101
|
Aubin M, Giguère A, Martin M, Verreault R, Fitch MI, Kazanjian A, Carmichael PH. Interventions to improve continuity of care in the follow-up of patients with cancer. Cochrane Database Syst Rev 2012:CD007672. [PMID: 22786508 DOI: 10.1002/14651858.cd007672.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Care from the family physician is generally interrupted when patients with cancer come under the care of second-line and third-line healthcare professionals who may also manage the patient's comorbid conditions. This situation may lead to fragmented and uncoordinated care, and results in an increased likelihood of not receiving recommended preventive services or recommended care. OBJECTIVES To classify, describe and evaluate the effectiveness of interventions aiming to improve continuity of cancer care on patient, healthcare provider and process outcomes. SEARCH METHODS We searched the Cochrane Effective Practice and Organization of Care Group (EPOC) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, and PsycINFO, using a strategy incorporating an EPOC Methodological filter. Reference lists of the included study reports and relevant reviews were also scanned, and ISI Web of Science and Google Scholar were used to identify relevant reports having cited the studies included in this review. SELECTION CRITERIA Randomised controlled trials (including cluster trials), controlled clinical trials, controlled before and after studies and interrupted time series evaluating interventions to improve continuity of cancer care were considered for inclusion. We included studies that involved a majority (> 50%) of adults with cancer or healthcare providers of adults with cancer. Primary outcomes considered for inclusion were the processes of healthcare services, objectively measured healthcare professional, informal carer and patient outcomes, and self-reported measures performed with scales deemed valid and reliable. Healthcare professional satisfaction was included as a secondary outcome. DATA COLLECTION AND ANALYSIS Two reviewers described the interventions, extracted data and assessed risk of bias. The authors contacted several investigators to obtain missing information. Interventions were regrouped by type of continuity targeted, model of care or interventional strategy and were compared to usual care. Given the expected clinical and methodological diversity, median changes in outcomes (and bootstrap confidence intervals) among groups of studies that shared specific features of interest were chosen to analyse the effectiveness of included interventions. MAIN RESULTS Fifty-one studies were included. They used three different models, namely case management, shared care, and interdisciplinary teams. Six additional interventional strategies were used besides these models: (1) patient-held record, (2) telephone follow-up, (3) communication and case discussion between distant healthcare professionals, (4) change in medical record system, (5) care protocols, directives and guidelines, and (6) coordination of assessments and treatment.Based on the median effect size estimates, no significant difference in patient health-related outcomes was found between patients assigned to interventions and those assigned to usual care. A limited number of studies reported psychological health, satisfaction of providers, or process of care measures. However, they could not be regrouped to calculate median effect size estimates because of a high heterogeneity among studies. AUTHORS' CONCLUSIONS Results from this Cochrane review do not allow us to conclude on the effectiveness of included interventions to improve continuity of care on patient, healthcare provider or process of care outcomes. Future research should evaluate interventions that target an improvement in continuity as their primary objective and describe these interventions with the categories proposed in this review. Also of importance, continuity measures should be validated with persons with cancer who have been followed in various settings.
Collapse
Affiliation(s)
- Michèle Aubin
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec city, Canada.
| | | | | | | | | | | | | |
Collapse
|
102
|
Ciaramella A, Spiegel D. Psychiatric disorders among cancer patients. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:557-72. [PMID: 22608644 DOI: 10.1016/b978-0-444-52002-9.00033-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
103
|
Spiegel D. Mind matters in cancer survival. Psychooncology 2012; 21:588-93. [PMID: 22438289 DOI: 10.1002/pon.3067] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 02/24/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The very name "psycho-oncology" implies interaction between brain and body. One of the most intriguing scientific questions for the field is whether or not living better may also mean living longer. METHODS Randomized intervention trials examining this question will be reviewed. RESULTS The majority show a survival advantage for patients randomized to psychologically effective interventions for individuals with a variety of cancers, including breast, melanoma, gastrointestinal, lymphoma, and lung cancers. Importantly, for breast and other cancers, when aggressive anti-tumor treatments are less effective, supportive approaches appear to become more useful. This is highlighted by a recent randomized clinical trial of palliative care for non-small cell lung cancer patients.There is growing evidence that disruption of circadian rhythms, including rest-activity patterns and hypothalamic-pituitary-adrenal (HPA) axis function, affects cancer risk and progression. Women with metastatic breast cancer have flatter diurnal cortisol patterns than normal, and the degree of loss of daily variation in cortisol predicts earlier mortality. Mechanisms by which abnormal cortisol patterns affect metabolism, gene expression, and immune function are reviewed. The HPA hyperactivity associated with depression can produce elevated levels of cytokines that affect the brain. Tumor cells can, in turn, co-opt certain mediators of inflammation such as NFkB, interleukin-6, and angiogenic factors to promote metastasis. Also, exposure to elevated levels of norepinephrine triggers release of vascular endothelial growth factor, which facilitates tumor growth. CONCLUSIONS Therefore, the stress of advancing cancer and management of it is associated with endocrine, immune, and autonomic dysfunction that has consequences for host resistance to cancer progression.
Collapse
Affiliation(s)
- David Spiegel
- Stanford University School of Medicine, Stanford, CA 94305, USA.
| |
Collapse
|
104
|
Van Cleave JH, Egleston BL, Bourbonniere M, Cardone L, McCorkle R. Functional status in older women following gynecological cancer surgery: can choice of measure influence evidence for clinical practice? Geriatr Nurs 2012; 33:118-26. [PMID: 22387192 DOI: 10.1016/j.gerinurse.2012.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/12/2012] [Accepted: 01/16/2012] [Indexed: 11/18/2022]
Abstract
Although functional status serves as a major predictor of morbidity, researchers and clinicians use different terms and measures, limiting comparisons across studies. To demonstrate how differing measures may generate varied findings, we compared and contrasted data from the SF-12 Health Survey Physical Component Summary Scale (SF-12 PCS) and the Enforced Social Dependency Scale (ESDS). The sample consisted of 49 women aged 65 and older recovering from gynecological cancer surgery with data collection at baseline (postoperative period) and then at 3 and 6 months. Analysis of the relationship between SF-12 PCS and ESDS over time using generalized estimating equations (GEE) demonstrated the relationship was less than 1.0, signaling less than perfect agreement between measures (β = 0.16, P = .002). These findings suggest that that the 2 measures are not interchangeable and may produce conflicting evidence. This highlights the importance of researchers' and clinicians' careful conceptualization and operationalization of functional status before measure selection.
Collapse
|
105
|
Kowdley GC, Merchant N, Richardson JP, Somerville J, Gorospe M, Cunningham SC. Cancer surgery in the elderly. ScientificWorldJournal 2012; 2012:303852. [PMID: 22272172 PMCID: PMC3259553 DOI: 10.1100/2012/303852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 10/18/2011] [Indexed: 12/21/2022] Open
Abstract
The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.
Collapse
Affiliation(s)
- Gopal C Kowdley
- Department of Surgery, Saint Agnes Hospital Center, 900 Caton Avenue, Baltimore, MD 21229, USA
| | | | | | | | | | | |
Collapse
|
106
|
Extermann M, Wedding U. Comorbidity and geriatric assessment for older patients with hematologic malignancies: A review of the evidence. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
107
|
Hopkinson JB, Brown JC, Okamoto I, Addington-Hall JM. The effectiveness of patient-family carer (couple) intervention for the management of symptoms and other health-related problems in people affected by cancer: a systematic literature search and narrative review. J Pain Symptom Manage 2012; 43:111-42. [PMID: 21719250 DOI: 10.1016/j.jpainsymman.2011.03.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/14/2011] [Accepted: 03/15/2011] [Indexed: 11/28/2022]
Abstract
CONTEXT Cancer is widely acknowledged to impact on the whole family. Yet, we do not know if there is benefit (or harm) from patient-family carer interventions in the context of cancer care. OBJECTIVES To report a systematic search for and narrative review of patient-family carer interventions tested in the context of cancer care for effect on symptoms and other health-related problems in patients and/or their family members. METHODS A systematic literature search was carried out using Cochrane principles. Searches were of MEDLINE, EMBASE, PsycINFO, and CINAHL databases for reported trials of patient-family carer focused interventions. Outcomes of interest were health indicators; measures of physical, psychological, social, and quality-of-life status of the patient and/or family member(s). Limits were English language; 1998 to March 2010; and adults. Relevant information was extracted, quality assessed using the Cochrane Collaboration's tool for assessing risk of bias, and presented as a narrative synthesis (meta-analysis was not appropriate). RESULTS The review found no empirically tested interventions for family groups (patient and two or more family members), but 22 interventions for patient-family carer partnerships (couple interventions) tested in 23 studies and reported in 27 publications. Recruitment and attrition were problematic in these studies, limiting the reliability and generalizability of their results. CONCLUSION In the trials of cancer couple interventions included in the review, a pattern emerged of improvement in the emotional health of cancer patients and their carers when the intervention included support for the patient-family carer relationship. Further investigation is warranted.
Collapse
|
108
|
Abstract
The sum of these intervention studies suggests that a CGA can be performed in a variety of settings (inpatient, outpatient, or home), is a multidisciplinary effort, and can lead to interventions that may decrease the risk of morbidity and mortality in older patients with cancer. Further studies are needed using a CGA to (1) guide and test interventions to improve the care of older adults with cancer and (2) evaluate the impact of cancer therapy on geriatric assessment domains.
Collapse
|
109
|
Muss HB, Busby-Whitehead J. Older women with breast cancer: slow progress, great opportunity, now is the time. J Clin Oncol 2011; 29:4608-10. [PMID: 22067402 DOI: 10.1200/jco.2011.38.6888] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
110
|
Hamaker ME, Buurman BM, van Munster BC, Kuper IMJA, Smorenburg CH, de Rooij SE. The value of a comprehensive geriatric assessment for patient care in acutely hospitalized older patients with cancer. Oncologist 2011; 16:1403-12. [PMID: 21914699 DOI: 10.1634/theoncologist.2010-0433] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A comprehensive geriatric assessment systematically collects information on geriatric conditions and is propagated in oncology as a useful tool when assessing older cancer patients. OBJECTIVES The objectives were: (a) to study the prevalence of geriatric conditions in cancer patients aged ≥ 65 years, acutely admitted to a general medicine ward; (b) to determine functional decline and mortality within 12 months after admission; and (c) to assess which geriatric conditions and cancer-related variables are associated with 12-month mortality. METHODS This was an observational cohort study of 292 cancer patients aged ≥ 65 years, acutely admitted to the general medicine and oncology wards of two university hospitals and one secondary teaching hospital. Baseline assessments included patient characteristics, reason for admission, comorbidity, and geriatric conditions. Follow-up at 3 and 12 months was aimed at functional decline (loss of one or more activities of daily living [ADL]) and mortality. RESULTS The median patient age was 74.9 years, and 95% lived independently; 126 patients (43%) had metastatic disease. A high prevalence of geriatric conditions was found for instrumental ADL impairment (78%), depressive symptoms (65%), pain (65%), impaired mobility (48%), malnutrition (46%), and ADL impairment (38%). Functional decline was observed in 8% and 33% of patients at 3 and 12 months, respectively. Mortality rates were 38% at 3 months and 64% at 12 months. Mortality was associated with cancer-related factors only. CONCLUSION In these acutely hospitalized older cancer patients, mortality was only associated with cancer-related factors. The prevalence of geriatric conditions in this population was high. Future research is needed to elucidate if addressing these conditions can improve quality of life.
Collapse
Affiliation(s)
- Marije E Hamaker
- Academic Medical Center, Department of Internal Medicine, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
111
|
McCorkle R. Interdisciplinary collaboration in the pursuit of science to improve psychosocial cancer care. Psychooncology 2011; 20:538-43. [PMID: 20878859 DOI: 10.1002/pon.1766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Drawing on her substantial research experience in oncology and nursing, the 2009 Fox Award winner, Dr McCorkle, describes ways to advance the science of psychosocial oncology through collaboration. METHODS Critical literature illustrating barriers to collaboration and successful collaborative process are reviewed and compared to the author's personal experiences. RESULTS Currently, many researchers are beginning to see the need for collaboration, and yet many infrastructures, universities, and centers continue to create isolated researchers and research environments. Despite the need, there is a dearth of practical and tangible guidelines as well as theoretical defenses for performing collaborative research. This article addresses these gaps with such insights as the need for a team of experts built on humility and trust, pre- and post-study networks across disciplines and settings, consistent meetings of staff as well as resources to support them, intervention monitoring techniques, and the crucial necessity for a stable institutionalized infrastructure that fosters collaboration, research and mentoring despite inevitable personnel turnover. CONCLUSIONS These insights that stem from the distinctive nursing lens provide crucial methods for advancing the science and addressing the uniquely interdisciplinary nature of oncology.
Collapse
Affiliation(s)
- Ruth McCorkle
- Yale University School of Nursing, New Haven, CT 06536-0740, USA.
| |
Collapse
|
112
|
O'Sullivan CK, Bowles KH, Jeon S, Ercolano E, McCorkle R. Psychological Distress during Ovarian Cancer Treatment: Improving Quality by Examining Patient Problems and Advanced Practice Nursing Interventions. Nurs Res Pract 2011; 2011:351642. [PMID: 21994822 PMCID: PMC3170021 DOI: 10.1155/2011/351642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 05/17/2011] [Indexed: 11/17/2022] Open
Abstract
Background/Significance. Ovarian cancer patients are prone to psychological distress. The clinical significance and best practices for distress among this population are poorly understood. Method. Secondary analysis of research records from a six month randomized control trial included 32 women with primary ovarian cancer. All received 18 advanced practice nurse (APN) visits over six months. Three sub-samples were determined by distress level (high/low) and mental health service consent for high distress. Demographic, clinical factors, patient problems and APN interventions obtained through content analysis and categorized via the Omaha System were compared. Results. Clinically-significant psychiatric conditions were identified in 8/18 (44%) high distress subjects consenting to mental health intervention. High distress subjects who refused mental health intervention had more income and housing problems than the other subjects, received the fewest interventions at baseline, and progressively more throughout the study, exceeding the other sub-samples by study completion. Conclusions. Highly-distressed women not psychologically ready to work through emotional consequences of cancer at treatment onset may obtain support from APNs to manage cancer problems as they arise. Additional studies may identify best practices for all highly-distressed women with cancer, particularly those who do not accept mental health services for distress, but suffer from its effects.
Collapse
Affiliation(s)
- Cynthia Kline O'Sullivan
- Yale University School of Nursing, New Haven, CT 0653b-0740, USA
- Department of Nursing, Southern Connecticut State University, New Haven, CT 06515-1330, USA
| | - Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA
| | - Sangchoon Jeon
- Yale University School of Nursing, New Haven, CT 0653b-0740, USA
| | | | - Ruth McCorkle
- Yale University School of Nursing, New Haven, CT 0653b-0740, USA
| |
Collapse
|
113
|
Nevidjon B, Rieger P, Miller Murphy C, Rosenzweig MQ, McCorkle MR, Baileys K. Filling the gap: development of the oncology nurse practitioner workforce. J Oncol Pract 2011; 6:2-6. [PMID: 20539723 DOI: 10.1200/jop.091072] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2009] [Indexed: 11/20/2022] Open
Abstract
A new strategy for oncology care delivery that includes increasing the numbers and expanding the roles of nonphysician practitioners is critically important to meet the current and potential cancer care needs of the US population.
Collapse
Affiliation(s)
- Brenda Nevidjon
- Duke University School of Nursing, Durham, NC; Oncology Nursing Society; and University of Pittsburgh School of Nursing, Pittsburgh, PA
| | | | | | | | | | | |
Collapse
|
114
|
Cheema FN, Abraham NS, Berger DH, Albo D, Taffet GE, Naik AD. Novel approaches to perioperative assessment and intervention may improve long-term outcomes after colorectal cancer resection in older adults. Ann Surg 2011; 253:867-74. [PMID: 21183846 DOI: 10.1097/sla.0b013e318208faf0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Colorectal cancer (CRC) is common among older adults and surgical resection with curative intent is the primary treatment of CRC. Despite the changing demographics of CRC patients and increasing prevalence of multiple comorbidities, surgery is increasingly performed in this complex aging population. Clinically important short-term outcomes have improved for this population, but little is known about long-term outcomes. We review the literature to evaluate trends in CRC surgery in the geriatric population and the outcomes of surgical treatment. We explore the specific gaps in understanding longitudinal patient-centered outcomes of CRC treatment. We then propose adaptations from the geriatrics literature to better predict both short and long-term outcomes after CRC surgery. Interventions, such as prehabilitation, coupled with comprehensive geriatric assessment may be important future strategies for identifying vulnerable older patients, ameliorating the modifiable causes of vulnerability, and improving patient-centered longitudinal outcomes. Further research is needed to determine relevant aspects of geriatric assessments, identify effective intervention strategies, and demonstrate their validity in improving outcomes for at-risk older adults.
Collapse
Affiliation(s)
- Faisal N Cheema
- *Houston Health Services Research and Development Center of Excellence at the Michael E. DeBakey VAMC, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | | | | | | |
Collapse
|
115
|
Cognitive behavioral symptom management intervention in patients with cancer: survival analysis. Support Care Cancer 2011; 20:1243-50. [DOI: 10.1007/s00520-011-1210-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 05/30/2011] [Indexed: 01/14/2023]
|
116
|
Faut-il modéliser l’EGS ? ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1991-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
117
|
The professional self-image of registered home nurses in Flanders (Belgium): a cross-sectional questionnaire survey. Appl Nurs Res 2011; 24:29-36. [DOI: 10.1016/j.apnr.2009.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 01/05/2009] [Accepted: 02/04/2009] [Indexed: 11/18/2022]
|
118
|
Abstract
BACKGROUND Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments. OBJECTIVE The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer. METHODS A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms. RESULTS There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours. DISCUSSION Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.
Collapse
|
119
|
Aparicio T, Girard L, Bouarioua N, Patry C, Legrain S, Soulé JC. A mini geriatric assessment helps treatment decision in elderly patients with digestive cancer. A pilot study. Crit Rev Oncol Hematol 2011; 77:63-9. [DOI: 10.1016/j.critrevonc.2010.01.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 09/18/2009] [Accepted: 01/06/2010] [Indexed: 12/27/2022] Open
|
120
|
Van Cleave JH, Egleston BL, Bourbonniere M, McCorkle R. Combining extant datasets with differing outcome measures across studies of older adults after cancer surgery. Res Gerontol Nurs 2011; 4:36-46. [PMID: 21210576 PMCID: PMC3263316 DOI: 10.3928/19404921-20101201-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/27/2010] [Indexed: 11/20/2022]
Abstract
Combining extant datasets with differing outcome measures, an economical method to generate evidence guiding older adults' cancer care, may introduce heterogeneity leading to invalid study results. We recently conducted a study combining extant datasets from five oncology nurse-directed clinical trials (parent studies) using norm-based scoring to standardize the differing outcome measures. The purpose of this article is to describe and analyze our methods in the recently completed study. Despite addressing and controlling for heterogeneity, our analysis found statistically significant heterogeneity (p < 0.0001) in temporal trends among the five parent studies. We concluded that assessing heterogeneity in combined extant datasets with differing outcome measures is important to ensure similar magnitude and direction of findings across parent studies. Future research should include investigating reasons for heterogeneity to generate hypotheses about subgroup differences or differing measurement domains that may have an impact on outcomes.
Collapse
|
121
|
McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, Wagner EH. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin 2011; 61:50-62. [PMID: 21205833 PMCID: PMC3058905 DOI: 10.3322/caac.20093] [Citation(s) in RCA: 594] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
With recent improvements in the early detection, diagnosis, and treatment of cancer, people with cancer are living longer, and their cancer may be managed as a chronic illness. Cancer as a chronic illness places new demands on patients and families to manage their own care, and it challenges old paradigms that oncology's work is done after treatment. As a chronic illness, however, cancer care occurs on a continuum that stretches from prevention to the end of life, with early detection, diagnosis, treatment, and survivorship in between. In this article, self-management interventions that enable patients and families to participate in managing their care along this continuum are reviewed. Randomized controlled trials of self-management interventions with cancer patients and families in the treatment, survivorship, and end-of-life phases of the cancer care continuum are reviewed, and the Chronic Care Model is presented as a model of care that oncology practices can use to enable and empower patients and families to engage in self-management. It is concluded that the need for a common language with which to speak about self-management and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually agreed upon care plans that enable and empower patients to care for themselves in the way they prefer.
Collapse
Affiliation(s)
- Ruth McCorkle
- School of Nursing, Yale University, New Haven, CT, USA.
| | | | | | | | | | | | | |
Collapse
|
122
|
Van Cleave JH, Egleston BL, McCorkle R. Factors affecting recovery of functional status in older adults after cancer surgery. J Am Geriatr Soc 2011; 59:34-43. [PMID: 21226675 PMCID: PMC3176326 DOI: 10.1111/j.1532-5415.2010.03210.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore factors influencing functional status over time after cancer surgery in adults aged 65 and older. DESIGN Secondary data analysis of combined data subsets. SETTING Five prospective, longitudinal oncology nurse-directed clinical studies conducted at three academic centers in the northwest and northeast United States. PARTICIPANTS Three hundred sixteen community-residing patients diagnosed with digestive system, thoracic, genitourinary, and gynecological cancers treated primarily with surgery. MEASUREMENTS Functional status, defined as performance of current life roles, was measured using the Enforced Social Dependency Scale and the Medical Outcomes Study 36-item Short-Form Survey (using physical component summary measures) after surgery (baseline) and again at 3 and 6 months. Number of symptoms, measured using the Symptom Distress Scale, quantified the effect of each additional common cancer symptom on functional status. RESULTS After controlling for cancer site and stage, comorbidities, symptoms, psychological status, treatment, and demographic variables, functional status was found to be significantly better at 3 and 6 months after surgery than at baseline. Factors associated with better functional status included higher income and better mental health. Factors associated with poorer average functional status were a greater number of symptoms and comorbidities. Persons reporting three or more symptoms experienced statistically significant and clinically meaningful poorer functional status than those without symptoms. Persons reporting three or more comorbidities were also found to have poorer functional status than those without comorbidities. No significant relationship existed between age and functional status in patients aged 65 and older. CONCLUSION Factors other than age affect recovery of functional status in older adults after cancer surgery.
Collapse
Affiliation(s)
- Janet H Van Cleave
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | | | | |
Collapse
|
123
|
Brain EGC, Mertens C, Girre V, Rousseau F, Blot E, Abadie S, Uwer L, Bourbouloux E, Van Praagh-Doreau I, Mourey L, Kirscher S, Laguerre B, Fourme E, Luneau S, Genève J, Debled M. Impact of liposomal doxorubicin-based adjuvant chemotherapy on autonomy in women over 70 with hormone-receptor-negative breast carcinoma: A French Geriatric Oncology Group (GERICO) phase II multicentre trial. Crit Rev Oncol Hematol 2010; 80:160-70. [PMID: 21035352 DOI: 10.1016/j.critrevonc.2010.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 08/27/2010] [Accepted: 10/04/2010] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Breast cancer is a disease of ageing. Functional independence in elderly patients, measured with the Katz activities of daily living (ADL) scale, predicts overall survival and the need for welfare support. Few prospective studies have examined the feasibility of adjuvant chemotherapy and its impact on autonomy in women over 70 years of age with high-risk breast cancer. This multicentre phase II trial was designed to assess the impact of adjuvant anthracycline-based chemotherapy on these patients' autonomy. DESIGN AND METHODS In a two-stage Fleming design, women aged ≥70 years with histologically proven hormone-receptor-negative early breast cancer and a significant risk of recurrence (pN+ or "high risk" pN0) received 4 cycles of nonpegylated liposomal doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) every 3 weeks postoperatively, on an outpatient basis. The primary endpoint was the change in the ADL score during chemotherapy. Secondary endpoints include comprehensive geriatric, quality-of-life and acceptability assessments, tolerability, and long-term outcome. The results for the primary endpoint and other scales at completion of adjuvant chemotherapy are reported here, while long-term follow-up is not yet complete. RESULTS Forty patients (median age 75 [70-82]) were enrolled between February 2006 and November 2007. Chemotherapy had no deleterious impact on ADL, cognition, mental status, or the frequency of comorbidities. In contrast, the number of patients at risk of malnutrition, based on the Mini Nutritional Assessment, more than doubled between baseline and the end of chemotherapy, rising from 15% to 38%. Quality-of-life deteriorated in terms of social and role functioning, likely owing to fatigue, loss of appetite, nausea and vomiting. Treatment acceptability was good. The main adverse effect was neutropenia, 15% of the patients experiencing febrile neutropenia. No cardiac toxicity or toxic deaths occurred. CONCLUSION This study demonstrates the feasibility of an adjuvant chemotherapy regimen combining nonpegylated liposomal doxorubicin and cyclophosphamide in fit elderly women <85 years with breast cancer. Although chemotherapy had an impact on social and role functioning, autonomy was not impaired and toxicity was acceptable. Special attention should be paid to nutritional status before and after treatment.
Collapse
|
124
|
Steer CB, Marx GM, Singhal N, McJannett M, Goldstein D, Prowse R. Cancer in older people: a tale of two disciplines. Intern Med J 2010; 39:771-5. [PMID: 19912404 DOI: 10.1111/j.1445-5994.2009.02056.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Management of cancer in the elderly presents an unprecedented challenge in Australia with the proportion of the population aged over 65 years set to double over the next four decades. Despite the complex healthcare needs of the older patient with cancer, there is currently little communication or cooperation between the fields of oncology and geriatrics. Improved interdisciplinary communication would facilitate care that is framed within current oncology practice while taking account of physiological age, complex comorbidities, risk of adverse events and pharmacological interactions as well as the implications of cognitive impairment on suitability for treatment and consent. An important first step has been taken towards the development of a strategic, focused and collaborative approach to the management of cancer in older people through a national interdisciplinary workshop convened by the Clinical Oncological Society of Australia in April 2008. Engagement and commitment of both oncology and geriatric disciplines is now critical to ensure that momentum is not lost in progressing this important and growing area of healthcare.
Collapse
Affiliation(s)
- C B Steer
- Border Medical Oncology, Wodonga, Australia
| | | | | | | | | | | |
Collapse
|
125
|
Abstract
Thanks to the global improvement of health care and living conditions, the world population is aging. Already, in developed countries half of the cancers occur in patients aged 70 and older. In booming Asian nations, such as South Korea, the aging trend is particularly striking, and therefore geriatric oncology is rapidly coming at the foreground of oncology practice. As older patients have a very variable health status, the need for proper integration of an oncologic and a geriatric approach has become increasingly clear. The last two decades have seen the development of geriatric oncology programs and research, which we review here. An increasing amount of data is making clear that a geriatric assessment identifies many problems in older people with cancer, adds prognostic information, and might improve the outcomes of these patients. The near future will likely deliver the following: Operationalization of geriatric assessment into assessment and decision tools, as well as multidisciplinary interventions, in oncology; cooperation of aging and cancer research in the understanding of cancer biology, aging physiology, pharmacology of anticancer drugs; improved clinical study designs; development of geriatric oncology programs, and screening tools accessible to the private practitioner.
Collapse
Affiliation(s)
- Martine Extermann
- Senior Adult Oncology, Moffitt Cancer Center, University of South Florida, Tampa, USA.
| |
Collapse
|
126
|
Gemmill R, Williams AC, Cooke L, Grant M. Challenges and strategies for recruitment and retention of vulnerable research participants: promoting the benefits of participation. Appl Nurs Res 2010; 25:101-7. [PMID: 20974092 DOI: 10.1016/j.apnr.2010.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/18/2010] [Accepted: 02/03/2010] [Indexed: 11/17/2022]
Abstract
The purpose of this article was to describe recruitment and retention of vulnerable hematopoietic cell transplant patients participating in a longitudinal intervention study. Utilizing Swanson's theory of caring model, nurse researchers facilitated patients' visualization of how study participation could enable them to share their experience and further clinical insights.
Collapse
Affiliation(s)
- Robin Gemmill
- City of Hope, Division of Nursing Research and Education, Department of Population Sciences, Duarte, CA 91010, USA.
| | | | | | | |
Collapse
|
127
|
Pallis AG, Fortpied C, Wedding U, Van Nes MC, Penninckx B, Ring A, Lacombe D, Monfardini S, Scalliet P, Wildiers H. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 2010; 46:1502-13. [PMID: 20227872 DOI: 10.1016/j.ejca.2010.02.022] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 02/16/2010] [Indexed: 12/15/2022]
Abstract
As a result of an increasing life expectancy, the incidence of cancer cases diagnosed in the older population is rising. Indeed, cancer incidence is 11-fold higher in persons over the age of 65 than in younger ones. Despite this high incidence of cancer in older patients, solid data regarding the most appropriate approach and best treatment for older cancer patients are still lacking, mostly due to under-representation of these patients in prospective clinical trials. The clinical behaviour of common malignant diseases, e.g. breast, ovarian and lung cancers, lymphomas and acute leukaemias, may be different in older patients because of intrinsic variation of the neoplastic cells and the ability of the tumour host to support neoplastic growth. The decision to treat or not these patients should be based on patients' functional age rather than the chronological age. Assessment of patients' functional age includes the evaluation of health, functional status, nutrition, cognition and the psychosocial and economic context. The purpose of this paper is to focus on the influence of age on cancer presentation and cancer management in older cancer patients and to provide suggestions on clinical trial development and methodology in this population.
Collapse
Affiliation(s)
- A G Pallis
- European Organization for Research and Treatment of Cancer, Elderly Task Force, EORTC Headquarters, Avenue E. Mounierlaan, 83/11, B-1200 Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
128
|
Abstract
The heterogeneity of the elderly population makes the simple application of standard therapeutic programs in oncological management complex, particularly if they have been validated on young populations. The NCCN and the SIOG recommend using a geriatric evaluation before setting up an individualized care program. Geriatric assessment has demonstrated its efficacy in a number of domains. This concept covers two broad activities: the Multidimensional Geriatric Evaluation (MGE), which is a standardized geriatric evaluation for detecting co-morbidities and broad geriatric syndromes, and the Detailed Geriatric Evaluation (DGE). The objective of the DGE is to inventory the patient's various problems, distinguish somatic and/or psychiatric pathologies from the physiological consequences of aging, assess the functional impact of diseases, understand how these diseases interfere with one another, assess their consequences on the patient's social environment, and prioritize the patient's different health issues. The DGE is a medical action organized into five phases designed to set up care so that the recommendations made can be followed.
Collapse
Affiliation(s)
- G Albrand
- Groupement de la Gériatrie des Hospices Civils de Lyon, UPCOG de Lyon: Programme Lyonnais d'Oncogériatrie (PROLOG), Hôpital gériatrique Antoine Charial, 40, Avenue de la Table de Pierre, 69340 Francheville, France.
| |
Collapse
|
129
|
Fu Y, Bryan HS, Yang I, Lai K. Signal quality classification for an ambulatory monitoring system. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:174-177. [PMID: 21096745 DOI: 10.1109/iembs.2010.5627482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A signal quality classification algorithm is presented to evaluate signal quality in ambulatory monitoring system. Acoustic based signal is classified as good signal, weak signal or noisy signal. Certain features in the acquired signal are extracted and analyzed to differentiate the class of signal quality. With this classification, wrong physiological estimation due to poor signal quality can be eliminated to avoid wrong conclusions and instructions in the ambulatory system.
Collapse
|
130
|
Droz JP, Balducci L, Bolla M, Emberton M, Fitzpatrick JM, Joniau S, Kattan MW, Monfardini S, Moul JW, Naeim A, van Poppel H, Saad F, Sternberg CN. Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults. Crit Rev Oncol Hematol 2010; 73:68-91. [PMID: 19836968 DOI: 10.1016/j.critrevonc.2009.09.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jean-Pierre Droz
- Department of Medical Oncology, Centre Léon-Bérard, 69008 Lyon, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
131
|
Molassiotis A, Brearley S, Saunders M, Craven O, Wardley A, Farrell C, Swindell R, Todd C, Luker K. Effectiveness of a Home Care Nursing Program in the Symptom Management of Patients With Colorectal and Breast Cancer Receiving Oral Chemotherapy: A Randomized, Controlled Trial. J Clin Oncol 2009; 27:6191-8. [DOI: 10.1200/jco.2008.20.6755] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the effectiveness of a symptom-focused home care program in patients with cancer who were receiving oral chemotherapy in relation to toxicity levels, anxiety, depression, quality of life, and service utilization. Patients and Methods A randomized, controlled trial was carried out with 164 patients with a diagnosis of colorectal (n = 110) and breast (n = 54) cancers who were receiving oral capecitabine. Patients were randomly assigned to receive either a home care program by a nurse or standard care for 18 weeks (ie, six cycles of chemotherapy). Toxicity assessments were carried out weekly for the duration of the patients' participation in the trial, and validated self-report tools assessed anxiety, depression, and quality of life. Results Significant improvements were observed in the home care group in relation to the symptoms of oral mucositis, diarrhea, constipation, nausea, pain, fatigue (first four cycles), and insomnia (all P < .05). This improvement was most significant during the initial two cycles. Unplanned service utilization, particularly the number of inpatient days (57 v 167 days; P = .02), also was lower in the home care group. Conclusion A symptom-focused home care program was able to assist patients to manage their treatment adverse effects more effectively than standard care. It is imperative that patients receiving oral chemotherapy are supported with such programs, particularly during initial treatment cycles, to improve their treatment and symptom experiences.
Collapse
Affiliation(s)
- Alex Molassiotis
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Sarah Brearley
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Mark Saunders
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Olive Craven
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Andrew Wardley
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Carole Farrell
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Ric Swindell
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Chris Todd
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| | - Karen Luker
- From the School of Nursing, Midwifery, and Social Work, University of Manchester; and Departments of Clinical Oncology, Medical Oncology, and Nursing Administration; and Clinical Trials Unit, Christie Hospital National Health Service Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
132
|
Clough-Gorr KM, Stuck AE, Thwin SS, Silliman RA. Older breast cancer survivors: geriatric assessment domains are associated with poor tolerance of treatment adverse effects and predict mortality over 7 years of follow-up. J Clin Oncol 2009; 28:380-6. [PMID: 20008637 DOI: 10.1200/jco.2009.23.5440] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate geriatric assessment (GA) domains in relation to clinically important outcomes in older breast cancer survivors. METHODS Six hundred sixty women diagnosed with primary breast cancer in four US geographic regions (Los Angeles, CA; Minnesota; North Carolina; and Rhode Island) were selected with disease stage I to IIIA, age >or= 65 years at date of diagnosis, and permission from attending physician to contact. Data were collected over 7 years of follow-up from consenting patients' medical records, telephone interviews, physician questionnaires, and the National Death Index. Outcomes included self-reported treatment tolerance and all-cause mortality. Four GA domains were described by six individual measures, as follows: sociodemographic by adequate finances; clinical by Charlson comorbidity index (CCI) and body mass index; function by number of physical function limitations; and psychosocial by the five-item Mental Health Index (MHI5) and Medical Outcomes Study Social Support Survey (MOS-SSS). Associations were evaluated using t tests, chi(2) tests, and regression analyses. RESULTS In multivariable regression including age and stage, three measures from two domains (clinical and psychosocial) were associated with poor treatment tolerance; these were CCI >or= 1 (odds ratio [OR] = 2.49; 95% CI, 1.18 to 5.25), MHI5 score less than 80 (OR = 2.36; 95% CI, 1.15 to 4.86), and MOS-SSS score less than 80 (OR = 3.32; 95% CI, 1.44 to 7.66). Four measures representing all four GA domains predicted mortality; these were inadequate finances (hazard ratio [HR] = 1.89; 95% CI, 1.24 to 2.88; CCI >or= 1 (HR = 1.38; 95% CI, 1.01 to 1.88), functional limitation (HR = 1.40; 95% CI, 1.01 to 1.93), and MHI5 score less than 80 (HR = 1.34; 95% CI, 1.01 to 1.85). In addition, the proportion of women with these outcomes incrementally increased as the number of GA deficits increased. CONCLUSION This study provides longitudinal evidence that GA domains are associated with poor treatment tolerance and predict mortality at 7 years of follow-up, independent of age and stage of disease.
Collapse
Affiliation(s)
- Kerri M Clough-Gorr
- Section of Geriatrics, Boston University School of Medicine, Boston, MA, USA.
| | | | | | | |
Collapse
|
133
|
Ross L, Frederiksen K, Boesen SH, Karlsen RV, Rasmussen MS, Sørensen LT, Jørgensen T, Claesson MH, Johansen C. No effect on survival of home psychosocial intervention in a randomized study of Danish colorectal cancer patients. Psychooncology 2009; 18:875-85. [PMID: 19137506 DOI: 10.1002/pon.1524] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We investigated whether regular home visits to persons with newly diagnosed colorectal cancer influenced their overall survival and selected immune parameters. METHODS A total of 249 Danish colorectal cancer patients undergoing abdominal surgery were randomly assigned to a control or an intervention group. The intervention group received 10 home visits from a project nurse or a medical doctor during the first 2 years after discharge. The home visits aimed at providing emotional support and information. A subgroup of 55 patients provided blood samples 3, 12 and 24 months after discharge for measurement of immune parameters. Survival was assessed 6.5-9.5 years after the first operation. RESULTS A total of 148 patients died during follow-up. The intervention was not significantly associated with survival (p=0.68) after adjustment for Dukes' stage, radicality of the operation, age, sex, family social class and marital status. Likewise, no significant interactions were found between group and these covariates (all p > or = 0.08). In the substudy of the possible effect of the intervention on immune parameters, there were no differences between the two groups with respect to lymphocyte proliferation (all p > or = 0.078) or natural killer cell activity (all p > or = 0.33) and no consistent effect on the number of specific subsets of cells (phenotypes) during follow-up. CONCLUSION The study failed to provide evidence that the psychosocial intervention provided as home visits significantly affected the prognosis or selected immune parameters of patients who had undergone surgery for colorectal cancer.
Collapse
Affiliation(s)
- Lone Ross
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
134
|
Brunello A, Sandri R, Extermann M. Multidimensional geriatric evaluation for older cancer patients as a clinical and research tool. Cancer Treat Rev 2009; 35:487-92. [DOI: 10.1016/j.ctrv.2009.04.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
135
|
Boyle H, Girre V, Mertens C, Falandry C, Gouttenoire F, Freyer G, Brain EGC. Recherche clinique en oncogériatrie. ONCOLOGIE 2009. [DOI: 10.1007/s10269-009-1078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
136
|
Caress AL, Chalmers K, Luker K. A narrative review of interventions to support family carers who provide physical care to family members with cancer. Int J Nurs Stud 2009; 46:1516-27. [PMID: 19403134 DOI: 10.1016/j.ijnurstu.2009.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 03/11/2009] [Accepted: 03/13/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Most reports of cancer caregivers' needs focus on information and psychosocial needs. Less is known about practical knowledge and support carers need to provide physical care in the home. This review aimed to identity and critique studies of the development and/or evaluation of interventions to enable family carers to provide physical/practical care to a family member with cancer. DESIGN Narrative review. DATA SOURCES Studies which included adult carers who provided care to a family member with cancer (any stage). Search sources included Psych Info., Cochrane Central Register of Controlled Trials, Embase Ovid, Embase, Ovid Medline, CINAHL, other databases, systematic and other reviews. REVIEW METHODS All types of study designs were included. Initially, multiple and broadly defined search strategies and terms were used to capture the range of potential studies; later more refined procedures were applied. RESULTS In total, 19 studies were included in the review. Interventions focused on skills development (n=1), managing symptoms (n=9), problem solving (n=5) and learning (n=4). Few studies were identified with well-defined and evaluated interventions to assist carers to provide physical care for their family member with cancer. CONCLUSIONS Future research is needed to develop well-defined interventions on practical skills and evaluate the outcomes for patients and caregivers.
Collapse
Affiliation(s)
- Ann-Louise Caress
- School of Nursing, Midwifery and Social Work, The University of Manchester, Jean McFarlane Building, Manchester, M13 9PL, UK.
| | | | | |
Collapse
|
137
|
|
138
|
Ouwens M, Hulscher M, Hermens R, Faber M, Marres H, Wollersheim H, Grol R. Implementation of integrated care for patients with cancer: a systematic review of interventions and effects. Int J Qual Health Care 2009; 21:137-44. [PMID: 19147593 DOI: 10.1093/intqhc/mzn061] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To review integrated care interventions and their effects on the quality of care for patients with cancer. DATA SOURCES Search in Medline and Cochrane Library databases from January 1996 to October 2006. STUDY SELECTION Randomized controlled trials and controlled before-after studies in which the intervention focused on at least one of the three principles of integrated care: patient-centredness, organization of care and multidisciplinary care. DATA EXTRACTION AND RESULTS: Of the 1397 references, 33 studies were included and analysed. No study focused on all three principles of integrated care: 16 studies focused on patient-centredness (48%), 14 on the organization of care (42%), 1 on multidisciplinary care and 2 on both patient-centredness and organization of care. There was a large variation in interventions reported and in outcomes used for evaluation. Effective interventions to improve patient-centredness are the 'provision of an audiotape of the consultation to the patient', 'provision of information to patients' and 'use of a decision aid'. Effective interventions to improve the organization of care can be 'follow-up' and 'case management', especially by nurses and 'one-stop clinics'. CONCLUSION To improve integrated care for patients with cancer, a multicomponent intervention programme is required focusing on patients, professionals and the organization of care. The promising interventions found in this review should be part of this programme. This programme should be evaluated using rigorous methods and unequivocal outcome measures linked to the intervention.
Collapse
Affiliation(s)
- Marielle Ouwens
- Department of IQ Healthcare (114 IQ), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
139
|
Abstract
PURPOSE Few studies have examined interventions that help adolescents who run away. This study both describes a home-visiting intervention program for young, sexually assaulted runaways (10-14 years old) and provides preliminary outcomes from the first 20 female participants. DESIGN AND METHODS Using a strengths-based approach, advanced practice nurses provided frequent home and school visits and case management, and assisted girls to access an empowerment group over a 1-year period. RESULTS Teens' risk behaviors decreased, including truancy, runaway episodes, sexually transmitted infections, and substance use. CONCLUSIONS Preliminary results suggest that this is an effective intervention for reducing risk behaviors and helping younger runaways reconnect to school and family. PRACTICE IMPLICATIONS Client-centered interventions in community settings can address the complex health needs of vulnerable young runaways.
Collapse
Affiliation(s)
- Laurel D Edinburgh
- Midwest Children's Resource Center, Children's Hospitals and Clinics of Minnesota, St. Paul, MN, USA
| | | |
Collapse
|
140
|
Sinding C, Wiernikowski J. Treatment decision making and its discontents. SOCIAL WORK IN HEALTH CARE 2009; 48:614-634. [PMID: 19860295 DOI: 10.1080/00981380902831303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Patient participation in treatment decision making is held as a virtue in clinical contexts, and has much to recommend it. Yet important questions have been raised about the assumptions underlying models of patient participation. Debates have arisen about the significance of medically defined risks and outcomes of treatment; the adequacy and relevance across social groups of the concept of autonomy; and the emphasis on the professional-patient dyad. This article contributes to the debate about treatment decision making with reference to a study focused on older women with cancer. Interviews with patients and cancer care professionals highlighted the salience to patients' treatment choices of experiential knowledge, social roles and responsibilities, and the health policy context. It appears that prevailing models of decision making may obscure patients' more typical decision processes as well as the social determinants of those choices.
Collapse
Affiliation(s)
- Chris Sinding
- Department of Health, Aging, and Society, and School of Social Work, McMaster University, Hamilton, Ontario, Canada.
| | | |
Collapse
|
141
|
Wulff CN, Thygesen M, Søndergaard J, Vedsted P. Case management used to optimize cancer care pathways: a systematic review. BMC Health Serv Res 2008; 8:227. [PMID: 18986554 PMCID: PMC2596122 DOI: 10.1186/1472-6963-8-227] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 11/06/2008] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Reports of inadequate cancer patient care have given rise to various interventions to support cancer care pathways which, overall, seem poorly studied. Case management (CM) is one method that may support a cost-effective, high-quality patient-centred treatment and care.The purpose of this article was to summarise intervention characteristics, outcomes of interest, results, and validity components of the published randomized controlled trials (RCTs) examining CM as a method for optimizing cancer care pathways. METHODS PubMed, Embase, Web of Science, CINAHL and The Cochrane Central Register of Controlled Trials were systematically searched for RCTs published all years up to August 2008. Identified papers were included if they passed the following standards. INCLUSION CRITERIA 1) The intervention should meet the criteria for CM which includes multidisciplinary collaboration, care co-ordination, and it should include in-person meetings between patient and the case manager aimed at supporting, informing and educating the patient. 2) The intervention should focus on cancer patient care. 3) The intervention should aim to improve subjective or objective quality outcomes, and effects should be reported in the paper. EXCLUSION CRITERIA Studies centred on cancer screening or palliative cancer care.Data extraction was conducted in order to obtain a descriptive overview of intervention characteristics, outcomes of interest and findings. Elements of CONSORT guidelines and checklists were used to assess aspects of study validity. RESULTS The searches identified 654 unique papers, of which 25 were retrieved for scrutiny. Seven papers were finally included. Intervention characteristics, outcomes studied, findings and methodological aspects were all very diverse. CONCLUSION Due to the scarcity of papers included (seven), significant heterogeneity in target group, intervention setting, outcomes measured and methodologies applied, no conclusions can be drawn about the effect of CM on cancer patient care.It is a major challenge that CM shrouds in a "black box", which means that it is difficult to determine which aspect(s) of interventions contribute to overall effects. More trials on rigorously developed CM interventions (opening up the "black box") are needed as is the re-testing of interventions and outcomes studied in various settings.
Collapse
Affiliation(s)
- Christian N Wulff
- The Research Unit for General Practice in Aarhus, University of Aarhus, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark
- Surgical Department P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Marianne Thygesen
- Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark, JB Winsløws Vej 12, 2 floor, 5000 Odense C, Denmark
| | - Jens Søndergaard
- The Research Unit for General Practice, Institute for Public Health, University of Southern Denmark, JB Winsløws Vej 9, 5000 Odense C, Denmark
| | - Peter Vedsted
- The Research Unit for General Practice in Aarhus, University of Aarhus, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark
| |
Collapse
|
142
|
Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention. CLIN NURSE SPEC 2008; 22:218-25. [PMID: 18753879 DOI: 10.1097/01.nur.0000325366.15927.2d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process.
Collapse
|
143
|
Droz JP, Aapro M, Balducci L. Overcoming challenges associated with chemotherapy treatment in the senior adult population. Crit Rev Oncol Hematol 2008; 68 Suppl 1:S1-8. [DOI: 10.1016/j.critrevonc.2008.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
144
|
Schulman-Green D, Ercolano E, Dowd M, Schwartz P, McCorkle R. Quality of life among women after surgery for ovarian cancer. Palliat Support Care 2008; 6:239-47. [PMID: 18662417 PMCID: PMC3648854 DOI: 10.1017/s1478951508000497] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Difficulties with diagnosis and aggressive, long-term treatment may result in lower quality of life (QOL), including high levels of anxiety, depression, and uncertainty, greater symptom distress, and lower overall QOL among women with ovarian cancer. The purpose of this study was to describe demographic, clinical, and other risk factors associated with compromised QOL among women who have undergone surgery for ovarian malignancies. METHODS Subjects were recruited to participate in a clinical trial that tested a specialized nursing intervention addressing psychological and physical care among women post-surgical for ovarian cancer. QOL was measured using five standardized self-report measures: the State-Trait Anxiety Scale (SAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Mishel Uncertainty in Illness Scale (MUIS), the Symptom Distress Scale (SDS), and the Short-Form Health Survey (SF-12). Baseline data were collected while women were hospitalized following surgery. RESULTS The sample (n=145) included women with ovarian cancer (58%) and other cancers metastasized to the ovaries and abdomen (42%). Mean scores on the measures were consistent with or higher than previously reported means for similar populations. Women reporting the lowest QOL were more likely to be younger, more educated, and have early stage disease. SIGNIFICANCE OF RESULTS Women who have undergone surgery for ovarian malignancies have psychological needs that are often considered secondary to physical needs. Interventions should include routine screening for distress and referral to appropriate psychological and social services, thereby facilitating quality cancer care.
Collapse
|
145
|
Abstract
PURPOSE OF REVIEW The effect of psychotherapy on the survival of cancer patients has been debated for the past 20 years, mainly due to contradictory findings in the studies published so far. Several reviews have been published, almost all of which criticize the methods used in the studies. In 2007, three replication studies were published, which indicate that the hypothesis that psychotherapy prolongs life should be abandoned. The purpose of the present review of randomized studies of psychosocial intervention is to determine the strength of the evidence for enhanced survival after participation in psychosocial interventions. RECENT FINDINGS Three recently published replication studies, which addressed a number of the methodological flaws of earlier studies, did not report better survival among the patients receiving the intervention than among those in the control group. SUMMARY The hypothesis that psychotherapy enhances survival should be abandoned in the light of the latest replication studies, which show null results for improved survival after psychotherapy. The evidence to date points to a need for investigating the interactions between the medical, psychological, social and health behaviour components of intervention programmes, as recently published studies indicate reduced mortality among patients who engage in physical activity and change to a healthier diet.
Collapse
|
146
|
Kim Y, Given BA. Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer 2008; 112:2556-68. [PMID: 18428199 DOI: 10.1002/cncr.23449] [Citation(s) in RCA: 303] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase. METHODS By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures. RESULTS The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment. CONCLUSIONS Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed.
Collapse
Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, Atlanta, Georgia 30303-1002, USA.
| | | |
Collapse
|
147
|
Bowles KH, McCorkle R, Nuamah IF. Homecare referrals and 12-week outcomes following surgery for cancer. Oncol Nurs Forum 2008; 35:377-83. [PMID: 18467288 DOI: 10.1188/08.onf.377-383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine characteristics of patients undergoing cancer surgery who do and do not receive homecare referral after hospitalization, relative to poor discharge outcomes. DESIGN Secondary analysis of a randomized clinical trial. SETTING Urban, academic cancer center in the northeastern United States. SAMPLE 375 patients 60 years and older and admitted for solid tumor cancer surgery. METHODS Stepwise, multiple logistic regression using patient characteristics related to homecare referrals or those related to poor discharge outcomes. MAIN RESEARCH VARIABLES Homecare referral and poor discharge outcome. FINDINGS Patients 70 years or older, single, hospitalized for a week or more for a late-stage cancer, with greater than four comorbid conditions, and discharged with more than four daily activity impairments, depressive symptoms, and a need for skilled nursing care were more likely to require home care. Patients not referred to home care who received adjuvant cancer therapies were about three times more likely to have poor discharge outcomes. CONCLUSIONS Patients who were referred for home care had characteristics similar to medical or surgical patients documented in the literature. However, younger patients with lengthy hospital stays and recipients of adjuvant cancer therapy did poorly after discharge and may benefit from home care. IMPLICATIONS FOR NURSING Certain characteristics, such as age, single marital status, depression, and cognition, should trigger further assessment of patients' needs after discharge, including anticipating needs of patients who will receive adjuvant therapies.
Collapse
Affiliation(s)
- Kathryn H Bowles
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, USA.
| | | | | |
Collapse
|
148
|
A mixed-method evaluation of nurse-led community-based supportive cancer care. Support Care Cancer 2008; 16:1343-52. [PMID: 18335260 DOI: 10.1007/s00520-008-0416-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 01/30/2008] [Indexed: 10/22/2022]
Abstract
GOALS OF WORK The study purpose was to evaluate a nurse-led supportive care clinical case management program in the community using multi-methods to delineate care processes prior to outcome evaluation. MATERIALS AND METHODS Multiple data sources including program service records, chart reviews and interviews with nurses and key interdisciplinary informants were used to identify population served (coverage and reach), processes of care (implementation), and providers' perceptions of the effectiveness of the nurse-led program (reaction). MAIN RESULTS The program provided care to over 700 cancer patients in a 1-year period. Nurse-led support interventions were focused on direct care inclusive of teaching/coaching for symptom management, counseling and support, and mobilization of services through system navigation based on an initial comprehensive assessment of supportive care needs. CONCLUSIONS Nurse-led models of supportive care have the potential to reduce unmet supportive care needs, improve continuity of care, and overall health-related quality of life that should be tested in future trials.
Collapse
|
149
|
Boesen EH, Boesen SH, Frederiksen K, Ross L, Dahlstrøm K, Schmidt G, Næsted J, Krag C, Johansen C. Survival After a Psychoeducational Intervention for Patients With Cutaneous Malignant Melanoma: A Replication Study. J Clin Oncol 2007; 25:5698-703. [DOI: 10.1200/jco.2007.10.8894] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The results of a randomized, intervention study done in 1993 of psychoeducation for patients with early-stage malignant melanoma showed a beneficial effect on recurrence and survival 6 years after the intervention. In the present study, we replicated the study with 258 Danish patients with malignant melanoma. We also compared recurrence and survival among the participants in the randomized study with 137 patients who refused to participate. Patients and Methods We randomly assigned 262 patients with primary malignant melanoma to a control or an intervention group. Patients in the intervention group were offered six weekly 2-hour sessions of psychoeducation. Participants and nonparticipants were followed up for vital status and recurrence 4 to 6 years after surgical treatment. Prognostic factors (thickness of the tumor and lymph node status), sex, and age were adjusted for in a Cox regression model (proportional hazards regression) to derive an adjusted survival rate ratio and an adjusted relapse-free survival rate ratio, with 95% CIs. Results The hazard ratio was 1.30 (95% CI, 0.5 to 3.5) for survival and 0.73 (95% CI, 0.3 to 1.9) for recurrence. Being a nonparticipant increased the risk for death by more than two-fold (hazard ratio, 2.26; 95% CI, 1.0 to 5.2) over that of participants. Conclusion Psychoeducation did not increase survival or the recurrence-free interval among patients with malignant melanoma; however, nonparticipants had a statistically significantly greater risk for death than participants.
Collapse
Affiliation(s)
- Ellen H. Boesen
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Sidsel H. Boesen
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Kirsten Frederiksen
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Lone Ross
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Karin Dahlstrøm
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Grethe Schmidt
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Jesper Næsted
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Christen Krag
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Christoffer Johansen
- From the Institute of Cancer Epidemiology, Danish Cancer Society; Department of Plastic Surgery, Herlev Hospital, University of Copenhagen, Herlev Ringvej, Copenhagen County; Department of Plastic Surgery and Burn Unit, Rigshospitalet, University of Copenhagen, Copenhagen; and the Department of Plastic and Recunstructive Surgery, Roskilde University Hospital, Roskilde, Denmark
| |
Collapse
|
150
|
Coyne JC, Palmer SC. Does Psychotherapy Extend Survival? Some Methodological Problems Overlooked. J Clin Oncol 2007; 25:4852-3; author reply 4853-4. [DOI: 10.1200/jco.2007.13.3967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- James C. Coyne
- University of Pennsylvania School of Medicine, Philadeliphia, PA
| | - Steven C. Palmer
- University of Pennsylvania School of Medicine, Philadeliphia, PA
| |
Collapse
|