Individualized Treatment Plans Research Articles

EXPLORING THE EXPERIENCES OF PHYSICAL THERAPISTS ON ASSESSMENT AND MANAGEMENT OF PELVIC FLOOR DISORDERS AMONG WOMEN IN REHABILITATION CENTERS IN METRO MANILA: A QUALITATIVE DESCRIPTIVE STUDY

Introduction: The study aimed to explore Physical Therapists’ experiences in assessing and managing women with pelvic floor disorders from selected rehabilitation centers in Metro Manila. Methods: This qualitative descriptive study used purposive sampling to recruit Physical Therapists who have managed pelvic floor disorders and have at least two years of working experience in rehabilitation centers in Metro Manila. The researchers conducted in-depth, semi-structured individual interviews using an interview guide approved by a women’s health Physical Therapist. A pilot study, which identifies potential problems before the implementation, included one participant, while five were included in the main study. Finalized transcription underwent coding analysis using the Taguette online software. Results: Pelvic floor disorders are infrequently diagnosed as standalone conditions, often presenting as incidental findings and frequently co-occurring with other health issues, particularly postsurgical cases. Observational assessments, including urinary habits and internal examinations, play a role in diagnosis. Treatment strategies involve individualized exercise programs and interventions addressing pelvic floor weaknesses, including Kegel and core strengthening exercises. However, there are limited direct pelvic floor disorder referrals from physicians. Discussion: Pelvic floor rehabilitation in the Philippines is in its early stages, with ongoing efforts to establish guidelines, training, and seminars. The advancement of the practice will be beneficial in giving patients a thorough assessment and individualized treatment plan. The lack of knowledge about pelvic floor disorders and rehabilitation among patients or even healthcare professionals is one of the primary reasons why the practice is still uncommon. Patient hesitancy and stigma around pelvic floor disorder treatment pose challenges, as patients may not receive the help they need. To enhance the practice, increasing public awareness and professional training are vital. Moreover, the widespread use of social media can be done to obtain information about the practice and to educate the public about pelvic floor disorders.

A predictive model for postoperative adverse outcomes following surgical treatment of acute type A aortic dissection based on machine learning.

Acute type A aortic dissection (AAAD) has a high probability of postoperative adverse outcomes (PAO) after emergency surgery, so exploring the risk factors for PAO during hospitalization is key to reducing postoperative mortality and improving prognosis. An artificial intelligence approach was used to build a predictive model of PAO by clinical data-driven machine learning to predict the incidence of PAO after total arch repair for AAAD. This study included 380 patients with AAAD. The clinical features that are associated with PAO were selected using the LASSO regression analysis. Six different machine learning algorithms were tried for modeling, and the performance of each model was analyzed comprehensively using receiver operating characteristic curves, calibration curve, precision recall curve, and decision analysis curves. Explain the optimal model through Shapley Additive Explanation (SHAP) and perform an individualized risk assessment. After comprehensive analysis, the authors believe that the extreme gradient boosting (XGBoost) model is the optimal model, with better performance than other models. The authors successfully built a prediction model for PAO in AAAD patients based on the XGBoost algorithm and interpreted the model with the SHAP method, which helps to identify high-risk AAAD patients at an early stage and to adjust individual patient-related clinical treatment plans in a timely manner.

Management of Hepatocellular Carcinoma in 2024: The Multidisciplinary Paradigm in an Evolving Treatment Landscape

Liver cancer is the third most common cause of cancer-related deaths worldwide, and hepatocellular carcinoma (HCC) makes up the majority of liver cancer cases. Despite the stabilization of incidence rates in recent years due to effective viral hepatitis treatments, as well as improved outcomes from early detection and treatment advances, the burden of HCC is anticipated to rise again due to increasing rates of metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease. The treatment landscape is evolving and requires a multidisciplinary approach, often involving multi-modal treatments that include surgical resection, transplantation, local regional therapies, and systemic treatments. The optimal approach to the care of the HCC patient requires a multidisciplinary team involving hepatology, medical oncology, diagnostic and interventional radiology, radiation oncology, and surgery. In order to determine which approach is best, an individualized treatment plan should consider the patient’s liver function, functional status, comorbidities, cancer stage, and preferences. In this review, we provide an overview of the current treatment options and key trials that have revolutionized the management of HCC. We also discuss evolving treatment paradigms for the future.

Use of a mobile app by people with Parkinson's disease to improve self-management

Background: Parkinson's disease is a complex neurodegenerative condition. Due to the heterogeneity of symptoms that may be experienced, individualised treatment plans are essential. Hear Me Now (HMN) is an app developed for individuals with learning disabilities. Anecdotal evidence suggested people with chronic conditions, such as Parkinson's disease, might also benefit from using HMN in managing their complex health condition. Aims: This feasibility study sought to explore whether HMN was suitable for use in people with Parkinson's disease. Methods: A purposive sample of 4 people with Parkinson's were recruited. Following training, participants used the HMN app at home over 3 months. Interviews were used to explore their use of functions within the app; ease of use; any impact it had on their daily life; any barriers or facilitators to using the app. Findings: Most participants found HMN beneficial in managing their health condition. Conclusion: The HMN app merits further research for use in patient self-management.

Chronic Cellulitis in the Unhoused: Case Study and Treatment Considerations.

This report seeks to discuss sequelae of chronic cellulitis that is commonly treated in the ambulatory setting, as exacerbated by the conditions of living outside. Further we hope to identify etiologic factors that contribute to complication development. Additionally, this article will touch on unique treatment plan considerations for unhoused patients with the intention to educate providers and reduce mortality and morbidity relating to pedal skin and soft tissue infections in this population. This piece examines the case of a 52-year-old man with a history of chronic diseases, substance use disorder, and recurrent cellulitis. We highlight systemic issues in healthcare delivery for unhoused patients, including inadequate discharge planning, limited access to medication, and challenges in shelter placement. The discussion section emphasizes the importance of accurate diagnosis and tailored treatment plans for cellulitis in houseless individuals, the importance of a multidisciplinary approach incorporating social work services, and addressing chronic illnesses, substance use disorder, and housing issues. The report advocates for heightened awareness of bilateral cellulitis in unhoused populations, emphasizing the need for comprehensive, individualized treatment plans.

Prevalence of Enuresis in Children, Adolescents, and Young Adults Diagnosed With Attention Deficit Hyperactivity Disorder.

Background Enuresis, or bedwetting, is a common condition affecting millions of children worldwide. This can be a source of distress for both children and their families. Children, adolescents, and young adults with attention deficit hyperactivity disorder (ADHD) are at risk of developing enuresis. They have difficulties with executive functioning, including impulse control and emotional regulation. These difficulties may contribute to the development of enuresis, as individuals may struggle to recognize the urge to use the bathroom or have difficulty controlling their bladder during sleep. Objective To assess the prevalence of enuresis in children, adolescents, and young adults with ADHD and determine whether the presence of other behavioral disorders such anxiety, depression, learning disabilities, and autism comorbid with ADHDis a risk factor for developing enuresis. Method A case-control studyincluded 213 children, adolescents, and young adults aged seven to 23 years, with 139 males and 74 females. A total of 161 participantswere diagnosed with ADHD. Data collection consisted of a semi-structured interview conducted with each participant or theirparents in person during their visit to Developmental Pediatric Clinics and Psychiatry Clinics. The questions were designed to collect data on the participant's ADHD diagnosis, enuresis history, other behavioral disorders, such as anxiety, depression, and learning difficulties, and any relevant medical or developmental history. The interview lasted approximately 30 minutes. Results Children, adolescents, and young adults with ADHD had a significantly higher prevalence of enuresis than the control group (13.6% vs. 0.9%, p = 0.01). Other behavioral disorders comorbid with ADHD did not pose a statistically significant risk for the development of enuresis (p = 0.36). Conclusions This study supports that children, adolescents, and young adults diagnosed with ADHD are more likely to have enuresis than those without ADHD. This finding is consistent with previous research and emphasizes the importance of a thorough evaluation and comprehensive treatment plan for individuals with ADHD.

Toxicity-benefit analysis of advanced prostate cancer trials using weighted toxicity scoring.

110 Background: The weighted toxicity score (WTS) is a metric suitable for comparing the toxicity burden in experimental versus control arms of randomized controlled trials (RCTs). When compared against clinical endpoints, the WTS can be used to evaluate the cost versus benefit of anti-cancer agents. This study sought to apply the WTS to prostate cancer (PC) clinical trials. Methods: Select phase 3 PC RCTs with reported adverse event (AE) data were compiled. The WTS was computed for each trial arm and compared to reported hazard ratios (HRs) of primary and/or secondary endpoints (i.e., overall survival (OS) and progression-free survival (PFS)). Average WTSs for the experimental versus control arms were used to calculate the toxicity differential between treatment arms. Average HRs for OS and PFS were used to compare efficacy. Results: Sixteen RCTs were analyzed (investigational agents: androgen-receptor signaling inhibitors (ARSi) [n = 4], poly (ADP-ribose) polymerase inhibitors (PARPi) monotherapy [n = 3], ARSi + PARPi as well as ARSi + ARSi combination therapies [n = 3 each], and triple therapy [n=3]). The median number of distinct reported AEs across all studies was 18 (range, 9-61). Overall, toxicity and efficacy were greater among experimental than control arms (6.62 versus 4.00 median WTS; median HR for OS 0.71, median HR for PFS 0.61). The triple therapy studies observed the lowest increase in toxicity by adding an ARSi to control therapy (10.4%), associated with 52% lower risk of progression, and 29% lower risk of death. Comparably, the ARSi + PARPi trials noted the highest increase in toxicity (79.7%), with 32% lower risk of progression and 12% lower risk of death. The PARPi monotherapy, ARSi monotherapy, and ARSi + ARSi combination therapy studies reported increased toxicity due to experimental therapy in descending order (Table). Conclusions: The WTS enables toxicity versus benefit assessment for anti-cancer regimens. Clinical application of this metric may facilitate individualized treatment planning in advanced PC management. [Table: see text]

Barriers And Challenges Of Multidisciplinary Teams In Oncology Management: A Scoping Review Protocol

IntroductionMultidisciplinary teams (MDTs) are integral to oncology management, involving specialised healthcare professionals who collaborate to develop individualised treatment plans for patients. However, as cancer care grows more complex, MDTs must...

Rationale and protocol of the LAQUA-HF trial: a factorial randomised controlled trial evaluating the effects of neurohormonal and diuretic agents on health-status reported outcomes in heart failure patients

IntroductionThe current guidelines strongly recommend early initiation of multiple classes of cardioprotective drugs for patients with heart failure with reduced ejection fraction to improve prognosis and health status. However, evidence...

From Pathophysiology to Personalized Treatment Strategies for Psoriasis

Background: Psoriasis is a chronic inflammatory and proliferative skin disorder characterized by redness and elevated patches covered in scaly, silvery-white skin. The National Psoriasis Foundation categorizes psoriasis into mild, moderate, and severe, impacting 2% to 5% of the global population. This article explores the types, development, and severity categories of psoriasis, delving into its pathophysiology. It also reviews both conventional and herbal topical therapies and their marketed formulations. Aim: The study aimed to contribute to the development of personalized treatment approaches for individuals with psoriasis. Objectives: This article explores the types, development, and severity categories of psoriasis, delving into its pathophysiology. It also reviews both conventional and herbal topical therapies and their marketed formulations. Methods: The article relies on a comprehensive review of existing literature and research studies on psoriasis. Information on types, severity categories, pathophysiology, and available treatments, both conventional and herbal, is gathered and analyzed. Results: The results highlight the potential advantages of incorporating herbal therapies into treatment plans for individuals with psoriasis, especially for those with severe cases. Conclusion: In conclusion, the article emphasizes the importance of individualized treatment plans for managing psoriasis. Both conventional and herbal topical formulations can be viable options, particularly for severe cases. By considering the safety profiles, side effects, and biological activities associated with these treatments, healthcare experts can collaborate with patients to create personalized and effective strategies for addressing the complexities of psoriasis management.

Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task

IntroductionTheory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder. Method31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described. ResultsIn the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = −3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance. ConclusionsOverall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.

Current approaches in the diagnosis and management of non-small cell lung cancer brain metastases

Brain metastases are a frequent consequence of “non-small cell lung cancer (NSCLC)”, one of the most prevalent cancers with a poor prognosis. For the best possible patient outcomes, detecting and treating NSCLC brain metastases involve substantial hurdles and calls for a multidisciplinary approach. This article intends to provide an overview of current methods for diagnosing and treating NSCLC brain metastases. It examines the various available treatment options, diagnostic techniques, and their effects on patient outcomes. A thorough literature review was done to find pertinent studies, clinical suggestions, and professional advice about the specialized management of NSCLC. The chosen articles were examined to learn about molecular screening techniques, individualized treatment plans, and diagnostic procedures. For individualized treatment, precise NSCLC identification and prognosis are essential. Techniques such as imaging and endoscopy are used to collect tissue samples. It is advised to do a molecular screening for oncogenic changes. Evaluation of PD-L1 expression informs therapy decisions. The molecular profile determines the first line of treatment, followed by chemotherapy and immunotherapy, and cancer tissue samples help to detect resistance mechanisms. For the best possible patient results, NSCLC therapy must be personalized and incorporate precise pathology evaluation, molecular assessment, and precision therapeutic approaches. To progress in precision medicine in lung cancer treatment, further research is required to find novel molecular markers, especially those that predict the effectiveness of immunotherapy.

CT-based peritumoral radiomics nomogram on prediction of response and survival to induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma

PurposeThe study aims to harness the value of radiomics models combining intratumoral and peritumoral features obtained from pretreatment CT to predict treatment response as well as the survival of LA-NPC(locoregionally advanced nasopharyngeal carcinoma) patients receiving multiple types of induction chemotherapies, including immunotherapy and targeted therapy.Methods276 LA-NPC patients (221 in the training and 55 in the testing cohort) were retrospectively enrolled. Various statistical analyses and feature selection techniques were applied to identify the most relevant radiomics features. Multiple machine learning models were trained and compared to build signatures for the intratumoral and each peritumoral region, along with a clinical signature. The performance of each model was evaluated using different metrics. Subsequently, a nomogram model was constructed by combining the best-performing radiomics and clinical models.ResultsIn the testing cohort, the nomogram model exhibited an AUC of 0.816, outperforming the other models. The nomogram model’s calibration curve showed good agreement between predicted and observed outcomes in both the training and testing sets. When predicting survival, the model’s concordance index (C-index) was 0.888 in the training cohort and 0.899 in the testing cohort, indicating its robust predictive ability.ConclusionIn conclusion, the combined nomogram model, incorporating radiomics and clinical features, outperformed other models in predicting treatment response and survival outcomes for LA-NPC patients receiving induction chemotherapies. These findings highlight the potential clinical utility of the model, suggesting its value in individualized treatment planning and decision-making.

Neoadjuvant therapy for resectable melanoma.

The standard of care for patients with resectable stage III/IV melanoma classically included upfront resection with adjuvant therapy. However, in more recent years, the amount of systemic therapies available for neoadjuvant use for these patients has increased. This article reviewed clinical trials investigating neoadjuvant therapy for patients with resectable stage III/IV melanoma. The outcomes of these trials have identified optimal treatment regimens to maximise patient response and minimize toxicities. Additionally, the date demonstrate advantages to neoadjuvant treatment compared to adjuvant therapy alone. Further research is needed to utilize a patient's response to neoadjuvant treatment for prognostication and creation of an individualized treatment plan.

Machine Learning and Deep Learning in Spinal Injury: A Narrative Review of Algorithms in Diagnosis and Prognosis

Spinal injuries, including cervical and thoracolumbar fractures, continue to be a major public health concern. Recent advancements in machine learning and deep learning technologies offer exciting prospects for improving both diagnostic and prognostic approaches in spinal injury care. This narrative review systematically explores the practical utility of these computational methods, with a focus on their application in imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI), as well as in structured clinical data. Of the 39 studies included, 34 were focused on diagnostic applications, chiefly using deep learning to carry out tasks like vertebral fracture identification, differentiation between benign and malignant fractures, and AO fracture classification. The remaining five were prognostic, using machine learning to analyze parameters for predicting outcomes such as vertebral collapse and future fracture risk. This review highlights the potential benefit of machine learning and deep learning in spinal injury care, especially their roles in enhancing diagnostic capabilities, detailed fracture characterization, risk assessments, and individualized treatment planning.

An update of clinical value of circulating tumor DNA in esophageal cancer: a systematic review and meta-analysis

BackgroundEsophageal cancer (EC) is a deadly disease with limited therapeutic options. Although circulating tumor DNA (ctDNA) could be a promising tool in this regard, the availiable evidence is limited. We performed a systematic review and meta-analysis to summarize the clinical applicability of the next-generation sequencing (NGS) and droplet digital polymerase chain reaction (ddPCR) technology on the ctDNA detection of the EC and listed the current challenges.MethodsWe systematically searched MEDLINE (via PubMed), Embase (via OVID), ISI Web of Science database and Cochrane Library from January, 2000 to April, 2023. Progression-free survival (PFS) and overall survival (OS) were set as primary outcome endpoints. Pathologic response was evaluated by tumor regression grade (TRG), according to the eighth edition of the American Joint Committee on Cancer (AJCC). Major pathologic regression (MPR) was defined as TRG 1 and 2. The MPR was set as secondary endpoint. Hazard rate (HR) and associated 95% CI were used as the effect indicators the association between ctDNA and prognosis of EC. MPR rates were also calculated. Fixed-effect model (Inverse Variance) or random-effect model (Mantel-Haenszel method) was performed depending on the statistically heterogeneity.ResultsTwenty-two studies, containing 1144 patients with EC, were included in this meta-analysis. The results showed that OS (HR = 3.87; 95% CI, 2.86–5.23) and PFS (HR = 4.28; 95% CI, 3.34–5.48) were shorter in ctDNA-positive patients. In the neoadjuvant therapy, the sensitivity analysis showed the clarified HR of ctDNA-positive was 1.13(95% CI, 1.01–1.28). We also found that TP53, NOTCH1, CCND1 and CNKN2A are the most frequent mutation genes.ConclusionsPositive ctDNA is associated with poor prognosis, which demonstrated clinical value of ctDNA. Longitudinal ctDNA monitoring showed potential prognostic value in the neoadjuvant therapy. In an era of precision medicine, ctDNA could be a promising tool to individualize treatment planning and to improve outcomes in EC.PROSPERO registration numberCRD42023412465.

Occupational Therapy’s Role in Return to Occupations Post-Concussion in High School Athletes

Aim This study was designed to explore experiences of high school athletes in order to understand their occupational engagement after sustaining a sports-related concussion. The study explored the role occupational therapists (OTs) can play in post-concussion care while supporting adolescents in returning to meaningful occupations. Methods The study utilized a qualitative, phenomenological approach by conducting interviews with high school athletes to understand their participation in occupations during recovery. Six student-athletes from 14–18 years of age were interviewed. Results The five identified themes from the study included impacts on ADL performance, school performance, sleep, mental health, and driver safety. Student-athletes reported feelings of loneliness and loss of identity. Dressing, showering, grooming, and driving were disturbed due to balance deficits, headaches, and nausea. Participants reported decreased participation in social, sports, and leisure occupations due to heightened symptoms. Conclusions Due to the considerable variability of disturbance in occupational participation post-concussion, occupational therapists can assist in creating and implementing individualized treatment plans to support high school athletes while recovering from a sports-related concussion.

Efficacy of Cervical Spinal Stabilization Exercise on Reducing Pain for People with Cervical Spondylosis

Background: The synovial joint capsule, subchondral bone, and joint cartilage are all impacted by the gradualdegenerative condition known as OA. This research work is designed to check the efficacy of modified progressiveresistance training for OA knee patients.Purpose: To compare the effectiveness of cervical stabilization exercises and conventional physiotherapy exercisein reducing pain for patients with cervical spondylosis.Materials and Methods: The study took place in Eyan Physiotherapy Centre, Sriperumbudur, A total no of 40subjects were recruited for this study through the purposeful sampling method. All subjects were recruited basedon the inclusion and exclusion criteria. The recruited subjects were assigned to two groups (Group A: 20 Subjects)underwent Cervical Stabilization Exercise and (Group B: 20 Subjects) underwent Conventional Exercise. Allindividuals are assessed for pain using Algometer as a pre-test prior to the intervention and again after 6 weeks ofintervention. The entire study process was performed from November 2022 to April 2023.Results: This study states that cervical stabilization exercises are found to be more significant and more effectivein reducing pain compared to conventional therapy. The comparison of post mean value of Algometer of both thegroups. Group-A(Cervical Stabilization Exercise) was 4.30 and Group B(Conventional Exercise) was 3.65 whichshows gradual increase with p value &lt;0.0001 statistically significant.Conclusion: This study recommended that clinicians consider incorporating cervical stabilization exercises intothe treatment plan for individuals with cervical spondylosis. The evidence supporting the efficacy of cervicalstabilization exercise in reducing pain in individuals with cervical spondylosis.

Comorbid treatment of traumatic brain injury and mental health disorders.

The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. This article reviews the EHVP. The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.

Impact of a Best Practices Program in Patients with Relapsed/Refractory Multiple Myeloma Receiving Selinexor.

Best practice (BP) in cancer care consists of a multifaceted approach comprising individualized treatment plans, evidence-based medicine, the optimal use of supportive care and patient education. We investigated the impact of a BP program in patients with relapsed/refractory multiple myeloma (RRMM) receiving selinexor. Features of the BP program that were specific to selinexor were initiating selinexor at doses ≤80 mg once weekly and the upfront use of standardized antiemetics. Study endpoints included time to treatment failure (TTF), duration of therapy, dose limiting toxicities and overall survival. Comparative analysis on TTF and duration of therapy was conducted using a log-rank test and multivariate Cox proportional hazard regression. Over the ensuing 12-month post-BP period, 41 patients received selinexor-based therapy compared to 68 patients who received selinexor-based therapy pre-BP implementation. Patients treated in the post-BP period had reductions in TTF (hazard ratio [HR] = 0.50; 95% CI: 0.27 to 0.92). Patients in the pre-BP period were four times more likely to stop therapy than those in the post-period (odds ratio [OR] = 4.0, 95% CI: 1.75 to 9.3). The findings suggest a BP program tailored to selinexor could increase the time to treatment failure, increase treatment duration and lower the incidence of drug limiting toxicities.