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Introduction: The availability of healthcare apps to support patient self-management of various medical conditions, including cancer, has increased considerably in the past decade. However, there are limited published data on the role of apps in the management of chronic myeloid leukaemia (CML). The primary aim of this study was to investigate the current and future role of apps as a means of supporting patients with CML. Methods: A 31-item questionnaire was developed and distributed to patients via three on-line CML support groups. Results: Responses were received from 286 patients. There was an approximate 2:1 female: male split and the majority (54%, n = 155) resided in the United Kingdom. 91% (n = 260) of respondents were currently receiving drug treatment for their CML. 23.4% (n = 67) of respondents were aware that apps were available to support their CML management and 11.5% (n = 33) had experience of using such an app. 94.1% (n = 238) of those who had not used a patient support app in the past stated that they would consider using an app in the future to help manage their disease. App awareness was significantly higher amongst male patients (30.3% vs. 19.9%). Likelihood of being a current or previous app user was higher amongst younger patients (16.3% for <55 years old vs. 5.6% for ≥55 years old) whilst younger patients and those with a more recent diagnosis of CML were both more likely to be interested in using an app in the future. When asked about potential app functionality, a drug interaction checker was the feature of greatest interest to respondents. Conclusions: We have identified both a lack of awareness of and a low uptake of patient support apps amongst CML patients. Importantly, we have demonstrated a clear interest in CML-specific apps amongst this population. Based on the functionality that study participants were most interested in, we will work with health care professionals, app developers and patients to develop a new app to deliver holistic support to CML patients. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus of 2019 pandemic has necessitated vast and rapid changes in the way oncology pharmacy services are delivered around the world. Methods/aims: An international survey of oncology pharmacists and technicians was conducted via the International Society of Oncology Pharmacy Practitioners and collaborating global pharmacy organisations to determine the impact that the coronavirus of 2019 has had on pharmacy service delivery, pharmacy practitioners and oncology practice. Results: The survey received 862 responses from 40 different countries from September to October 2020. The majority of respondents were pharmacists (n = 841, 97.6%), with 24% involved in the direct care of patients with the coronavirus of 2019. Of the survey participants, 55% increased their time working remotely, with remote activities including dispensing, patient assessment/follow-up and attending multi-disciplinary rounds. Respondents reported a 72% increase in the use of technology to perform remote patient interaction activities and that participation in educational meetings and quality improvement projects was reduced by 68% and 44%, respectively. Workforce impacts included altered working hours (50%), cancelled leave (48%) and forced leave/furloughing (30%). During the pandemic, respondents reported reduced access to intensive care (19%) and anti-cancer (15%) medications. In addition, 39% of respondents reported reduced access to personal protective equipment, including N95 masks for chemotherapy compounding. Almost half of respondents (49%) reported that cancer treatments were delayed or intervals were altered for patients being treated with curative intent. A third of practitioners (30%) believed that patient outcomes would be adversely impacted by changes to pharmacy services. Sixty-five percent of respondents reported impacts on their mental health, with 12% utilising support services. Conclusion: The coronavirus of 2019 pandemic has altered the way oncology pharmacy services are delivered. These results demonstrate the adaptability of the oncology pharmacy profession and highlight the importance of formal evaluation of the varied practice models to determine the evidence-based practices that enhance pharmacy services and, thus, should be reinstated as soon as practical and reasonable. [ABSTRACT FROM AUTHOR]

Introduction: Estimated rates of non-adherence to medicines for long-term conditions may be as high as 50%.1 Currently, little published information on adherence to oral therapies for multiple myeloma exists. However, complex treatment schedules, and patient demographics, make sub-optimal adherence possible. We undertook a mixed-methods adherence study (The ATOMM study: IRAS 258091)) utilising a combination of validated questionnaires and focus groups. We report on the focus group component of the study, the aims of which were to explore behaviour, values and views associated with adherence to oral therapies and potential strategies to improve adherence. Methods: Participants were recruited through the myeloma clinic in a UK tertiary referral centre. Three remote focus groups were undertaken: two patient groups, each composed of four patients, and one health care professional (HCP) group, composed of two myeloma physicians, a clinical nurse specialist and a pharmacist independent prescriber. Two members of the study team facilitated the groups, working from a discussion guide. Focus groups were recorded and transcribed verbatim. One of the facilitators reviewed the transcripts for accuracy and transcripts were anonymised prior to analysis. A thematic framework analysis2 was then undertaken. Coding and themes were developed and consensus was reached amongst the three study team members responsible for the analysis. Results: Qualitative analysis identified seven interconnected themes (see Figure 1). Side effects emerged as a key theme, with patients raising the importance of being able to negotiate doses and schedules with their HCP as a way of allowing them to feel in control of their medication taking. Information provision was also highlighted by all participants: patients were concerned about the complexity and detail within package inserts and expressed a need for simpler, more targeted, provision of medicines-related information. Similarly, HCPs felt that patients were at risk of information overload due to the complexity of the disease and its treatment. “Drip-feeding” information and focusing on key points were provided as potential solutions. Inconsistent findings were found on the impact of time since diagnosis and the number of previous lines of therapy on adherence behaviours: whilst it was noted that familiarity with medication could encourage improved adherence, concern was raised that motivation for treatment may wane over time and poorer physical health may also have a negative effect. Strategies to improve adherence included patient diaries/reminder charts, better communication between the clinical team and patients, technological support (apps, phone reminders), and pill organisers. Support networks (e.g. engaging family members, and joining myeloma support groups) were also identified as potentially beneficial tools by both patients and HCPs. Discussion and conclusions: Side effects, the complexity of treatment and knowledge gaps all emerged as clear barriers to adherence in myeloma patients. A variety of strategies (focusing on information provision, enhanced patient-to-patient and patient-to-HCP communication and physical inputs) were suggested as ways of improving adherence and might inform interventions to enhance adherence behaviours in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Herpes zoster infection, caused by reactivation of latent varicella zoster virus (VZV), is a common complication following haematopoietic stem cell transplantation (HSCT). It typically presents as a self-limiting dermatomal rash, but can also lead to dissemination, post-herpetic neuralgia, and opportunistic infections.1 Aciclovir is widely used to reduce the risk of herpes virus reactivation but there is a lack of consensus as to the most appropriate duration of prophylaxis. Guidelines at the Queen Elizabeth Hospital (QEH) were updated in August 2019, such that the duration of prophylaxis was increased from a short-term (35 or 100 days depending on patient factors) to a long-term schedule, whereby all VZV seropositive patients received oral aciclovir (400mg twice daily), until 1-year post-transplant. We aimed to assess the efficacy of long-term aciclovir by determining the effect of the new and old schedules on VZV reactivation rates and levels of rebound reactivation, whilst also identifying any predisposing factors for VZV reactivation. Methods: Patients who underwent an allogeneic HSCT at the QEH between 01 June 2018 and 29 September 2020 and received prophylactic aciclovir were included. Patients were split into two groups depending on the length of prophylaxis [≤ 100 days (cohort 1) vs. >100 days (cohort 2)]. Relevant demographic and outcome data were collected from hospital electronic patient records. Statistical analysis was performed using IBM SPSS Statistics Software version 27. Results: 200 patients were included in the study, 45 patients in cohort 1 and 155 patients in cohort 2. Overall, the incidence of VZV reactivation was low with 4% of patients reactivating within the first year of transplant and a total of 10% reactivating during the total study period (with a follow-up range of 438–1202 days) (Figure 1). Long-term prophylaxis with aciclovir reduced the VZV reactivation rate at one-year posttransplant when compared to short-term prophylaxis but this difference was not statistically significant. (3.2% vs. 6.7%, OR = 0.47, [0.11–2.03, 95% CI], p = 0.38, Fisher’s exact test). Similar levels of rebound reactivation were seen on cessation of aciclovir in both cohorts and there was no difference in the rates of reactivation over the whole study period (10.3% for cohort 2 vs 8.9% for cohort 1 p = 1.0, Fisher’s exact test) The presence of GVHD was the only statistically significant risk factor for VZV reactivation in this patient cohort (OR = 4.47 [1.44–13.89, 95% CI] p = 0.009, chi-squared test). Discussion/conclusions: The low VZV reactivation rate in our study supports the use of aciclovir as an effective strategy for preventing VZV reactivation.1 The optimal duration of aciclovir remains unclear with only a trend towards benefit shown with the longer (1 year) strategy. This lack of statistically significant benefit may have been influenced by sample size and there may be merit in extending the study to include a larger patient cohort. Importantly, GVHD emerged as a clear risk factor for VZV reactivation with a 4-fold increase in risk demonstrated. Finally, the issue of rebound reactivation may be best addressed by additional prophylactic strategies such as the inactivated varicella zoster vaccine.2 [ABSTRACT FROM AUTHOR]

Background: Mobile health is an increasingly utilized healthcare technology. Within the field of oncology and haematology, smartphone applications (apps) can help empower patients to self-monitor their health and support medication adherence.1 Additionally, medication apps can offer additional features that can track disease symptoms, side effects, identify drug interactions, and support ongoing engagement with health.1 In patients living with Chronic Myeloid Leukaemia (CML), this technology can be especially beneficial in reducing the burden associated with tyrosine kinase inhibitor therapy, routine laboratory and molecular testing, and managing side effects and complications.2 Aims: The aim of this study was to better understand the current mobile health technologies available to CML patients by systematically evaluating the functionality, practicality and quality of four CML apps. Method: As part of a larger study, ‘Evaluation of a Smartphone App (My CML) to Support Patients with Chronic Myeloid Leukemia’, existing CML apps were identified and benchmarked using validated medication app scoring tools. The four apps identified were ‘My CML’, ‘CML Life’, ‘CML Today’ and ‘Know Your CML’. Two investigators (a clinical pharmacist and a pharmacy student) downloaded the Android and Apple versions of all four apps. They were not made aware beforehand that the ‘My CML’ app was being evaluated in the larger study. Each app was first assessed for practicality and functionality.3 This was followed by an assessment for quality using the MARS scoring tool, a validated instrument that rates apps according to four categories: engagement, functionality, aesthetics, and information quality.4 Both investigators tested the apps for 10 min prior to rating them. Any major discrepancies in the assessment were identified post-evaluation and resolved between the two investigators. Results and discussion: In terms of functionality, practicality, and quality, the ‘My CML’ app consistently ranked the highest, while ‘CML Life’ ranked the lowest (Table 1). Contributing to the ‘My CML’ app’s high practicality and functionality score were its medication database and tracking capability, adherence statistics and charts, offline useability, and stability between Android and Apple versions, which were features not consistently present for the other three apps. None of the apps, however, offered multiple user support, visual aids for correct medication use, or gamification elements such as adherence rewards and customizable alert sounds. Using the MARS quality scoring tool, investigators rated the ‘My CML’ app the highest in nearly every category, noting its simple but engaging design, the accuracy of information, and the variety of features it provided (Table 1). Conclusion: Smartphone apps are useful tools that CML patients can use to enhance control of their health. Through a systematic evaluation of four apps currently on the market for CML patients, the ‘My CML’ app consistently ranked the highest in terms of functionality, practicality and quality. It is important to recognize that comparisons between apps are difficult as all four apps had the differing scope and intended purposes, which likely impacted app development. It is also crucial that further evaluations are completed by CML patients, as they are the end users and therefore the most important stakeholders in the evaluation process. [ABSTRACT FROM AUTHOR]

Introduction: In the past decade there has been a marked increase in the availability of healthcare apps to support patients with medical conditions, including cancer.1 Following an earlier investigation of the potential role of apps to support patients with chronic myeloid leukaemia (CML),2 we developed a patient app (My CML) that launched in March 2022. We then undertook a post-launch evaluation of the app from both healthcare professional and patient perspectives. The specific objectives of this part of the evaluation were to determine levels of uptake and engagement with the app amongst patients and to assess their attitudes towards the usability of the app in relation to the following 3 domains: ease of use; interface and satisfaction; usefulness. Methods: Google Analytics (https://analytics.google. com) was employed to collect usage data for the first 4 months post-launch. Data fields included numbers of users and geographical location, time spent on the app and usage breakdown by specific function. An online survey based on a validated health app usability questionnaire (MAUQ)3 was prepared and publicised to CML patients via three international CML support groups and also on the app itself. The MAUQ contained 18 statements divided into three domains (see introduction) that participants scored on a scale of 1 (strongly disagree) through to 7 (strongly agree). Usability (on a scale of 1–7) was determined by calculating the average of the responses to all 18 statements. The survey was open for 1 month in May-June 2022. Results: 808 users were recorded in the first 4 months post-launch. The app was downloaded by patients in 65 different countries: the majority (59%) were from the UK. The average engagement time was 10 min 47 s and the most popular app functions were the My Progress and Drug Interaction Checker functions. Survey responses were received from 44 patients. 61% were female, 64% were residents of the UK, and 80% had been diagnosed in the past 5 years. 82% of respondents were still using the app at the time of completing the survey and the majority of these (53%) used the app every day. The overall mean usability score amongst all respondents was 5.8 (95% confidence interval (CI) 5.5–6.1). Results for the three subdomains and for subgroups are presented in Table 1. Discussion and conclusions: The app achieved high download levels and excellent geographical reach within 4 months of launch. Usability scores from respondents were generally high although there was a degree of variation in scores for the three subdomains. It was unsurprising that respondents who had stopped using the app scored its usability as being significantly lower than current users and it was noteworthy that there was a trend in favour of increased usability amongst iPhone users compared with Android users. One weakness of the study was the relatively low response rate although it is planned to strengthen the overall evaluation through the use of focus groups and interviews. Combined data from all parts of the evaluation will be used to further develop and improve the app. [ABSTRACT FROM AUTHOR]

Background: On average 20% of patients require a systemic anti-cancer treatment (SACT) delay.1 The risk of toxicity-related dose delays, with SACT, should be included as part of pre-treatment education and be considered by clinicians upon prescribing chemotherapy. An objective measure of individual risk could influence clinical decisions, such as the escalation of standard supportive care and stratification of some patients, to receive proactive toxicity monitoring. The understanding of this risk may also support the advanced preparation of treatments for those that have a lower risk of delay. Data available within hospital systems can support the understanding of risk through the development of a risk score. In this study, we developed and validated a score to assess the risk of a SACT dose delay of 7 days (delay-7 score). Objectives: To develop and internally validate a risk score to predict the occurrence of a 7-day dose delay for patients receiving cycle 1 treatments for breast and colorectal cancers and diffuse large b-cell lymphomas. To assess the discrimination and calibration of the model. Methods: Four hospitals were included in our study, recruited through BOPA. Data were collected for patients aged 18 or over, identified through the chemotherapy prescribing systems at each hospital for the period of 1 January 2013 to 1 January 2018. The first chemotherapy treatment date was used as the index date for entry to the cohort during the study period. The study data was restricted to the following three tumour groups: breast, colorectal and diffuse large B-Cell lymphoma. Data included hospital treatment, age at the start of SACT, gender, ethnicity, body mass index, cancer diagnosis, chemotherapy regimen, colony-stimulating factor use, first cycle dose modifications and baseline blood values. Baseline blood values included neutrophils, platelets, haemoglobin, creatinine and bilirubin. A risk prediction model was developed using multivariable logistic regression and all analysis methods complied with the Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD).2 Shrinkage was used to adjust for over-optimism of predictor effects. For internal validation (of the full models in the development data) we computed the ability of the models to discriminate between those with and without poor outcomes (c-statistic), and the agreement between predicted and observed risk (calibration slope). Results: A total of 4604 patients were included in our study of which 628 (13.6%) incurred a 7-day delay to the second cycle of chemotherapy. Delay-7 showed good discrimination and calibration, with a c-statistic of 0.68 [95% confidence interval (CI) 0.66–0.7], following internal validation and calibration-in-the-large of −0.006. Conclusions: Delay-7 predicts a patient’s individualised risk of a treatment-related delay at cycle two of treatment. The score can be used to stratify interventions to reduce the occurrence of treatment-related toxicity. However, to be used in the clinical setting a prospective study should be conducted to ensure the reliability of the score. Nonetheless, we have identified that the score can be useful to support advance preparation in pharmacy aseptic units and a small validation in this setting is planned. [ABSTRACT FROM AUTHOR]

Introduction: Haemorrhagic cystitis (HC) is a relatively common complication after allogeneic stem cell transplantation (SCT). Early onset HC is usually caused by the direct effects of chemotherapy or radiotherapy on the bladder mucosa. Late onset HC is most commonly caused by the BK virus, has an incidence of 7%–25%,1 and is associated with significant morbidity. Although debate exists as to the most appropriate treatment, encouraging results have been reported with cidofovir.2 Although its long half-life allows for once-weekly dosing, it is associated with significant nephrotoxicity with a reported incidence of renal dysfunction of 25%–30%.2,3 The aim of this study was to evaluate the realworld efficacy and tolerability of cidofovir in SCT patients with BK virus infection. Methods: Electronic patient records at the Queen Elizabeth Hospital, Birmingham were used to collect data on all allogeneic SCT patients who received at least one dose of cidofovir for the treatment of symptomatic BK virus infection during a 3-year period (Feb 2018–Feb 2021). Key parameters included demographic details, dosing and duration of cidofovir, clinical and virological outcomes and renal function. Data were recorded using Microsoft Excel and descriptive statistical analyses were undertaken. Results: 29 patients (median age: 48, range: 17–72) received cidofovir during the study period (27 male, two female). Six patients had concurrent cytomegalovirus (CMV) infection. The median time from transplant to development of symptomatic BK infection was 36 days (range: 2–820). The median starting dose of cidofovir was 5 mg/kg (range: 1.5–5 mg/kg) and the median number of doses received was 3 (range: 1–13). All patients received concomitant probenecid. In terms of efficacy (based on definitions from Bedi et al.4), a complete response (CR) was achieved in 25 patients (86.2), a partial response (PR) in three patients (10.3%) and clinical failure in one patient (3.5%). For those patients with serial viral load measurements, 89% demonstrated a ≥ 1 log reduction in urinary BK load and 52% demonstrated a ≥ 1 log reduction in blood BK load from baseline. The median baseline creatinine in the cohort was 95 μmol/L (range: 39–214 μmol/L) and at the end of treatment, this had increased to 112 μmol/L (range: 44–327 μmol/L). Nine patients (31%) developed CTCAE grade 2 nephrotoxicity (> 1.5–3 fold increase in creatinine from baseline) and four patients (14%) stopped cidofovir due to nephrotoxicity although in three cases, they had achieved a clinical response prior to cessation. Dose adjustments for baseline renal function5 were observed in 13 patients (45%). Further dose adjustments occurred for 12 patients: seven patients (24%) required a dose reduction due to worsening renal function and five patients (17%) had a dose increase due to improved renal parameters. Discussion and conclusions: IV cidofovir was an effective treatment for BK virus infection after allogeneic SCT. The high response rates seen were comparable to previous work in this area.2 Rates of nephrotoxicity were also similar to literature estimates2,3 and it is noteworthy that 75% of patients in the study were receiving concomitant ciclosporin. The retrospective nature of the study made data collection challenging and future work in this area should focus on a prospective data set. [ABSTRACT FROM AUTHOR]

Background: Reduced intensity conditioning regimens permit the delivery of a potentially curative graft-versus-leukemia effect in older patients with acute myeloid leukemia. Although T-cell depletion is increasingly used to reduce the risk of graft-versus-host disease its impact on the graft-versus-leukemia effect and long-term outcome post-transplant is unknown., Design and Methods: We have characterized pre- and post-transplant factors determining overall survival in 168 patients with acute myeloid leukemia transplanted using an alemtuzumab based reduced intensity conditioning regimen with a median duration of follow-up of 37 months., Results: The 3-year overall survival for patients transplanted in CR1 or CR2/CR3 was 50% (95% CI, 38% to 62%) and 44% (95% CI, 31% to 56%), respectively compared to 15% (95% CI, 2% to 36%) for patients with relapsed/refractory disease. Multivariate analysis demonstrated that both survival and disease relapse were influenced by status at transplant (P=0.008) and presentation cytogenetics (P=0.01). Increased exposure to cyclosporine A (CsA) in the first 21 days post-transplant was associated with an increased relapse risk (P<0.0001) and decreased overall survival (P<0.0001)., Conclusions: Disease stage, presentation karyotype and post-transplant CsA exposure are important predictors of outcome in patients undergoing a T-cell depleted reduced intensity conditioning allograft for acute myeloid leukemia. These data confirm the presence of a potent graft-versus-leukemia effect after a T-cell depleted reduced intensity conditioning allograft in acute myeloid leukemia and identify CsA exposure as a manipulable determinant of outcome in this setting.