Physicians’ experience in blood supply shortages and the top factors that impact the clinical, economic, and humanistic outcomes of patients with myelodysplastic syndromes in 5 European countries

Figures & data

Figure 1. Survey respondents’ medical specialties. Figure adapted from Gupta et al.¹¹.

Table 1. Physician characteristics by country.

Characteristic	Total N = 378	UK n = 76	France n = 75	Germany n = 76	Italy n = 76	Spain n = 75
Age, n (%), years
<35	28 (7.4)	5(6.6)	3 (4.0)	1 (1.3)	18 (23.7)	1 (1.3)
35–44	138 (36.5)	32 (42.1)	23 (30.7)	24 (31.6)	26 (34.2)	33 (44.0)
45–54	156 (41.3)	33 (43.4)	35 (46.7)	35 (46.1)	25 (32.9)	28 (37.3)
55–64	55 (14.6)	6 (7.9)	13 (17.3)	16 (21.1)	7 (9.2)	13 (17.3)
≥65	1 (0.3)	0 (0.0)	1 (1.3)	0 (0.0)	0 (0.0)	0 (0.0)
Sex, n (%)
Male	243 (64.3)	49 (64.5)	54 (72.0)	63 (82.9)	35 (46.1)	42 (56.0)
Female	135 (35.7)	27 (35.5)	21 (28.0)	13 (17.1)	41 (53.9)	33 (44.0)
Years in practice, mean (SE)	14.70 (0.32)	13.05 (0.59)	16.75 (0.70)	14.46 (0.64)	13.29 (0.69)	16.00 (0.75)
% Professional time spent in direct patient care, mean (SE)	88.72 (0.36)	87.70 (0.73)	89.64 (0.80)	88.28 (0.78)	89.66 (0.87)	88.35 (0.83)
No. of MDS patients seen and/or treated in past 3 months, mean (SE)	54.47 (2.26)	41.53 (3.71)	59.68 (5.43)	55.97 (5.26)	63.14 (5.10)	52.08 (5.38)
MDS classification categories used by physicians, n (%)
IPSS	158 (41.8)	39 (51.3)	40 (53.3)	30 (39.5)	32 (42.1)	17 (22.7)
IPSS-R	220 (58.2)	37 (48.7)	35 (46.7)	46 (60.5)	44 (57.9)	58 (77.3)
% TD patients, mean (SE)	47.41 (1.02)	46.84 (2.35)	45.04 (2.18)	50.67 (2.55)	47.95 (2.20)	46.52 (2.06)
Practice locations, n (%)
Urban	334 (88.4)	56 (73.7)	69 (92.0)	68 (89.5)	72 (94.7)	69 (92.0)
Suburban	39 (10.3)	20 (26.3)	6 (8.0)	5 (6.6)	4 (5.3)	4 (5.3)
Rural	5 (1.3)	0 (0.0)	0 (0.0)	3 (3.9)	0 (0.0)	2 (2.7)
No. of oncologists/hematologists in the practice, n (%)
1	6 (1.6)	0 (0.0)	0 (0.0)	6 (7.9)	0 (0.0)	0 (0.0)
2–4	107 (28.3)	20 (26.3)	18 (24.0)	46 (60.5)	13 (17.1)	10 (13.3)
5–10	116 (30.7)	26 (34.2)	30 (40.0)	12 (15.8)	22 (28.9)	26 (34.7)
>10	149 (39.4)	30 (39.5)	27 (36.0)	12 (15.8)	41 (53.9)	39 (52.0)

Abbreviations. IPSS-R, revised International Prognostic Scoring System; MDS, myelodysplastic syndromes; n, number of physicians with observations; SE, standard error; TD, transfusion dependent.

Figure 2. Consequences of blood supply shortages, (A) length of treatment delay; (B) percent of patients requiring additional visits to healthcare providers. Numbers to the right of the data bars indicate the mean, and error bars show the upper limit of the 95% CI. Abbreviations. CI, confidence interval; n, number of physicians with observations.

Table 2. Blood supply shortage metrics for patients with MDS requiring RBC transfusions.

	Total (N = 378)	UK (n = 76)	France (n = 75)	Germany (n = 76)	Italy (n = 76)	Spain (n = 75)	p value*
Physicians reporting patients encountering transfusion delay due to blood supply shortage, n (%)	248 (65.6)	56 (73.7)	41 (54.7)	51 (67.1)	55 (72.4)	45 (60.0)	.065
Physicians reporting ≥ 25% of patients encountering transfusion delay due to blood supply shortage, n (%)	65 (17.2)	13 (17.1)	11 (14.7)	10 (13.2)	24 (31.6)^a	7 (9.3)^a	.004
Patients with MDS encountering transfusion delay due to blood supply shortage, mean % (95% CI)	9.03 (7.64–10.43)	8.80 (6.11–11.49)	7.32 (4.24–10.40)	8.30 (5.47–11.13)	14.07^b (10.05–18.09)	6.63^b (3.85–9.41)	.008
Among physicians reporting a blood supply shortage (n = 248), patients with MDS encountering transfusion delay due to blood supply shortage, mean % (95% CI)	13.77 (11.89–15.65)	11.95 (8.66–15.24)	13.39 (8.41–18.37)	12.37 (8.62–16.13)	19.44 (14.57–24.30)	11.04 (6.84–15.25)	.030

Abbreviations. ANOVA, analysis of variance; CI, confidence interval; MDS, myelodysplastic syndromes; n, number of physicians with observations; RBC, red blood cell.

*Unadjusted p value resulting from overall ANOVA tests to compare data across countries, significant values are highlighted in bold.

Superscripts of the same letter indicate significant differences of p < .05 (Scheffé’s adjusted p value) between countries.

Table 3. Top 10 factors and mean impact scores by country.

Variable	Response	Total N = 378	UK n = 76	France n = 75	Germany n = 76	Italy n = 76	Spain n = 75	p value*
ECOG PS	Top 10 factor count, n (%)	282 (74.6)	63 (82.9)	55 (73.3)	59 (77.6)	51 (67.1)	54 (72.0)	.222
	Mean contribution-points out of 100 (SE)	8.93 (0.44)	8.84 (0.84)	8.43 (0.90)	11.04 (1.21)	6.91 (0.79)	9.45 (1.12)	.054
Bone marrow, % blasts at diagnosis	Top 10 factor count, n (%)	227 (60.1)	55 (72.4)	37 (49.3)	45 (59.2)	41 (53.9)	49 (65.3)	.033
	Mean contribution-points out of 100 (SE)	8.25 (0.46)	10.34 (0.99)	6.49 (0.95)	8.91 (1.25)	6.71 (0.91)	8.76 (0.98)	.041
Patient age, years	Top 10 factor count, n (%)	252 (66.7)	49 (64.5)	50 (66.7)	45 (59.2)	57 (75.0)	51 (68.0)	.342
	Mean contribution-points out of 100 (SE)	7.24 (0.37)	6.76 (0.72)	7.20 (0.84)	5.71 (0.76)	8.86 (1.03)	7.68 (0.73)	.098
Hemoglobin level	Top 10 factor count, n (%)	252 (66.7)	54 (71.1)	58^a (77.3)	48 (63.2)	40^a (52.6)	52 (69.3)	.018
	Mean contribution-points out of 100 (SE)	6.75 (0.34)	6.76 (0.64)	7.57 (0.71)	6.38 (0.81)	6.42 (0.92)	6.61 (0.71)	.808
Presence of comorbidities/comorbidity index	Top 10 factor count, n (%)	225 (59.5)	45 (59.2)	41 (54.7)	45 (59.2)	50 (65.8)	44 (58.7)	.735
	Mean contribution-points out of 100 (SE)	6.59 (0.37)	5.83 (0.73)	6.81 (0.94)	6.33 (0.77)	8.33 (0.90)	5.64 (0.74)	.146
Genetic abnormalities	Top 10 factor count, n (%)	190 (50.3)	45 (59.2)	39 (52.0)	28 (36.8)	41 (53.9)	37 (49.3)	.077
	Mean contribution-points out of 100 (SE)	6.40 (0.41)	8.53^b (1.11)	6.88 (0.96)	3.84^b (0.64)	6.64 (0.91)	6.12 (0.85)	.008
Infection	Top 10 factor count, n (%)	231 (61.1)	50 (65.8)	46 (61.3)	52 (68.4)	37 (48.7)	46 (61.3)	.118
	Mean contribution-points out of 100 (SE)	6.08 (0.33)	6.33 (0.76)	5.87 (0.71)	7.25 (0.77)	5.34 (0.79)	5.63 (0.70)	.407
Platelets	Top 10 factor count, n (%)	213 (56.3)	42 (55.3)	51 (68.0)	43 (56.6)	41 (53.9)	36 (48.0)	.166
	Mean contribution-points out of 100 (SE)	5.24 (0.32)	4.66 (0.64)	6.97 (0.76)	5.22 (0.75)	5.18 (0.68)	4.16 (0.66)	.061
Peripheral blood, % blasts at diagnosis	Top 10 factor count, n (%)	173 (45.8)	46^c (60.5)	30 (40.0)	26^c (34.2)	37 (48.7)	34 (45.3)	.017
	Mean contribution-points out of 100 (SE)	5.01 (0.36)	7.63^d (0.97)	4.20 (0.71)	3.08^d (0.56)	5.21 (0.85)	4.92 (0.78)	.001
Cardiovascular comorbidity	Top 10 factor count, n (%)	200 (52.9)	36 (47.4)	39 (52.0)	43 (56.6)	39 (51.3)	43 (57.3)	.729
	Mean contribution-points out of 100 (SE)	4.79 (0.29)	3.89 (0.52)	4.84 (0.69)	5.86 (0.71)	4.03 (0.57)	5.32 (0.76)	.163
White blood cell count	Top 10 factor count, n (%)	183 (48.4)	41 (53.9)	38 (50.7)	38 (50.0)	39 (51.3)	27 (36.0)	.196
	Mean contribution-points out of 100 (SE)	4.28 (0.28)	4.82 (0.59)	4.61 (0.68)	4.03 (0.60)	4.70 (0.71)	3.21 (0.58)	.360

Abbreviations. ANOVA, analysis of variance; ECOG PS, Eastern Cooperative Oncology Group performance status; MDS, myelodysplastic syndromes; N, number of physicians; n, number of physicians with observations; SE, standard error.

*Unadjusted p value resulting from overall ANOVA tests to compare data across countries, significant values are highlighted in bold.

Superscripts of the same letter indicate significant differences of p < .05 (Scheffé’s adjusted P value) between countries.

Gupta S, Kulasekararaj AG, Costantino H, et al. Association between transfusion status and clinical and economic outcomes in patients with myelodysplastic syndromes from the physicians’ perspective. Cancer Rep. 2022;2022:e1680.

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