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Mitchell RJ, Delaney GP, Arnolda G, Liauw W, Lystad RP, Braithwaite J. Three-year hospital service use trajectories of people diagnosed with cancer: A retrospective cohort study. Cancer Epidemiol 2024; 93:102676. [PMID: 39303658 DOI: 10.1016/j.canep.2024.102676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/27/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Information regarding hospital service use by people newly diagnosed with cancer can inform patterns of healthcare utilisation and resource demands. This study aims to identify characteristics of group-based trajectories of hospital service use three years after an individual was diagnosed with cancer; and determine factors predictive of trajectory group membership. METHOD A group-based trajectory analysis of hospital service use of people aged ≥30 years who had a new diagnosis of cancer during 2018 in New South Wales, Australia was conducted. Linked cancer registry, hospital and mortality data were examined for a three-year period after diagnosis. Group-based trajectory models were derived based on number of hospital admissions. Multinominal logistic regression examined predictors of trajectory group membership. RESULTS Of the 44,577 new cancer diagnosis patients, 29,085 (65.2 %) were hospitalised at least once since their cancer diagnosis. Four distinct trajectory groups of hospital users were identified: Low (68.4 %), Very-Low (25.1 %), Moderate-Chronic (2.2 %), and Early-High (4.2 %). Key predictors of trajectory group membership were age group, cancer type, degree of cancer spread, prior history of cancer, receiving chemotherapy, and presence of comorbidities, including renal disease, moderate/serious liver disease, or anxiety. CONCLUSIONS Comorbidities should be considered in cancer treatment and management decision making. Caring for people diagnosed with cancer with multimorbidity requires multidisciplinary shared care.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Geoffrey P Delaney
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), University of New South Wales, Sydney, Australia; Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, South-Western Sydney Clinical School, University of New South Wales, Sydney, Australia; University of New South Wales School of Clinical Medicine, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Winston Liauw
- University of New South Wales School of Clinical Medicine, Sydney, Australia; Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Mitchell RJ, Delaney GP, Arnolda G, Liauw W, Lystad RP, Braithwaite J. Survival of patients who had cancer diagnosed through an emergency hospital admission: A retrospective matched case-comparison study in Australia. Cancer Epidemiol 2024; 91:102584. [PMID: 38772062 DOI: 10.1016/j.canep.2024.102584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/30/2024] [Accepted: 05/12/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Individuals diagnosed with cancer via emergency admission are likely to have poor outcomes. This study aims to identify cancer diagnosed through an emergency hospital admission and examine predictors associated with mortality within 12-months. METHOD A population-based retrospective 1:1 propensity-matched case-comparison study of people who had an emergency versus a planned hospital admission with a principal diagnosis of cancer during 2013-2020 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Conditional logistic regression examined predictors of mortality at 12-months. RESULTS There were 28,502 matched case-comparisons. Individuals who had an emergency admission were four times more likely to die within 12-months (Odds Ratio (OR) 3.93; 95 % confidence interval (CI) 3.75-4.13) compared to individuals who had a planned admission for cancer. Older individuals, diagnosed with lung (OR 1.89; 95 %CI 1.36-2.63) or digestive organ, excluding colorectal (OR1.78; 95 %CI 1.30-2.43) cancers, where the degree of spread was metastatic (OR 3.61; 95 %CI 2.62-4.50), who had a mental disorder diagnosis (OR 2.08; 95 %CI 1.89-2.30), lived in rural (OR 1.27; 95 %CI 1.17-1.37) or more disadvantaged neighbourhoods had a higher likelihood of death within 12-months following an unplanned admission compared to referent groups. Females (OR 0.87; 95 %CI 0.81-0.93) had an 13 % lower likelihood of mortality within 12-months compared to males. CONCLUSIONS While some emergency cancer admissions are not avoidable, the importance of preventive screening and promotion of help-seeking for early cancer symptoms should not be overlooked as mechanisms to reduce emergency admissions related to cancer and to improve cancer survival.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Geoffrey P Delaney
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), UNSW, Sydney, Australia; Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Collaboration for Cancer Outcomes Research and Evaluation, South-Western Sydney Clinical School, UNSW, Sydney, Australia; University of New South Wales School of Clinical Medicine, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Winston Liauw
- University of New South Wales School of Clinical Medicine, Sydney, Australia; Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Knoerl R, Mazzola E, Woods H, Buchbinder E, Frazier L, LaCasce A, Luskin MR, Phillips CS, Thornton K, Berry DL, Ligibel J. Exploring Influencing Factors of Anxiety Improvement Following Mindfulness-Based Music Therapy in Young Adults with Cancer. J Music Ther 2023:7036622. [PMID: 36787235 DOI: 10.1093/jmt/thac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The purpose of this secondary analysis was to explore physiological, psychological, and situational influencing factors that may affect the impact of a mindfulness-music therapy intervention on anxiety severity in young adults receiving cancer treatment. Young adults receiving cancer treatment for ≥ eight weeks were recruited from adult and pediatric oncology outpatient centers at Dana-Farber Cancer Institute. Participants were asked to attend up to four, in-person (offered virtually via Zoom video conference after the onset of the COVID-19 pandemic) 45-min mindfulness-based music therapy sessions over twelve weeks with a board-certified music therapist. Participants completed questionnaires about anxiety, stress, and other cancer treatment-related outcomes before and after participating in the intervention. Changes in anxiety (i.e., PROMIS Anxiety 4a) over time were compared among baseline physiological (e.g., age or sex), psychological (e.g., stress), and situational influencing (i.e., intervention delivery format) factors using Wilcoxon-rank sum tests. Thirty-one of the 37 enrolled participants completed the baseline and post-intervention measures and were eligible for inclusion in the secondary analysis. Results revealed that higher baseline physical functioning (median change = -6.65), anxiety (median change=-5.65), fatigue (median change = -5.6), sleep disturbance (median change = -5.6), female sex (median change = -5.15), or virtual intervention delivery (median change = -4.65) were potential physiological, psychological, or situational influencing factors associated with anxiety improvement following mindfulness-based music therapy. Additional investigation into physiological, psychological, or situational influencing factors associated with anxiety response will help to tailor the design of future mindfulness-music therapy interventions to decrease psychological distress and address the unique psychosocial concerns among young adults receiving cancer treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT03709225.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Heather Woods
- The Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Lindsay Frazier
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Marlise R Luskin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Carolyn S Phillips
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Katherine Thornton
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Jennifer Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Muzyka M, Tagliafico L, Serafini G, Baiardini I, Braido F, Nencioni A, Monacelli F. Neuropsychiatric Disorders and Frailty in Older Adults over the Spectrum of Cancer: A Narrative Review. Cancers (Basel) 2022; 14:258. [PMID: 35008421 PMCID: PMC8796027 DOI: 10.3390/cancers14010258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The interplay between different neuropsychiatric conditions, beyond dementia, in the presence of a diagnosis of cancer in older adults may mediate patients' fitness and cancer-related outcomes. Here, we aimed to investigate the presence of depression, sleep disturbances, anxiety, attitude, motivation, and support in older adults receiving a diagnosis of cancer and the dimension of frailty in order to understand the magnitude of the problem. METHODS This review provides an update of the state of the art based on references from searches of PubMed between 2000 and June 2021. RESULTS The evidence obtained underscored the tight association between frailty and unfavorable clinical outcomes in older adults with cancer. Given the intrinsic correlation of neuropsychiatric disorders with frailty in the realm of cancer survivorship, the evidence showed they might have a correlation with unfavorable clinical outcomes, late-life geriatric syndromes and higher degree of frailty. CONCLUSIONS The identification of common vulnerabilities among neuropsychiatric disorders, frailty, and cancer may hold promise to unmask similar shared pathways, potentially intercepting targeted new interventions over the spectrum of cancer with the delivery of better pathways of care for older adults with cancer.
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Affiliation(s)
- Mariya Muzyka
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Luca Tagliafico
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Gianluca Serafini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Ilaria Baiardini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
| | - Fulvio Braido
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
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Williams JTW, Pearce A, Smith A'B. A systematic review of fear of cancer recurrence related healthcare use and intervention cost-effectiveness. Psychooncology 2021; 30:1185-1195. [PMID: 33880822 DOI: 10.1002/pon.5673] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/02/2021] [Accepted: 03/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is a common and burdensome psychological condition affecting cancer survivors. This systematic review aims to synthesise current evidence regarding: (1) FCR-related healthcare usage and costs and (2) the cost-effectiveness of FCR treatments. METHODS We searched MEDLINE, CINAHL, Cochrane and other electronic databases using MeSH headings and keywords for cancer, FCR and costs from their inception to September 2019. Identified studies were screened for eligibility. Original, peer-reviewed journal articles reporting quantitative data from samples of adults treated for cancer written in English were included. Quality was appraised using the Drummond checklist for economic evaluations or the relevant Joanna Briggs Institute Critical Appraisal Tool. RESULTS Data from 11 studies were extracted and synthesised. Seven studies addressed the costs of FCR and suggested an increase in the use of primary and secondary healthcare. Four studies addressed the cost-effectiveness of different FCR treatments and suggest that some treatments may cost-effectively reduce FCR and improve quality of life. Reviewed treatments had an incremental cost-effectiveness ratio between AU$3,233 and AU$152,050 per quality-adjusted life year gained when adjusted to 2019 Australian dollars. All studies were of sufficient quality to be synthesised in this review. CONCLUSIONS FCR appears to be associated with greater use of certain healthcare resources, and FCR may be treated cost-effectively. Thus, appropriate FCR treatments may not only reduce the individual burden, but also the strain on the healthcare system. Further high-quality research is needed to confirm this and ensure the future implementation of efficient and sustainable FCR treatments.
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Affiliation(s)
| | - Alison Pearce
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Allan 'Ben' Smith
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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Guzman D, Ann-Yi S, Bruera E, Wu J, Williams JL, Najera J, Raznahan M, Carmack CL. Enhancing palliative care patient access to psychological counseling through outreach telehealth services. Psychooncology 2019; 29:132-138. [PMID: 31707735 DOI: 10.1002/pon.5270] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/02/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
Abstract
CONTEXT Palliative care encompasses an interdisciplinary team, including mental health care professionals, to address psychological distress of cancer patients. OBJECTIVES To present the implementation of an outreach counseling program via videoconferencing or telephone to patients receiving care in an outpatient palliative care clinic and to compare patients using this service to those who only received psychological counseling in our outpatient clinic. METHODS We conducted a retrospective chart review of cancer patients seen for psychology counseling services in an outpatient supportive care center between June 2015 and March 2017. RESULTS We reviewed 2072 unique patients (52% of the total patients seen at the outpatient Supportive Care Center), who had 4567 total counseling encounters across outreach and outpatient settings. A total of 452 (22%) patients participated in a combination of outpatient and outreach counseling services. Patients who participated in outreach services had significantly more encounters (311 [69%] had two to five sessions) compared with those who had outpatient services only (1137 [70%] had one session only) (P < .001). Outreach patients also had shorter times between the initial and follow-up encounters (median 14 days) compared with those who had outpatient services only (median 30 days) (P < .0001). CONCLUSIONS Outreach telehealth counseling services was found to enhance palliative care patient access to psychological counseling. These services represent an additional modality for providing continuous psychological care.
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Affiliation(s)
- Diana Guzman
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas
| | - Sujin Ann-Yi
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston Texas, United States
| | - Janet L Williams
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas
| | - John Najera
- Department of Behavioral Sciences, Houston, Texas
| | - Monica Raznahan
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas
| | - Cindy L Carmack
- Department of Palliative Care, Rehabilitation and Integrative Medicine, Houston, Texas
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Abstract
PURPOSE OF REVIEW To review recent studies which assess comorbidity, that is, prevalence of co-occurrence, relationships and treatment implications between anxiety disorders and various medical illnesses. RECENT FINDINGS The prevalence rates of anxiety disorders in patients with medical illnesses are high, with percentage up to 29% in patients with epilepsy, 48.9% in patients with multiple sclerosis, 30.1% in patients with Parkinson's disease, 30% in patients with cardiovascular disease, 47.0% in patients with diabetes mellitus, and so on. The most prevalent anxiety disorders among individuals with somatic illnesses are generalized anxiety disorder and panic disorder. In addition, various medical illnesses are highly prevalent in samples of patients with anxiety disorders. Anxiety disorders co-occurring with medical illnesses have a number of clinical implications, including a greater severity and negative impact on treatment outcome of both medical illnesses and anxiety disorders. SUMMARY It is important for clinicians to look for possible anxiety disorders among patients with medical illnesses. Further studies need to ascertain how to best treat individuals suffering from both anxiety disorders and medical illnesses, and focus on the issue of causality when these conditions co-occur.
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Weller D. Cancer recurrence-A complex issue. Eur J Cancer Care (Engl) 2019; 27:e12943. [PMID: 30255660 DOI: 10.1111/ecc.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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