Best Practices in Hematologic Malignancies – December 2017 Vol 8

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Myeloproliferative Neoplasms

Symptom Burden Linked to Disability Leave Among Patients with Myeloproliferative Neoplasms


A recent survey of patients with myeloproliferative neoplasms (MPNs), including myelofibrosis, polycythemia vera, and essential thrombocythemia, has identified a strong association between symptom burden and medical disability leave. According to findings presented at the 59th American Society of Hematology Annual Meeting & Exposition (Abstract #1637), approximately one-quarter of employed patients took medical disability leave because of their MPN, with the majority (62.6%) not returning to work. What’s more, patients who took disability leave had significantly higher symptom burden compared with those with no employment change.

“Effectively managing MPN diseases and associated symptoms may reduce disability leave among those patients,” said Jingbo Yu, PhD, Associate Director of Health Economics and Outcomes at Incyte Corporation, who presented the data.

As Dr Yu explained, compared with the general population, patients with MPNs have reduced survival and experience heavy symptom burden, including fatigue, inactivity, concentration problems, bone pain, night sweats, early satiety, and difficulty sleeping. Moreover, these symptoms have a substantial impact on patient quality of life and negatively affect patients’ ability to work. To evaluate the impact of MPN diseases on employment and everyday life, Dr Yu and colleagues conducted the Living with MPN survey between April and November 2016. The online survey included approximately 100 questions related to MPN diagnosis, disease-related medical history, changes in employment status, work productivity, and daily activities, as well as MPN-related symptoms and quality-of-life measures.

High Prevalence of Medical Disability Leave

As Dr Yu reported, among the 904 patients who participated in the survey, 592 were employed at the time of MPN diagnosis. Of those who were employed, 147 (24.8%) went on disability leave because of their MPN, and 293 reported no employment changes. The remaining 152 patients reported other changes to their employment, including early retirement and work-hour reduction, Dr Yu noted, but these patients were not included in the analysis.

Although demographics and MPN disease duration were generally similar between patients who went on medical leave and those who reported no employment changes, patients who went on leave were twice as likely to have had a history of at least 1 thrombotic event. The mean duration from diagnosis to first medical disability leave was 2.3 years, with 29.9% of patients taking at least 2 medical leaves. The most recent leave was long-term for nearly half of patients, Dr Yu reported, and the majority of those who took medical leave did not return to work (62.6%). Of those who returned to work, the mean duration of medical leave was 4.3 months.

High Symptom Burden and Functional Impairment

Compared with patients who had no employment change, all 10 symptoms from the MPN Symptom Assessment Form were more common and more severe among patients who went on medical leave, but fatigue, bone pain, and night sweats were the most severe symptoms, Dr Yu reported. Impairments in physical, mental, and social functions were also greater among those who took medical disability leave compared with those who did not have any employment changes. These impairments included difficulty with strenuous physical activities (91.2% vs 64.8%), difficulty remembering things (90.5% vs 60.8%), and difficulty sleeping (84.4% vs 58.7%). According to the authors, effective management of MPN-related symptoms may reduce disability leave among these patients.

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