title: Health care setting and severity, symptom burden, and complications in patients with Philadelphia-negative myeloproliferative neoplasms (MPN): a comparison between university hospitals, community hospitals, and office-based physicians.
abstract: Philadelphia-negative myeloproliferative neoplasms (MPN) comprise a heterogeneous group of chronic hematological malignancies with significant variations in clinical characteristics. Due to the long survival and the feasibility of oral or subcutaneous therapy, these patients are frequently treated outside of larger academic centers. This analysis was performed to elucidate differences in MPN patients in three different health care settings: university hospitals (UH), community hospitals (CH), and office-based physicians (OBP). The MPN registry of the Study Alliance Leukemia is a non-interventional prospective study including adult patients with an MPN according to WHO criteria (2008). For statistical analysis, descriptive methods and tests for significant differences were used. Besides a different distribution of MPN subtypes between the settings, patients contributed by UH showed an impaired medical condition, a higher comorbidity burden, and more vascular complications. In the risk group analyses, the majority of polycythemia vera (PV) and essential thrombocythemia (ET) patients from UH were classified into the high-risk category due to previous vascular events, while for PV and ET patients in the CH and OBP settings, age was the major parameter for a high-risk categorization. Regarding MPN-directed therapy, PV patients from the UH setting were more likely to receive ruxolitinib within the framework of a clinical trial. In summary, the characteristics and management of patients differed significantly between the three health care settings with a higher burden of vascular events and comorbidities in patients contributed by UH. These differences need to be taken into account for further analyses and design of clinical trials.
authors.affiliation: Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.|Institute for Occupational and Social Medicine, Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kaifie
authors.affiliation: Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Isfort
authors.affiliation: Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Gattermann
authors.affiliation: Practice for Hematology and Oncology Altona, Mörkenstrasse 47, 22767, Hamburg, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Hollburg
authors.affiliation: Practice for Hematology and Oncology, Elisenstrasse 28, 63739, Aschaffenburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Klausmann
authors.affiliation: Internal Medicine 3, Oncology, Hematology, Immunooncology, and Rheumatology, University Clinic Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wolf
authors.affiliation: Practice for Hematology and Oncology, Mauerfeldchen 72, 52146, Würselen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Maintz
authors.affiliation: Department for Hematology, Oncology, Stem Cell Transplantation, Hospital Chemnitz, Bürgerstrasse 2, 09113, Chemnitz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hänel
authors.affiliation: Practice for Hematology-Oncology Eppendorf, Eppendorfer Landstrasse 42, 20249, Hamburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Goekkurt
authors.affiliation: Department for Hematology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
authors.forename: J R
authors.initials: JR
authors.lastname: Göthert
authors.affiliation: Department for Hematology, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Platzbecker
authors.affiliation: Department for Internal Medicine III, Diakonie Hospital Schwäbisch Hall, Diakoniestrasse 20, 74523, Schwäbisch-Hall, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Geer
authors.affiliation: Department for Hematology, Oncology and Palliative Care, Rems-Murr-Hospitals, Am Jakobsweg 1, 71364, Winnenden, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Parmentier
authors.affiliation: Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Jost
authors.affiliation: Department for Hematology and Oncology, University Hospital Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Serve
authors.affiliation: Department for Hematology, University Hospital Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Ehninger
authors.affiliation: Department of Medicine A, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
authors.forename: W E
authors.initials: WE
authors.lastname: Berdel
authors.affiliation: Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
authors.forename: T H
authors.initials: TH
authors.lastname: Brümmendorf
authors.affiliation: Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. skoschmieder@ukaachen.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Koschmieder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000150:complications / Q000235:genetics / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010677:Philadelphia Chromosome; D010820:Physicians / Q000706:statistics & numerical data; D010824:Physicians' Offices / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data*
keywords: Comorbidities; Essential thrombocythemia; Myeloproliferative neoplasms (MPN); Polycythemia vera; Primary myelofibrosis; Vascular events