"text":"rare blood disorders"},{"text":" like hemophilia.","_key":"15aae21c5e52","_type":"span","marks":[]},{"marks":["superscript"],"text":"3","_key":"0e9627f3b838","_type":"span"},{"_type":"span","marks":[],"text":" ","_key":"dd898787a8f5"}],"_type":"block","style":"normal","_key":"beeac100f20e"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"ac4a3cd3587b","_type":"span"}],"_type":"block","style":"normal","_key":"6e6faab2e578"},{"markDefs":[{"_type":"link","href":"https://www.ajmc.com/topic/center-on-health-equity-and-access","_key":"814d08b08247","blank":true},{"_key":"c872f66ace7b","nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/view/breaking-barriers-in-bleeding-disorders-experts-call-for-more-data-on-women"}],"children":[{"_type":"span","marks":[],"text":"A discrepancy exists in how treatments for hemophilia are tested in clinical trials, primarily focusing on men. This can limit the scope of treatments for women who generally have higher hormone levels, Margaret Ragni, MD, MPH, professor of medicine and clinical and translational research in the Division of Hematology/Oncology at the University of Pittsburgh, director of the Hemophilia Center of Western Pennsylvania, and American Society of Hematology expert, explained in an ","_key":"c4c6f6599c970"},{"_key":"c35a7d5f340a","_type":"span","marks":["c872f66ace7b"],"text":"interview"},{"_type":"span","marks":[],"text":" with ","_key":"876c6f31e367"},{"text":"The American Journal of Managed Care","_key":"82161bfe24ab","_type":"span","marks":["em"]},{"_type":"span","marks":["superscript"],"text":"®","_key":"810d503ed657"},{"_type":"span","marks":[],"text":" (","_key":"f2d59db9a89f"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"89b670cb5cbb"},{"_type":"span","marks":["superscript"],"text":"®","_key":"6fda27a29344"},{"_type":"span","marks":[],"text":") ","_key":"91cbaa029bde"},{"_type":"span","marks":["814d08b08247"],"text":"Center on Health Equity \u0026 Access","_key":"69ca8d14d9eb"},{"text":".","_key":"d110dd1c7716","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"730dfca00dce"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"7bf94255f494","_type":"span"}],"_type":"block","style":"normal","_key":"697d9159a4e2"},{"_type":"block","style":"normal","_key":"2d2cd28492dd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Treatment options for iron deficiency include oral iron supplements and intravenous iron therapy.","_key":"3ee38737c65e0"},{"_type":"span","marks":["superscript"],"text":"1","_key":"95ad879425b1"},{"_key":"d92df4950774","_type":"span","marks":[],"text":" Oral iron is generally cost-effective; however, gastrointestinal adverse effects can limit its use for some patients. Alternatively, intravenous iron is safe and effective but may be difficult to access due to logistical or financial barriers."}]},{"_type":"block","style":"normal","_key":"0def125fc7c4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"316c3f70b3630"}]},{"_key":"e9c1b33e76d7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Functional iron deficiency typically requires treatment of the underlying inflammatory condition, adding another layer of complexity to its management. In LMICs, additional challenges exacerbate the issue. Food insecurity, untreated heavy menstrual bleeding, and increasing inflammatory conditions, such as obesity, contribute to the prevalence of iron deficiency. This condition often reflects broader health inequities and serves as an indicator of unmet nutritional and health care needs.","_key":"853955daff7d0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"39136b2b7afe","markDefs":[],"children":[{"_key":"dac55da0cb25","_type":"span","marks":[],"text":""}],"_type":"block"},{"markDefs":[],"children":[{"text":"Iron Deficiency: A Marker of Inequality","_key":"271c4f3a3e20","_type":"span","marks":["strong"]}],"_type":"block","style":"h3","_key":"ee96250f8f97"},{"style":"normal","_key":"5d31a61a3186","markDefs":[],"children":[{"text":"Increased research has highlighted the widespread issue of iron deficiency, especially among women, and the difficulties in diagnosing and treating it. This increasing awareness should now lead to significant changes in health care to enable timely and effective diagnosis and management.","_key":"ab02d4c9e26f0","_type":"span","marks":[]}],"_type":"block"},{"style":"normal","_key":"3edc48e54eba","markDefs":[],"children":[{"text":"","_key":"780bb2f62de2","_type":"span","marks":[]}],"_type":"block"},{"_type":"block","style":"normal","_key":"343ce342c237","markDefs":[],"children":[{"_type":"span","marks":[],"text":"\"Iron deficiency itself can serve as a marker of inequality and unmet health needs since it emerges when nutrition is not optimal or when a related condition or disease is not being adequately managed,\" the article stated. \"Numerous barriers to the recognition of non-[anemic] iron deficiency as a substantial health burden still exist.\"","_key":"de30c4510d680"}]},{"_type":"block","style":"normal","_key":"b40f1e922351","markDefs":[],"children":[{"_key":"e762316edc5e","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"marks":[],"text":"The need for improved diagnostic criteria, such as raising ferritin cutoff levels and incorporating measures for functional iron deficiency, was further emphasized. 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","_key":"f9f77c7dcb520","_type":"span","marks":[]},{"marks":["em"],"text":"Lancet Haematol","_key":"f9f77c7dcb521","_type":"span"},{"_type":"span","marks":[],"text":". 2024;11(11):e803. doi:10.1016/S2352-3026(24)00318-1","_key":"f9f77c7dcb522"}]},{"style":"normal","_key":"d323142727ac","markDefs":[],"children":[{"marks":[],"text":"2. Cogan J, Meyer J, Jiang Z, Sholzberg M. Iron deficiency resolution and time to resolution in an American health system. ","_key":"67fafe6e36ae","_type":"span"},{"_key":"810be7429ae7","_type":"span","marks":["em","em"],"text":"Blood Adv."},{"_key":"1bc3f8f587dc","_type":"span","marks":[],"text":" 2024; bloodadvances.2024013197. doi:10.1182/bloodadvances.2024013197"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"3. Grossi G. Breaking barriers in bleeding disorders: experts call for more data on women. ","_key":"f7295ffdc94a"},{"text":"Am J Accountable Care. 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Exacerbations were found to be more severe among patients with MG who had comorbidities and those receiving immunosuppressive therapy, such as corticosteroids."}],"_type":"block","style":"normal","_key":"ed433cadbb3f","markDefs":[]},{"_key":"88f945190704","markDefs":[],"children":[{"marks":[],"text":"","_key":"523a2b7424580","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"e821e7210a86","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Most COVID-19 infections were primarily managed at home, but a few cases required hospitalization. Eight patients with COVID-19 infection (3.4%) developed respiratory failure that required mechanical ventilation, and 3 patients were admitted to the ICU. No deaths were reported within this cohort. However, 14.9% of patients experienced prolonged symptoms of fatigue, tiredness, and shortness of breath.","_key":"a8247d692e3d0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7b39509e0dd00"}],"_type":"block","style":"normal","_key":"4772327b8df1"},{"_type":"block","style":"normal","_key":"94f7576911ed","markDefs":[],"children":[{"marks":[],"text":"To further investigate the impact of COVID-19 on patients with MG, the researchers conducted a survival analysis comparing MG exacerbations in 2 time periods: December 1, 2022 to March 10, 2023 (DTM23), covering the Omicron wave, and January 2021 to April 2021 (JTA21), an earlier period without COVID-19 exposure. 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Although COVID-19 vaccines effectively reduce severe illness, they may offer limited protection against infection with COVID-19 due to the development of unique variants.","_key":"a0d36c7301920"}],"_type":"block","style":"normal","_key":"9f68fc8008a2","markDefs":[]},{"style":"normal","_key":"2ef57ee9e298","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1fadcdc5e1b20"}],"_type":"block"},{"_type":"block","style":"normal","_key":"b40369efdd6d","markDefs":[],"children":[{"_key":"effcf725c4820","_type":"span","marks":[],"text":"Infection, particularly respiratory infections, has long been known as a trigger for MG exacerbation. This is supported by previous studies showing that viral infections like influenza can similarly increase exacerbation risk."},{"_type":"span","marks":["superscript"],"text":"2,3","_key":"1b77d53b9173"},{"marks":[],"text":" The results of this study align with recent data from the COVID-19 Associated Risks and Effects in Myasthenia Gravis (CARE-MG) registry that suggests patients with MG infected with COVID-19 are more frequently hospitalized, experience increased disease exacerbations, and have higher mortality rates compared to the general COVID-19 population.","_key":"2574bcdecaaa","_type":"span"},{"_type":"span","marks":["superscript"],"text":"4","_key":"98650c5589f8"},{"text":" ","_key":"d8664363b173","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_key":"f4ecd16e57150","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"555bffcfee43"},{"_type":"block","style":"normal","_key":"b387cb476159","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It should be noted that in this study, COVID-19 diagnosis was not based strictly on laboratory tests but rather on typical COVID-19 symptoms. 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","_key":"83a7db335ce80"},{"text":"Lancet Neurol","_key":"f351bd12c07a","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2020;19(12):970-971. doi:10.1016/S1474-4422(20)30413-0","_key":"02046fc03a85"}],"level":1,"_type":"block","style":"normal","_key":"75a3ef326fb6","listItem":"number"}],"is_visible":true,"url":"covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds","_updatedAt":"2024-11-21T14:33:13Z","_type":"article","published":"2024-11-22T13:52:00.000Z","title":"COVID-19 Infection Raises Myasthenia Gravis Exacerbation Risk, Study Finds","_createdAt":"2024-11-21T14:32:55Z","thumbnail":{"_type":"mainImage","alt":"Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Cutie - stock.adobe.com","caption":"Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Cutie - stock.adobe.com","asset":{"_ref":"image-e16c42f428ff1dae499535cfedd861067c30dce4-4096x4096-jpg","_type":"reference"}},"_rev":"EbkpNMUbiIwDU1ASlh7Yec","contentCategory":{"_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh"},"factCheckAuthors":null,"documentGroup":null,"summary":"A new study shows that COVID-19 infection significantly increases the risk of exacerbation in patients with myasthenia gravis (MG). 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Panelists discussed advances in treatment methods, technology, and immunotherapy across disease states, with some innovations destined to become best practices.","_key":"b179e226d6880"}]},{"_key":"b7c46eb7eef7","alignment":"left","asset":{"_ref":"image-c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645-png","_type":"reference"},"widthP":25,"disableTextWrap":false,"disableLightBox":true,"_type":"figure"},{"_key":"1c6e5fbc7136","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Glenn Balasky, executive director of Rocky Mountain Cancer Centers in Colorado, moderated the session “Implementing New Technology and Innovations in Cancer Care in Rural Communities.” The session featured Ken Cohen, MD, executive director of translational research at Optum Care, and Rhonda Henschel, MBA, senior vice president of payer and care transformation at The US Oncology Network.\n\n","_key":"bb7bfad5ce10"},{"_type":"span","marks":["strong"],"text":"Innovative Methods Within Rural Cancer Care","_key":"e2379f23b82d"},{"_type":"span","marks":[],"text":"\n","_key":"2e02e89255b1"}],"_type":"block","style":"normal"},{"disableLightBox":true,"alignment":"left","asset":{"_ref":"image-e9f57485f9ad536c4310c5d28ab219d09a86e10d-225x225-jpg","_type":"reference"},"_type":"figure","widthP":25,"alt":"Glenn Balasky | Image: Rocky Mountain Cancer Centers","disableTextWrap":false,"imgcaption":[{"markDefs":[],"children":[{"_key":"37ec4350efc4","_type":"span","marks":[],"text":"Glenn Balasky | Image: Rocky Mountain Cancer Centers"}],"_type":"block","style":"normal","_key":"5960bb8926b4"}],"_key":"ee325aa09d48"},{"children":[{"_type":"span","marks":[],"text":"Balasky began the session by asking Cohen and Henschel for their perspectives on rural cancer care. Cohen explained that therapeutic complications may occur in patients who live near a rural hospital that lacks experience in managing these adverse events. Henschel noted that financial means and transportation needs are huge factors that can determine who has access to care in rural areas.","_key":"082a017f5008"}],"_type":"block","style":"normal","_key":"2c822fd6283e","markDefs":[]},{"imgcaption":[{"children":[{"_key":"1cc85b223efc","_type":"span","marks":[],"text":"Ken Cohen, MD | Image: Optum"}],"_type":"block","style":"normal","_key":"e9f4af73026f","markDefs":[]}],"_key":"45a02a2b111d","alt":"Ken Cohen, MD | Image: Optum","alignment":"left","asset":{"_ref":"image-5c85b4966d84d5615aff74d9a12be85688f3da54-220x229-jpg","_type":"reference"},"disableTextWrap":false,"_type":"figure","disableLightBox":true,"widthP":25},{"markDefs":[],"children":[{"marks":[],"text":"“One important thing brought up a couple of times this evening is the concept of decentralized clinical trials, which was a nonstarter before the [COVID-19] pandemic,” Cohen said. “I’ve been a trialist for 30 years, and the FDA wouldn’t let you draw a laboratory [test] outside of a clinical research center, but everything changed at the beginning of the pandemic.”","_key":"7ba105328e60","_type":"span"}],"_type":"block","style":"normal","_key":"aefedb549541"},{"_key":"e2eef6e8a0b8","markDefs":[],"children":[{"text":"Henschel said her greatest concern is the significant lack of oncology providers for patients with cancer who live in rural areas. This compounds financial toxicity for these patients and their caregivers, who often take off work to travel to treatment facilities. Henschel suggested a multistakeholder strategy that focuses heavily on small, rural communities to close these accessibility gaps.","_key":"cf6d34a42722","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“I think where we start to see concerns is in access to clinical trials in some of these rural areas,” Henschel said. With cellular therapy, for example, “I think we’ve seen a lot of information, especially as we partner with the Leukemia \u0026 Lymphoma Society, on the lack of access of cellular therapies, new and novel treatments, and getting those penetrated into rural areas,” she said.","_key":"9e55892f95f5"}],"_type":"block","style":"normal","_key":"5129dea8716c"},{"_type":"block","style":"normal","_key":"89b2464fb63f","markDefs":[],"children":[{"_key":"67d4282bd8b5","_type":"span","marks":[],"text":"Balasky asked the panelists whether they believe patients with cancer “are already filtered out based on their social determinants of health.” Primary care physicians often give patients a diagnosis based on laboratory results, and those in rural areas may be referred to specialist surgeons in metropolitan centers due to limited local options."}]},{"disableTextWrap":false,"_type":"figure","alt":"Rhonda Henschel | Image: The US Oncology Network","alignment":"left","widthP":25,"_key":"a1bc02af1bb4","asset":{"_ref":"image-24cccff952af8c38e2b8b88d388c8e69f7e60bc1-512x512-jpg","_type":"reference"},"disableLightBox":true,"imgcaption":[{"children":[{"_type":"span","marks":[],"text":"Rhonda Henschel | Image: The US Oncology Network","_key":"347e5fea5df4"}],"_type":"block","style":"normal","_key":"d48ae7d46033","markDefs":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Henschel addressed a project she is working on in Texas to secure state funding from Medicaid coverage plans to help with increased screening rates. She believes that after this is achieved, communities and hospitals can form partnerships to offer patients the care they need.\n\n","_key":"cfc8a856ed21"},{"_type":"span","marks":["strong"],"text":"The Role of Telemedicine","_key":"f2d10719e25e"},{"_key":"68031455ab8b","_type":"span","marks":[],"text":"\nThe discussion shifted to technology as a potential solution for filling knowledge gaps, accessibility, and financial toxicity in rural cancer care. Telemedicine was suggested as a solution to provide widespread care to various regions. Cohen explained that although telemedicine is not the end-all, be-all solution, there are helpful models that utilize technology in a relevant manner."}],"_type":"block","style":"normal","_key":"5301a22f7d04"},{"style":"normal","_key":"4beae0f8c85e","markDefs":[],"children":[{"text":"He provided examples such as “grandpads,” which are similar to an iPad tablet but instead have large font sizes, limited icons, and connect only to primary care offices through a virtual video call. They allow medical providers to establish and maintain relationships to ensure adequate access to medications and food.","_key":"78283bfebe21","_type":"span","marks":[]}],"_type":"block"},{"_key":"cb13304af149","markDefs":[],"children":[{"text":"Another model, still in testing, began at The Everett Clinic, now Optum Care Washington, which operates as a precancer clinic with oncologists using relevant patient data to come to a definitive diagnosis, expediting the overall process. Lastly, Cohen mentioned the WISDOM trial (NCT02620852), a new trial looking at different ways to review breast cancer.","_key":"8bb61a98b14a","_type":"span","marks":[]},{"marks":["superscript"],"text":"1","_key":"f3cc0ed62087","_type":"span"},{"text":" Prior to a mammography, breast screening practices can include polygenetic testing, and obtaining a detailed family and personal history. Once a person reaches screening age, mammogram assessments of breast density can be uploaded. A team then works to define a personal screening regimen based on these characteristics, which is completed remotely.","_key":"d48e62960003","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_key":"ccf037264511","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Cohen emphasized that implementing these telemedicine methods within rural areas is largely dependent on state mandates. He acknowledged there are areas in the US where geographic proximity to a high-functioning system doesn’t exist and better mechanisms are necessary. Cohen referenced a study published in ","_key":"cbbad77b7f32"},{"_type":"span","marks":["em"],"text":"JAMA Network Open","_key":"94af27568272"},{"_type":"span","marks":[],"text":" that conducted screenings for colorectal, cervical, and breast cancers in rural Indiana and Ohio by taking a mobile screening van into communities.","_key":"8a0cd86d7038"},{"_type":"span","marks":["superscript"],"text":"2","_key":"8ac2dacd09ce"},{"_type":"span","marks":[],"text":" Results found the screening rates doubled in these rural regions, but the study still only reached 50% of the population.","_key":"b29f2fd1ed17"}],"_type":"block","style":"normal"},{"style":"normal","_key":"d8fd458d1c20","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The discussion focused on how technology, particularly screening methods, can enhance cancer care. Cohen noted that the pandemic accelerated the shift toward remote patient monitoring, which has potential applications in oncology. However, both he and Henschel acknowledged that this technology is still in its developmental stages and hasn’t realized its full potential.\n\n","_key":"11079cb00bba"},{"text":"Therapeutic Advances","_key":"3126b432dfd6","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":"\n","_key":"5f3f70057a5a"}],"_type":"block"},{"_type":"figure","alt":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers","asset":{"_ref":"image-d447adb68e95c40a32b67a3e106204096ded2512-200x200-jpg","_type":"reference"},"widthP":25,"disableTextWrap":false,"_key":"c2d874e6bb9b","alignment":"left","disableLightBox":true,"imgcaption":[{"markDefs":[],"children":[{"_key":"02aa1460fade","_type":"span","marks":[],"text":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers"}],"_type":"block","style":"normal","_key":"15e4bbaf4e85"}]},{"_type":"block","style":"normal","_key":"716e82860d50","markDefs":[],"children":[{"_type":"span","marks":[],"text":"All IVBM sessions explore newer treatment methods that consider cost-effectiveness in cancer care. Amy Sidorski, MS, ANP-C, advanced practice provider for oncology and hematology at Rocky Mountain Cancer Centers, explained the evolution of multiple myeloma treatment within their practice over the past several years through the introduction of quadruplet therapy based on the phase 3 PERSEUS trial, which has altered first-line treatment for patients. Results from PERSEUS (NCT03710603), presented in December 2023 at the American Society of Hematology Annual Meeting and Exposition, showed that patients who received daratumumab (Darzalex), bortezomib (Velcade), lenalidomide (Revlimid), dexamethasone (D-VRd) induction/consolidation followed by daratumumab plus lenalidomide maintenance had lower risk of disease progression or death than the VRd group, and improved minimal residual disease negativity.","_key":"7375da5a57e8"},{"_key":"64db89dd6b36","_type":"span","marks":["superscript"],"text":"3"}]},{"style":"normal","_key":"81de327a6fd5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In addition, Sidorksi said, having chimeric antigen receptor (CAR) T-cell therapy and bispecific T-cell engagers for use in second-line treatment has changed her practices’ operations.","_key":"23b660d7cdd5"}],"_type":"block"},{"markDefs":[],"children":[{"text":"“It’s an amazing time to be a myeloma doctor,” Jorge Monge, MD, assistant professor of medicine and hematology at the University of Colorado School of Medicine in Aurora, said. Monge emphasized advancements made in multiple myeloma treatment from 1985 to 2024, emphasizing that a key area of evolution has been in the patient’s quality of life.","_key":"aa530af5a2f9","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c87eb11ebe11"},{"_type":"block","style":"normal","_key":"1b1e6c212a25","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Lida Bighash, PharmD, BCOP, clinical pharmacy specialist in oncology at Denver Health, reviewed the past decade of advances in non–small cell lung cancer (NSCLC) treatment. As recently as a decade ago, there were no approved agents for use in NSCLC. Currently, there are several options for patients among all areas of NSCLC in neoadjuvant, adjuvant, and perioperative settings.","_key":"81e0b6b4e77a"}]},{"disableTextWrap":false,"_type":"figure","imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Tejas Patil, MD | Image: University of Colorado","_key":"1b01259dcaf9"}],"_type":"block","style":"normal","_key":"f0a3f9ae75eb"}],"alt":"Tejas Patil, MD | Image: University of Colorado","_key":"5910fde13802","widthP":25,"alignment":"left","asset":{"_ref":"image-53e969cbdbb7ddb733d3e127f4dbea8f818f7170-500x500-jpg","_type":"reference"},"disableLightBox":true},{"markDefs":[],"children":[{"marks":[],"text":"Tejas Patil, MD, oncologist and assistant professor at the University of Colorado Cancer Center agreed with Bighash on the focal areas of development, referring to CHECKMATE-816, KEYNOTE-671, CHECKMATE-77T, as well as other clinical trials that led to improvements in patients’ pathologic complete response.","_key":"68781585f8c9","_type":"span"},{"_type":"span","marks":["superscript"],"text":"4-6","_key":"8a1a82e6db12"}],"_type":"block","style":"normal","_key":"4eaf0b172016"},{"_type":"block","style":"normal","_key":"751733a9f193","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Virginia Borges, MD, professor of medicine and medical oncology at the University of Colorado, discussed the significance of ribociclib (Kisqali) in early breast cancer treatment based on results from the phase 3. NATALEE trial (NCT03701334).","_key":"8e6f5ff384a6"},{"_type":"span","marks":["superscript"],"text":"7","_key":"3d1893568deb"},{"_type":"span","marks":[],"text":" Borges explained patients with early-stage HR+/HER2-negative breast cancer have a pair of CDK4/6 inhibitor options for treatment: abemaciclib (Verzenio) or ribociclib, although she noted that some patients are unable to tolerate either therapy.","_key":"32fb5a0d994c"}]},{"markDefs":[],"children":[{"_key":"0f5fc89c2441","_type":"span","marks":[],"text":"Financial toxicity was a theme mentioned across all panels because the best therapies can have high out-of-pocket costs. “The main factor that alters a woman’s life and drives the financial cost of treating breast cancer through the roof is a metastatic diagnosis,” Borges said."}],"_type":"block","style":"normal","_key":"afa16ed3c372"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"She explained that a metastatic diagnosis includes higher-cost medications used for longer durations and in routine procedures, whereas a diagnosis of early-stage breast cancer is significantly less expensive. Borges referred to public support programs for patients who are uninsured or underinsured. Overall, she highlighted the cost-effectiveness of preventing metastatic breast cancer compared with treating it.","_key":"0911b1e95b11"}],"_type":"block","style":"normal","_key":"382a9b62e3d2"},{"asset":{"_ref":"image-2d330678dfcdd6731a1750cdad0d1e581842adda-200x200-jpg","_type":"reference"},"disableTextWrap":false,"_key":"2ec27a02fe1e","alignment":"left","widthP":25,"disableLightBox":true,"_type":"figure","imgcaption":[{"children":[{"_key":"6f03be26012b","_type":"span","marks":[],"text":" Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn"}],"_type":"block","style":"normal","_key":"f80a6e656336","markDefs":[]}],"alt":"Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The moderator for the multiple myeloma panel, Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, clinical pharmacy manager in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Health System, asked Sidorski and Monge about the cost-effectiveness of CAR T-cell therapies. Sidorski stressed the importance of affordable CAR T-cell therapies for patients with myeloma but agreed that access has not been easy. She hypothesized that CAR T-cell therapies may be a more cost-effective option that will allow patients to move forward from previous therapy, potentially saving money down the line.","_key":"70e023a00d29"}],"_type":"block","style":"normal","_key":"0c47fcb50c27"},{"children":[{"_type":"span","marks":[],"text":"Monge explained why it is important to determine the duration of treatment on bispecific therapies, because starting treatment earlier for patients who remain on therapy the same length as patients starting later will result in similar financial toxicities. Transparent communication with appropriate stakeholders was suggested to develop models of cost ineffectiveness, which included fixed durations of therapy or minimal residual disease–adapted therapy.","_key":"bb7f54650c5a"}],"_type":"block","style":"normal","_key":"be73d7e3003d","markDefs":[]},{"style":"normal","_key":"b8b0f9679ce0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Both Patil and Bighash emphasized the importance in considering financial toxicity within NSCLC treatment, acknowledging how one affects the other. They suggested patient assistance programs created by drug manufacturers as proposed solutions to lower the high costs of immunotherapies.\n“There are a lot of trials that are looking at this question of de-escalation, which goes hand-in-hand with financial toxicity,” Patil said.","_key":"fabb7d1ae072"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Bighash noted that if the institutions, insurance companies, or patients cannot pay out-of-pocket expenses for adequate care medications, then the patients are not receiving the best quality treatment from health care providers.\n\n","_key":"ddb9daa905ee"},{"marks":["strong"],"text":"Takeaways and Next Steps\n","_key":"3cc3820e940c","_type":"span"},{"_type":"span","marks":[],"text":"Moving forward, the cancer care community must continue to focus on developing innovative treatments, improving access to care, and addressing financial toxicity for patients. By working together, we can create a more equitable and effective cancer care system for all, panelists agreed.","_key":"d0562f193c8d"}],"_type":"block","style":"normal","_key":"a40bf20eabe2"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“My best idea would be that we bridge the connection with people and then they make trips into the big city for what they need or [find] ways to get them to the city. Transportation [issues] can be overcome, but you can’t just bring very sophisticated care out everywhere. It’s just not economically feasible,” Balasky said in an interview with ","_key":"a06512dba397"},{"text":"AJMC","_key":"c4fb58bda4c7","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". \n\n","_key":"05d76c82066c"},{"marks":["strong"],"text":"References","_key":"fc937ebfb1f8","_type":"span"},{"_type":"span","marks":[],"text":"\n1. Eklund M, Broglio K, Yau C, Connor JT, Stover Fiscalini A, Esserman LJ. The WISDOM personalized breast cancer screening trial: simulation study to assess potential bias and analytic approaches. ","_key":"3ad47b83c420"},{"_key":"d4c09311b118","_type":"span","marks":["em"],"text":"JNCI Cancer Spectr"},{"_key":"b4cdaa20724d","_type":"span","marks":[],"text":". 2019;2(4):1-7. doi:10.1093/jncics/pky067\n2. Champion VL, Paskett ED, Stump TE, et al. Comparative effectiveness of 2 interventions to increase breast, cervical, and colorectal cancer screening among women in the rural US: a randomized clinical trial. "},{"_type":"span","marks":["em"],"text":"JAMA Netw Open.","_key":"a7cb766f16b0"},{"text":" 2023;6(4):e2311004. doi:10.1001/jamanetworkopen.2023.11004\n3. Sonneveld P, Dimopoulos M A, Boccadoro M, et al; PERSEUS Trial Investigators. Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2023;390(4):301-313. doi:10.1056/nejmoa2312054\n4. A neoadjuvant study of nivolumab plus ipilimumab or nivolumab plus chemotherapy versus chemotherapy alone in early stage non-small cell lung cancer (NSCLC) (CheckMate 816). Clinicaltrials.gov. October 16, 2023. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT02998528\n5. Efficacy and safety of pembrolizumab (MK-3475) with platinum doublet chemotherapy as neoadjuvant/adjuvant therapy for participants with resectable stage III, IIIA, and resectable IIIB (T3-4N2) non-small cell lung cancer (MK-3475-671/KEYNOTE-671). Clinicaltrials.gov. September 19, 2024. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT03425643\n6. A study of neoadjuvant chemotherapy plus nivolumab versus neoadjuvant chemotherapy plus placebo, followed by surgical removal and adjuvant treatment with nivolumab or placebo for participants with surgically removeable early stage non-small cell lung cancer. Clinicaltrials.gov. July 23, 2024. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT04025879\n7. A trial to evaluate efficacy and safety of ribociclib with endocrine therapy as adjuvant treatment in patients with HR+/HER2-early breast cancer (NATALEE). Clinicaltrials.gov. October 10, 2024. Accessed October 23, 2024. https://clinicaltrials.gov/study/NCT03701334","_key":"ab84ec6ac1a5","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"f8a886b17e4a"}],"_type":"article","audioUrl":"https://s3.us-east-1.amazonaws.com/ai-generated-audios/www.ajmc.com/3ab0a249-35da-4929-895b-bc3bc50fe93c_1732210014543.06803a02-47fd-4bc2-a9ed-621eeaa817e4.mp3","contentCategory":{"_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh"},"gptTakeaways":"• Decentralized clinical trials and telemedicine are pivotal in addressing rural cancer care challenges, enhancing accessibility and patient outcomes.\n\n• Therapeutic advancements, such as CAR T-cell therapy and quadruplet therapy, are transforming multiple myeloma treatment, improving patient quality of life.\n\n• Financial toxicity in cancer care is a critical issue, necessitating 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