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Implementing a systematic approach to meeting patients' cancer and fertility needs: a review of the Fertile Hope Centers Of Excellence program

Reinecke, Joyce D; Kelvin, Joanne F; Arvey, Sarah R; Quinn, Gwendolyn P; Levine, Jennifer; Beck, Lindsay N; Miller, Andy
PURPOSE: National guidelines recommend patients with cancer of reproductive age be informed of their risk for infertility resulting from cancer treatment. Despite existing technologies to preserve fertility, many patients report not receiving timely information about fertility risk, and oncology providers report multiple barriers to discussing or referring patients on this topic. METHODS: Nine cancer centers have been recognized as Fertile Hope Centers of Excellence, a designation awarded to cancer centers with an institutionalized approach to addressing fertility issues. Individual semistructured interviews were conducted with each of these centers to identify strengths of and challenges to their approaches. RESULTS: All institutions had procedures for the provision of topical professional and patient education and for notification of patients. Notification methods varied widely, from use of customized consent forms to highly automated electronic alerts for providers. Referral routines and enactment of institutional policies also differed. Key components of successful programs emerged, including the value of internal champions, affiliation with complementary programs, and resource sharing. CONCLUSION: The programs described provide examples of systems that can be assembled in different types of clinical settings, depending on the availability of resources and infrastructure. As institutions develop programs, metrics to evaluate notification systems, in particular, as well as the supportive program components, should be used so identification of best practices can continue. Widespread adoption of programs that incorporate the baseline elements identified will not only comply with national guidelines but also address patients' reproductive needs and fundamentally affect future quality of life.
PMID: 23277768
ISSN: 1935-469x
CID: 2587622

Sequential multiple-assignment randomized trial design of neurobehavioral treatment for patients with metastatic malignant melanoma undergoing high-dose interferon-alpha therapy

Auyeung, S Freda; Long, Qi; Royster, Erica Bruce; Murthy, Smitha; McNutt, Marcia D; Lawson, David; Miller, Andrew; Manatunga, Amita; Musselman, Dominique L
BACKGROUND:Interferon-alpha therapy, which is used to treat metastatic malignant melanoma, can cause patients to develop two distinct neurobehavioral symptom complexes: a mood syndrome and a neurovegetative syndrome. Interferon-alpha effects on serotonin metabolism appear to contribute to the mood and anxiety syndrome, while the neurovegetative syndrome appears to be related to interferon-alpha effects on dopamine. PURPOSE/OBJECTIVE:Our goal is to propose a design for utilizing a sequential, multiple assignment, randomized trial design for patients with malignant melanoma to test the relative efficacy of drugs that target serotonin versus dopamine metabolism during 4 weeks of intravenous, then 8 weeks of subcutaneous, interferon-alpha therapy. METHODS:Patients will be offered participation in a double-blinded, randomized, controlled, 14-week trial involving two treatment phases. During the first month of intravenous interferon-alpha therapy, we will test the hypotheses that escitalopram will be more effective in reducing depressed mood, anxiety, and irritability, whereas methylphenidate will be more effective in diminishing interferon-alpha-induced neurovegetative symptoms, such as fatigue and psychomotor slowing. During the next 8 weeks of subcutaneous interferon therapy, participants whose symptoms do not improve significantly will be randomized to the alternate agent alone versus escitalopram and methylphenidate together. RESULTS:We present a prototype for a single-center, sequential, multiple assignment, randomized trial, which seeks to determine the efficacy of sequenced and targeted treatment for the two distinct symptom complexes suffered by patients treated with interferon-alpha. LIMITATIONS/CONCLUSIONS:Because we cannot completely control for external factors, a relevant question is whether or not 'short-term' neuropsychiatric interventions can increase the number of interferon-alpha doses tolerated and improve long-term survival. CONCLUSIONS:This sequential, multiple assignment, randomized trial proposes a framework for developing optimal treatment strategies; however, additional studies are needed to determine the best strategy for treating or preventing neurobehavioral symptoms induced by the immunotherapy interferon-alpha.
PMID: 19786415
ISSN: 1740-7753
CID: 4569052

Prevention of recurrent Reis-Bucklers dystrophy following excimer laser phototherapeutic keratectomy with topical mitomycin C [Case Report]

Miller, Andrew; Solomon, Renee; Bloom, Adam; Palmer, Carrie; Perry, Henry D; Donnenfeld, Eric D
PURPOSE: To report a case of excimer laser phototherapeutic keratectomy (PTK) for Reis-Bucklers dystrophy with a single intraoperative application of adjunctive topical 0.02% mitomycin C (MMC). METHODS: Interventional case report and review of the literature. RESULTS: A 73-year-old woman with visually significant Reis-Bucklers dystrophy underwent PTK of her right eye with 0.02% adjunctive MMC for visual rehabilitation. Before treatment, best corrected visual acuity (BCVA) was 20/400. The left eye had previously undergone PTK on 2 occasions without MMC, and the dystrophy had recurred following each treatment. One year after the procedure, her MMC-treated cornea remains clear with no recurrence of Reis-Bucklers dystrophy. CONCLUSIONS: The use of topical MMC in conjunction with PTK may be a safe and effective treatment of Reis-Bucklers dystrophy and may be helpful in preventing recurrence of the disease
PMID: 15448504
ISSN: 0277-3740
CID: 80454

Dodick laser photolysis cataract extraction experience of ophthalmology residents at Manhattan Eye Ear and Throat Hospital [Meeting Abstract]

Glavas, IP; Miller, AI; Pettinelli, D; Shrier, E; Stein, JJ; Ali, I
ISSN: 0146-0404
CID: 55414

Laser photolysis cataract extraction, irrigation fluid and corneal edema [Meeting Abstract]

Park, L; Miller, AI; Ali, I; Dodick, J
ISSN: 0146-0404
CID: 55415

Initial clinical experience with the accomodating intraocular lens following cataract surgery [Meeting Abstract]

Miller, AI; Pettinell, DJ; Stein, JJ; Kanellopoulos, A
ISSN: 0146-0404
CID: 55480

Initial clinical experience with the wavelight ALLEGRETTO-WAVE Excimer laser in 287 consecutive myopic eyes treated with LASIK [Meeting Abstract]

Stein, JJ; Miller, AI; Pettinelli, DJ; Kanellopoulos, A
ISSN: 0146-0404
CID: 55489

Comparison of pre- and post-LASIK high order aberrations and coma with the wavelight ALLEGRETTO-WAVE laser in non wavefront-guided procedures and measured by the wavelight ALLEGRETTO aberrometer in 85 consecutive eyes [Meeting Abstract]

Pettinelli, DJ; Miller, AI; Stein, JJ; Kanellopoulos, A
ISSN: 0146-0404
CID: 55490

Comparison of the wavelight ALLEGRETTO-WAVE aberrometer to subjective refraction data in pre-operative evaluation of LASIK candidates [Meeting Abstract]

Tai, A; Stein, J; Miller, A; Pettinelli, D; Kanellopoulos, A
ISSN: 0146-0404
CID: 55491

Yellowish subretinal deposits in a leopard-spot pattern in central serous chorioretinopathy [Meeting Abstract]

Miller, AI; Iida, T; Spaide, RF; Haas, A; Yannuzzi, L
ISSN: 0146-0404
CID: 103644