Psychosocial Impact and Disease Management in Patients with Congenital Factor VII Deficiency

Skye Peltier; Angela Kellum; Janet Brewer; Alexander Duncan; David L Cooper; Hossam Saad

doi:10.2147/JBM.S259909

Psychosocial Impact and Disease Management in Patients with Congenital Factor VII Deficiency

J Blood Med. 2020 Sep 11:11:297-303. doi: 10.2147/JBM.S259909. eCollection 2020.

Authors

Skye Peltier¹, Angela Kellum², Janet Brewer³, Alexander Duncan⁴, David L Cooper⁵, Hossam Saad⁵

Affiliations

¹ Center for Bleeding and Clotting Disorders, University of Minnesota Medical Center - Fairview, Minneapolis, MN, USA.
² Louisiana Center for Bleeding and Clotting Disorders, Tulane University, New Orleans, LA, USA.
³ Comprehensive Health Education Services, Hanson, MA, USA.
⁴ Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Novo Nordisk Inc., Plainsboro, NJ, USA.

Abstract

Purpose: Congenital factor VII (FVII) deficiency is a rare bleeding disorder of variable phenotype with predominantly mucocutaneous bleeding. The aim of this study was to identify the burden of FVII deficiency on patients and caregivers through a better understanding of the management and psychosocial impact of this disease.

Materials and methods: A rare disease specialty recruiter from Comprehensive Health Education Services recruited participants for this online survey, which was conducted from January 31 to March 12, 2019. A moderator-assisted questionnaire was used to collect data on demographics, diagnosis, treatment, and psychosocial impact.

Results: Of the 45 respondents (25 patients and 20 caregivers), the majority were female (56%). Respondents reported a wide variety of initial bleeding symptoms, including bruising (58%), epistaxis (56%), and menorrhagia (36% of females). Because symptoms varied between individuals and were not always severe, diagnosis was often delayed. Mean time to obtain a diagnosis was 6.5 years and mean age at first diagnosis was 12.9 years. One-quarter (24%) of the respondents reported more than 100 bleeds of any severity over the previous year. When treating bleeds, 44% of patients reported using antifibrinolytics, and 42% reported using recombinant activated factor VII. Almost 31% of respondents reported missing schooldays as children, and 16% reported losing or resigning from a job in adulthood as a direct result of their disease. Notably, 29% of caregivers and 10% of their partners had also experienced issues with employment. Forty percent of respondents reported not participating in contact sports during childhood, and 22% continued to avoid contact sports in adulthood.

Conclusion: Overall, FVII deficiency has a substantial psychosocial impact, but most patients are satisfied with their disease management and are optimistic about their future. Patients desire additional educational, social, and financial support.

Keywords: bleeding disorder; psychosocial impact; recombinant activated factor VII; survey.