Background IDH-mutant (mIDH) gliomas affect relatively young and otherwise healthy patients with high workforce participation. Management typically involves surgery, radiotherapy, and/or chemotherapy (RT/CT), although immediate post-surgery treatment may be deferred in favor of active observation (AO) to preserve functioning. This study aimed to evaluate how disease progression and treatments impact work activity, medical and societal costs, and overall survival (OS) in grade 2 mIDH glioma patients initially managed with AO.Methods This retrospective longitudinal study utilized Danish administrative registries. Patients with mIDH gliomas initially managed with AO between 2010 and 2022 were included. Employment rates, sick leaves, treatment patterns, medical resources and costs, and OS were examined from diagnosis to the end of follow-up or death.Results Data from 237 patients were analyzed; 72.9% were alive at 10 years. After surgical recovery, ability to work was most impaired during RT/CT, necessitating nearly full-time sick leave. Work activity continuously decreased after each RT/CT treatment. Employment rates were similarly affected, from under 20% unemployment at baseline and during AO, up to 41% and 59% after first and second RT/CT. Similar trends were observed for medical resources and costs, and productivity losses.Conclusions Patients with grade 2 mIDH glioma remain active at work after initial surgery when managed with AO. Work impairment increases over successive RT/CT courses, highlighting the need to preserve quality of life by integrating work ability into clinical practice and by developing new treatment strategies to delay aggressive therapies and avoid substantial medical and productivity costs.
Treatment of IDH-mutant (mIDH) gliomas, including oligodendrogliomas and diffuse astrocytomas, typically involve surgery, radiotherapy, and/or chemotherapy (RT/CT). Immediate post-surgery RT/CT is not indicated for all patients and active observation (AO) could be the first option, withholding a treatment with potential negative influence on the patients’ functioning and daily life. This study aims to describe treatment patterns of patients with mIDH gliomas who are not in immediate need of RT/CT after initial surgery. This retrospective longitudinal study utilized Danish administrative registries. Patients with mIDH glioma diagnosed between 2010 and 2022 were identified and for those initially managed with AO, patterns and duration of treatment sequences from diagnosis until end of follow-up or death, including AO, re-surgeries, 1st and 2nd RT/CT treatment and the following monitoring periods were analyzed. In total, 439 mIDH patients, 168 (38%) with an oligodendroglioma and 271 (62%) with a diffuse astrocytoma, were retrieved over the period, corresponding to a mean age adjusted incidence rate of 0.58 per 100.000 person years. Of the 413 patients without prior malignancies, 237 (57%) did not require immediate RT/CT after surgery. Among these, the mean age was 40.3 years (SD 16.3) and 47.3% were women. Median time from diagnosis to RT/CT or re-surgery (Time To Next Intervention, TTNI) was 36.1 months. During follow-up (median (IQR) 6.1 (3.8-8.9) years), half of the patients (115/237) progressed to receive RT and/or CT with a median time of 69 months. Among these patients, 74% received RT and 82% received CT as first-line oncological treatment. Thereafter, 43% (49/115) progressed to a 2nd line, with only 14% receiving RT and 90% CT. Forty-eight percent of patients received on average 1.3 re-surgeries before the 1st RT/CT, and then <15% and <20% of cases received re-surgeries during monitoring period after 1st and 2nd line, respectively. Overall survival after 1, 5 and 10 years was 100%, 86.7% and 72.9 %, respectively. Patients with mIDH gliomas managed with AO exhibit a median TTNI of approximately 3 years and high survival rates. Thus, it is crucial to develop more efficient strategies to further delay RT/CT and better preserve functioning and quality of life for this young, working-age population.
IntroductionSuboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia.MethodsWe searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2.ResultsOf 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence.ConclusionsOur findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.
