CLIPI Score Validation: Proposal as Tool for Level of Nursing Coordination in Mycosis Fungoides/Sezary Syndrome

2.50
Hdl Handle:
http://hdl.handle.net/10755/621857
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
CLIPI Score Validation: Proposal as Tool for Level of Nursing Coordination in Mycosis Fungoides/Sezary Syndrome
Other Titles:
Care Initiatives for Chronic Conditions
Author(s):
Roe, Christa; Estrada, Brett; Glass, Frank; Komorokji, Rami; Sokol, Lubomir
Lead Author STTI Affiliation:
Phi Gamma
Author Details:
Christa Roe, MA, BS, RN, OCN, Professional Experience: (2013-Present) Principal presenter and developer for over 25 Lymphoma professional, scientific, and CEU lectures throughout the United states (2013-Present) Lymphoma nurse navigator Moffitt Cancer Center, Tampa, FL (December 2015) Havana, Cuba, Institute of Oncology and Radiology Lymphoma Overview and Nursing Implications Educational Development for Cutaneous Lymphoma: (August, 2016) Co-course director, Eighth Annual Cutaneous Lymphoma Symposium, CME accredited (November, 2016) ASCO Annual Fall Session, educational track planning committee Educational Videos and Continuing Education on Cutaneous Lymphomas (2014) Managing adverse events of novel agents in Cutaneous T Cell Lymphoma (July 2016) Communicating with your Healthcare Provider, Cutaneous Lymphoma Foundation, Publications on Cutaneous Lymphomas (December 3, 2015) Sézary Syndrome: Clinicopathological and Immunophenotypical Characteristics and Outcomes. Blood Journal: 126 (23), (August, 2016) Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type: Symptoms, Treatment, and Prognosis. Overview of Malignant Lymphoma. Nova Science Publishers. Vol 1, Author Summary: Christa has been at the Department of Malignant Hematology at Moffitt Cancer Center & Research Institute since 2013. Christa is currently enrolled in the Masters of Science in Nursing (ARNP) program at USF with emphasis in Adult Gerontology Primary Care. She was nominated for the 2016 ANCC National Magnet of the Year. She was awarded H. Lee Moffitt Cancer Center’s 2015 Outpatient Nurse of the Year.
Abstract:

Background/Rationale

Cutaneous T-cell Lymphomas (CTCL) with mature CD4+ t-lymphocytes are rare complex forms of malignant neoplasms that present primarily on the skin, the most common subtypes include Mycosis Fungoides (MF) and Seźary Syndrome (SS) (Scarisbrick et al., 2015). CTCL is a chronic condition characterized by multiple relapses with the need for multiple and consecutive treatment modalities (Jawed, Myskowski, Horwitz, Moskowitz, & Querfeld, 2014). The goal of therapy is to decrease recurrence and/or progression of disease, and increase the patient’s quality of life (QoL) (Jawed, Myskowski, Horwitz, Moskowitz, & Querfeld, 2014). Nursing involvement in the coordination of care for patients diagnosed with CTCL is not well integrated into every day practice (Lucas & Ciccolini, 2016). However, through evidenced based practice and competency nurses can ensure patient safety and maximize outcomes.

We hypothesized that the use of the Cutaneous Lymphoma International Prognostic Indicator (CLIPI) score as a nursing tool to identify patients with more advanced disease would lead to more extensive coordination of care. The CLIPI score is designed as a prognostic index for both early (IA-IIA) and late stage (IIB-IVB) disease (Benton et al., 2013). The score is based on risk factors measured at time of diagnosis. Early stage risk factors include male gender, age greater than 60, presence of plaques, folliculotropism, and nodal status. Late stage includes male gender, age greater than 60, blood and visceral involvement, and nodal status (Benton et al., 2013).

Purpose of the Study/ Methodology

The objective of this study was to validate the CLIPI score could be used to determine intensity of RN services needed by patients with MF and SS in a multidisciplinary CTCL clinic setting. Institutional review board (IRB) and Scientific Review Committee approval obtained. CTCL patient database, demographics, overall survival (OS), number of therapies, CLIPI score and stage were determined.

Findings/Interpretation

We identified 287 patients with MF/SS. Median age at diagnosis was 62 years. Male to female ratio was 179/108. Most patients were Caucasians (83%). Ninety-five (33%) patients had a CLIPI score of equal to or less than 2 and 192 (67%) patients had a CLIPI score of 3-5. The median number of therapies for patients with a CLIPI score of 2 or less was 2 lines. The median number of therapies for patients with a CLIPI score of 3-5 was 3 lines. The median OS for patients with a CLIPI score less than 2 was not reached compared to 123 months (mos.) with a CLIPI score of 3-5 (p value < .005). Among cases with known date of first line therapy the mean time to first treatment was 48 mos. in patients with CLIPI score < 2 compared to 24 mos. if CLIPI score >2 (p=0.001). In multivariable analysis, CLIPI score < or > 2 was predictive of overall survival independent from disease stage at diagnosis (CLIPI score Hazard ratio (HR) 3, p=0.003 and Stage at diagnosis HR 1.3, p=<0.005).

Implications/Discussion

A majority of patients with CLIPI score of three or greater required extensive care coordination, several lines of therapy, and had a poorer prognosis independent of the disease stage. To our knowledge, this is the largest retrospective analysis that has validated CLIPI score as an indicator of intensity of RN services needed. Through specialized, interdisciplinary, and coordinated care continuity, patient understanding and satisfaction are likely to increase (Lucas & Ciccolini, 2016). The only study of its kind described in literature reported results that patients’ perceptions of disease coherence was poor (Eder, Kammerstatter, Erhart, Mairhofer-Muri, & Trautinger, 2016). This measureable condition could be explained by the rarity of the disease but also the lack of patient specific education and coordination of care. 

Beynon et al. (2015) conducted a quality of life study that suggested patients are most burdened by physical symptoms associated with the disease including skin discomfort and pruritus. Although these are important factors to remember while coordinating patient care, they are not calculated in the current CLIPI score prognostic index. Wagner et al. (2014) conducted a study on nurse navigators in early cancer care which suggests that coordination of care leads to a reduction of problems, psychosocial issues, and health care costs. Unfortunately, no CTCL nurse navigator role has been defined or exists. We propose using the CLIPI score to identify pts who will need extensive coordinated care. By further utilizing the CLIPI score, our future research directions include creation of a CTCL nurse navigator pathway and to conduct quality of life studies.

Keywords:
Coordination of care; Cutaneous Lymphoma International Prognostic Indicator; Cutaneous T-cell Lymphomas
Repository Posting Date:
17-Jul-2017
Date of Publication:
17-Jul-2017
Other Identifiers:
INRC17E02
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship
Note:
This session was accepted for presentation at the International Nursing Research Congress 2017, but not presented.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleCLIPI Score Validation: Proposal as Tool for Level of Nursing Coordination in Mycosis Fungoides/Sezary Syndromeen_US
dc.title.alternativeCare Initiatives for Chronic Conditionsen
dc.contributor.authorRoe, Christaen
dc.contributor.authorEstrada, Bretten
dc.contributor.authorGlass, Franken
dc.contributor.authorKomorokji, Ramien
dc.contributor.authorSokol, Lubomiren
dc.contributor.departmentPhi Gammaen
dc.author.detailsChrista Roe, MA, BS, RN, OCN, Professional Experience: (2013-Present) Principal presenter and developer for over 25 Lymphoma professional, scientific, and CEU lectures throughout the United states (2013-Present) Lymphoma nurse navigator Moffitt Cancer Center, Tampa, FL (December 2015) Havana, Cuba, Institute of Oncology and Radiology Lymphoma Overview and Nursing Implications Educational Development for Cutaneous Lymphoma: (August, 2016) Co-course director, Eighth Annual Cutaneous Lymphoma Symposium, CME accredited (November, 2016) ASCO Annual Fall Session, educational track planning committee Educational Videos and Continuing Education on Cutaneous Lymphomas (2014) Managing adverse events of novel agents in Cutaneous T Cell Lymphoma (July 2016) Communicating with your Healthcare Provider, Cutaneous Lymphoma Foundation, Publications on Cutaneous Lymphomas (December 3, 2015) Sézary Syndrome: Clinicopathological and Immunophenotypical Characteristics and Outcomes. Blood Journal: 126 (23), (August, 2016) Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type: Symptoms, Treatment, and Prognosis. Overview of Malignant Lymphoma. Nova Science Publishers. Vol 1, Author Summary: Christa has been at the Department of Malignant Hematology at Moffitt Cancer Center & Research Institute since 2013. Christa is currently enrolled in the Masters of Science in Nursing (ARNP) program at USF with emphasis in Adult Gerontology Primary Care. She was nominated for the 2016 ANCC National Magnet of the Year. She was awarded H. Lee Moffitt Cancer Center’s 2015 Outpatient Nurse of the Year.en
dc.identifier.urihttp://hdl.handle.net/10755/621857-
dc.description.abstract<p><strong>Background/Rationale</strong></p> <p>Cutaneous T-cell Lymphomas (CTCL) with mature CD4+ t-lymphocytes are rare complex forms of malignant neoplasms that present primarily on the skin, the most common subtypes include Mycosis Fungoides (MF) and Seźary Syndrome (SS) (Scarisbrick et al., 2015). CTCL is a chronic condition characterized by multiple relapses with the need for multiple and consecutive treatment modalities (Jawed, Myskowski, Horwitz, Moskowitz, & Querfeld, 2014). The goal of therapy is to decrease recurrence and/or progression of disease, and increase the patient’s quality of life (QoL) (Jawed, Myskowski, Horwitz, Moskowitz, & Querfeld, 2014). Nursing involvement in the coordination of care for patients diagnosed with CTCL is not well integrated into every day practice (Lucas & Ciccolini, 2016). However, through evidenced based practice and competency nurses can ensure patient safety and maximize outcomes.</p> <p>We hypothesized that the use of the Cutaneous Lymphoma International Prognostic Indicator (CLIPI) score as a nursing tool to identify patients with more advanced disease would lead to more extensive coordination of care. The CLIPI score is designed as a prognostic index for both early (IA-IIA) and late stage (IIB-IVB) disease (Benton et al., 2013). The score is based on risk factors measured at time of diagnosis. Early stage risk factors include male gender, age greater than 60, presence of plaques, folliculotropism, and nodal status. Late stage includes male gender, age greater than 60, blood and visceral involvement, and nodal status (Benton et al., 2013).</p> <p><strong>Purpose of the Study/ Methodology</strong></p> <p>The objective of this study was to validate the CLIPI score could be used to determine intensity of RN services needed by patients with MF and SS in a multidisciplinary CTCL clinic setting. Institutional review board (IRB) and Scientific Review Committee approval obtained. CTCL patient database, demographics, overall survival (OS), number of therapies, CLIPI score and stage were determined.</p> <p><strong>Findings/Interpretation</strong></p> <p>We identified 287 patients with MF/SS. Median age at diagnosis was 62 years. Male to female ratio was 179/108. Most patients were Caucasians (83%). Ninety-five (33%) patients had a CLIPI score of equal to or less than 2 and 192 (67%) patients had a CLIPI score of 3-5. The median number of therapies for patients with a CLIPI score of 2 or less was 2 lines. The median number of therapies for patients with a CLIPI score of 3-5 was 3 lines. The median OS for patients with a CLIPI score less than 2 was not reached compared to 123 months (mos.) with a CLIPI score of 3-5 (p value < .005). Among cases with known date of first line therapy the mean time to first treatment was 48 mos. in patients with CLIPI score < 2 compared to 24 mos. if CLIPI score >2 (p=0.001). In multivariable analysis, CLIPI score < or > 2 was predictive of overall survival independent from disease stage at diagnosis (CLIPI score Hazard ratio (HR) 3, p=0.003 and Stage at diagnosis HR 1.3, p=<0.005).</p> <p><strong>Implications/Discussion</strong></p> <p>A majority of patients with CLIPI score of three or greater required extensive care coordination, several lines of therapy, and had a poorer prognosis independent of the disease stage. To our knowledge, this is the largest retrospective analysis that has validated CLIPI score as an indicator of intensity of RN services needed. Through specialized, interdisciplinary, and coordinated care continuity, patient understanding and satisfaction are likely to increase (Lucas & Ciccolini, 2016). The only study of its kind described in literature reported results that patients’ perceptions of disease coherence was poor (Eder, Kammerstatter, Erhart, Mairhofer-Muri, & Trautinger, 2016). This measureable condition could be explained by the rarity of the disease but also the lack of patient specific education and coordination of care. </p> <p>Beynon et al. (2015) conducted a quality of life study that suggested patients are most burdened by physical symptoms associated with the disease including skin discomfort and pruritus. Although these are important factors to remember while coordinating patient care, they are not calculated in the current CLIPI score prognostic index. Wagner et al. (2014) conducted a study on nurse navigators in early cancer care which suggests that coordination of care leads to a reduction of problems, psychosocial issues, and health care costs. Unfortunately, no CTCL nurse navigator role has been defined or exists. We propose using the CLIPI score to identify pts who will need extensive coordinated care. By further utilizing the CLIPI score, our future research directions include creation of a CTCL nurse navigator pathway and to conduct quality of life studies.</p>en
dc.subjectCoordination of careen
dc.subjectCutaneous Lymphoma International Prognostic Indicatoren
dc.subjectCutaneous T-cell Lymphomasen
dc.date.available2017-07-17T13:48:02Z-
dc.date.issued2017-07-17-
dc.date.accessioned2017-07-17T13:48:02Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
dc.description.noteThis session was accepted for presentation at the International Nursing Research Congress 2017, but not presented.-
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