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My name is Ashley Leak Bryant and I am an Assistant Professor at the University of North Carolina at Chapel Hill School of Nursing. Today I'm going to be speaking about the impact of patient reported symptoms on physical function and quality of life in adults with acute leukemia.
At ONS Congress, I was presented with the Victoria Mock New Investigator Award. Dr. Mock was a pioneer in laying the ground work for fatigue management intervention. She was a symptom scientist with a focus on fatigue management as well as she had a passion for mentoring nurses.
My program research has focused on adults with acute leukemia. As you can see in this slide, leukemia is the second most common blood cancer with more than 62,000 people who will be diagnosed in 2017. On the right hand side, you'll see that the five year survival rate has increased from 1960 to now in the 2000's, the rate has increased from 14% to 62% with a five year survival rate, but we know that there needs to be more work done in symptom management and treatment modality to increase the survival rate in this population.
Fatigue is a common symptom among adults with acute leukemia. It is a persistent distressing symptom. Often times it leads to decreased functionality, social isolation, and poor quality of life. Symptomatic literature review led me to further investigate how we can assist adults with acute leukemia and management of fatigue during hospitalization.
This slide here presents the work that has been done with the inpatient exercise studies in acute leukemia. As you can see, there have been six exercise studies in this population. The first being in 2008, which was a randomized control trial and the very last study that was recently completed, was by Ashley Bryant and colleagues in 2017, which was also a randomized control trial. Bryant and colleagues named this trial the Exercise and Quality of Life in Adults with Acute Leukemia also known as EQUAL. Of that study, they had 17 patients and intervention included aerobic and resistance training. It was conducted four times a week with two sessions during the day. From that study, they found that patients had decreased fatigue, anxiety, depressive symptoms, decreased sleep disturbances, and their cognition improved as well as their quality of life and function improved on exercise intervention.
Dr. Bryant also was interested in looking at and gaining insight into the intervention participant's overall view about the exercise intervention. Some semi-structure interviews were conducted and the patient stated that one of the benefits of the intervention was that it made them feel better. They enjoyed the structured exercise that they received. They felt that it gave them willpower and motivated them. They felt that the timing of the exercise was important and they appreciated that it needs to be scheduled. The post-hospital plan was also important. These patients remain in the hospital for almost 30 days and they have the attention of their medical team as well as nurses, but often times if they leave to go home, they aren't sure what to do to continue to remain active in their home life. We've had some participants say they were planning to go potentially to the gym, as an alternative, but they felt that the gym was a way in which they would potentially try to avoid infection and mold. The other person said that social support was key to them.
Future direction from this work, my goal is to continue to decrease symptoms and enhance functional ability and quality of life of adults being treated for acute leukemia. The Cancer Moonshot Initiative encourages us as researchers to continue to develop a database of symptoms and to track patient reported outcomes. In patient reported outcomes, it's key to be able to get the patient's perspective via an interview and by survey, which would really be a holistic approach to how they're dealing with their illness. Palliative care and symptom management discussions are key at the time of diagnosis to prevent functional decline. Understanding the physiological mechanisms of exercise is also a future direction of this work. We need interventions that are less resource driven, that are practical, and that use existing staff to deliver the intervention.
That concludes my presentation.