scholarly journals Treatment goals and changes over time in older patients with non-curable cancer

2020 ◽  
Author(s):  
M. E. Stegmann ◽  
D. Brandenbarg ◽  
A. K. L. Reyners ◽  
W. H. van Geffen ◽  
T. J. N. Hiltermann ◽  
...  
Keyword(s):  
Qualitative Analysis ◽  
Life Events ◽  
Older Patients ◽  
Late Phase ◽  
Treatment Goals ◽  
Electronic Patient Records ◽  
Patient Goals ◽  
Changes Over Time ◽  
Over Time

Abstract Purpose To investigate the treatment goals of older patients with non-curable cancer, whether those goals changed over time, and if so, what triggered those changes. Methods We performed a descriptive and qualitative analysis using the Outcome Prioritization Tool (OPT) to assess patient goals across four conversations with general practitioners (GPs) over 6 months. Text entries from electronic patient records (hospital and general practice) were then analyzed qualitatively for this period. Results Of the 29 included patients, 10 (34%) rated extending life and 9 (31%) rated maintaining independence as their most important goals. Patients in the last year before death (late phase) prioritized extending life less often (3 patients; 21%) than those in the early phase (7 patients; 47%). Goals changed for 16 patients during follow-up (12 in the late phase). Qualitative analysis revealed three themes that explained the baseline OPT scores (prioritizing a specific goal, rating a goal as unimportant, and treatment choices related to goals). Another three themes related to changes in OPT scores (symptoms, disease course, and life events) and stability of OPT scores (stable situation, disease-unrelated motivation, and stability despite symptoms). Conclusion Patients most often prioritized extending life as the most important goal. However, priorities differed in the late phase of the disease, leading to changed goals. Triggers for change related to both the disease (e.g., symptoms and course) and to other life events. We therefore recommend that goals should be discussed repeatedly, especially near the end of life. Trial registration OPTion study: NTR5419

Comparability and Short-Term Stability of Techniques to Assess Extension of Thinking about One's Personal Future

1983 ◽  
Vol 56 (2) ◽  
pp. 559-564 ◽  
Author(s):  
William Rakowski ◽  
Clifton E. Barber ◽  
Wayne C. Seelbach
Keyword(s):  
Data Collection ◽  
Life Events ◽  
Short Term ◽  
Life Event ◽  
Term Stability ◽  
The Future ◽  
Changes Over Time ◽  
Over Time

Three techniques for assessing extension of one's personal future (line-marking, open-ended report, life-events) were compared in a sample of 74 respondents. Two points of data collection were employed to examine short-term stability. At both administrations, correlations among indices suggested that techniques were only moderately comparable. Short-term stabilities were variable; correlations ranged from .42 to .79. Across subgroups of the sample, the direct, open-ended report of extension showed the greatest stability, while life-event extension showed the least. Apparently, extension of thinking about the future should be assessed by more than one technique to investigate potential relationships with other variables or changes over time in perspective about the future.

scholarly journals Stress-related inflammation and social withdrawal in mothers after childhood cancer diagnosis

2021 ◽  
Author(s):  
Emily K Lindsay ◽  
Tristen K. Inagaki ◽  
Catherine Walsh ◽  
Berhane Messay ◽  
Linda Ewing ◽  
...  
Keyword(s):  
Social Network ◽  
Social Behavior ◽  
Systemic Inflammation ◽  
Cancer Diagnosis ◽  
Social Roles ◽  
Social Changes ◽  
Related Stress ◽  
Changes Over Time ◽  
Over Time

Objective: Acute inflammation-induced sickness behavior involves changes in social behavior that are believed to promote recovery. Whether chronic inflammation can influence social behaviors in ways that promote recovery is unknown. In a sample of mothers of a child with cancer, this report explores the relationship between inflammation that accompanies the stress of diagnosis and changes in social network, cancer-related stress, and inflammation across one year. Three hypotheses were tested, that (1) initial stress would associate with initial inflammation, (2) initial inflammation would predict social changes over time, and (3) social changes over time would buffer stress and inflammation over time. Methods: Cancer-related stress (Impact of Events Scale), social network (social roles and contacts from the Social Network Inventory), and systemic inflammation (circulating IL-6) were assessed in 120 mothers three times after their child’s cancer diagnosis: following diagnosis (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Results: Consistent with predictions, greater cancer-related stress following diagnosis (T1) was associated with higher IL-6 following diagnosis (T1; b=.014, p=.008). In turn, higher IL-6 following diagnosis (T1) was associated with a decrease in social roles over time (T1-->T3; B=-.030, p=.041), particularly peripheral social roles. Finally, dropping social roles over time (T1-->T3) was associated with decreases in cancer-related stress (B=21.83, p=.040) and slower increases in IL-6 (B=.940, p=.036) over time.Conclusions: This study provides a first indication that chronic stress-related systemic inflammation may predict changes in social behavior that associate with stress recovery and slower increases in inflammation in the year following a major life stressor.

scholarly journals Evolution of impulsive–compulsive behaviors and cognition in Parkinson’s disease

2019 ◽  
Vol 267 (1) ◽  
pp. 259-266
Author(s):  
Aleksander H. Erga ◽  
Guido Alves ◽  
Ole Bjørn Tysnes ◽  
Kenn Freddy Pedersen
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Short Form ◽  
Population Based ◽  
Self Report ◽  
Cognitive Changes ◽  
Compulsive Behaviors ◽  
Changes Over Time ◽  
Over Time

Abstract The longitudinal course of ICBs in patients with Parkinson’s disease (PwP) relative to controls has not been explored as of yet. The aim of this study is to determine the frequency, evolution and associated cognitive and clinical features of impulsive and compulsive behaviors (ICBs) over 4 years of prospective follow-up in a population-based cohort with early Parkinson’s disease (PD). We recruited 124 cognitively intact participants with early PD and 156 matched controls from the Norwegian ParkWest study. ICBs were assessed using the self-report short form version of the Questionnaire for Impulsive–Compulsive Disorders in PD. Cognitive changes were examined in PwP with and without ICBs who completed the 4-year follow-up. Generalized linear mixed modelling and mixed linear regression were used to analyze clinical factors and cognitive changes associated with ICBs in PwP over time. ICBs were more common in PwP than controls at all visits, with an age-adjusted odds ratio (OR) varying between 2.5 (95% CI 1.1–5.6; p = 0.022) and 5.1 (95% CI 2.4–11.0; p < 0.001). The 4-year cumulative frequency of ICBs in PwP was 46.8% and 23.3% developed incident ICBs during the study period, but the presence of ICBs was non-persistent in nearly 30%. ICBs were independently associated with younger age (OR 0.95, 95% CI 0.91–0.99: p = 0.008) and use of dopamine agonist (OR 4.1, 95% CI 1.56–10.69). Cognitive changes over time did not differ between patients with and without ICBs. In conclusion, ICBs are common in PwP, but are often non-persistent and not associated with greater cognitive impairment over time.

Changes in Voice- and Swallowing-Related Symptoms After Thyroidectomy: One-Year Follow-Up Study

2018 ◽  
Vol 127 (3) ◽  
pp. 171-177 ◽  
Author(s):  
Young Min Park ◽  
Kyung Ho Oh ◽  
Jae-Gu Cho ◽  
Seung-Kuk Baek ◽  
Soon-Young Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Symptom Relief ◽  
Temporal Changes ◽  
Rehabilitation Programs ◽  
Significant Difference ◽  
One Year ◽  
Associated Risk Factors ◽  
Changes Over Time ◽  
Over Time

Objective: We analyzed the changes in voice- and swallowing-related symptoms that occurred over time in patients who underwent thyroidectomy and identified any associated risk factors. Methods: One hundred and three patients who underwent thyroidectomy were enrolled. Results: The mean thyroidectomy voice-related questionnaire (TVQ) score before surgery was 12.41 ± 12.19; it significantly increased to 28.24 ± 18.01 ( P < .001) 1 month postoperatively, decreased to 24.02 ± 17.30 ( P = .014) and 20.66 ± 15.29 ( P = .023) 3 and 6 months postoperatively, respectively. It was continuously decreased to 18.83 ± 14.63 twelve months postoperatively. The temporal changes in TVQ scores between patients who underwent total thyroidectomy or lobectomy were significantly different. There was a statistically significant difference in the temporal changes in TVQ according to whether neck dissection was performed. The temporal changes in TVQ in patients with and without extrathyroidal extension were significantly different. Conclusions: Voice- and swallowing-related discomfort in patients who received thyroidectomy showed dynamic changes over time. There was a significant difference in the degree of change according to clinicopathological factors. Patients with these risk factors may benefit from appropriate patient education and various rehabilitation programs for symptom relief.

Incidence of fractures and changes over time among the aged in a Finnish municipality: a population-based 12-year follow-up

2007 ◽  
Vol 19 (4) ◽  
pp. 269-276 ◽  
Author(s):  
Maarit Piirtola ◽  
Tero Vahlberg ◽  
Raimo Isoaho ◽  
Pertti Aarnio ◽  
Sirkka-Liisa Kivelä
Keyword(s):  
Population Based ◽  
Changes Over Time ◽  
Over Time

scholarly journals Changes in health-related quality of life among patients with coronary artery disease: a 2-year follow-up

Medicina ◽  
2010 ◽  
Vol 46 (12) ◽  
pp. 843 ◽  
Author(s):  
Margarita Staniūtė ◽  
Julija Brožaitienė
Keyword(s):  
Quality Of Life ◽  
Older Patients ◽  
Treatment Method ◽  
Effect Sizes ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Over Time

The aim of this study was to evaluate the changes in health-related quality of life in patients with coronary heart disease according to age, gender, and treatment method. Material and methods. The study enrolled 167 patients after acute myocardial infarction (MI), percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG). The mean age was 59.3 years; there were 71.9% of males. General health-related quality of life was measured using the SF-36 questionnaire. Patients were examined at the beginning of rehabilitation and after 6-, 12-, 18-, and 24-month follow-up. Effect sizes were computed to assess the changes in health-related quality of life over time. Results. Health-related quality of life significantly improved at 6 months, but improvements did not continue over time. The largest effect size was seen in the pain domain. Effect sizes were greater in the physical health domains among male patients and among female patients in the mental health domain. With regard to age, effect sizes were greater in the physical functioning domain among older patients. With regard to treatment method, at baseline, the CABG patients had the poorest healthrelated quality of life; however, the largest effect sizes were seen in this group. Conclusions. Health-related quality of life improved over 2 years; the greatest improvement was seen at 6 months. Males better improved on the physical component summary domain; there was no significant improvement in the mental component summary domain in males and females. Older patients improved better on the physical activity and physical component summary domains. Changes in health-related quality of life were related to treatment method.

OS09.4.A Health-related quality of life in low-grade glioma survivors 26 years after diagnosis

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii12-ii12
Author(s):  
F W Boele ◽  
J C Reijneveld ◽  
P C de Witt Hamer ◽  
H F van Thuijl ◽  
P Wesseling ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Low Grade ◽  
Group Level ◽  
Related Quality ◽  
Health Related ◽  
Changes Over Time ◽  
Over Time

Abstract BACKGROUND Many patients with low-grade gliomas (LGGs) continue to survive for many years, yet little is known about patients’ health-related quality of life (HRQOL) in long-term survivorship. We previously investigated HRQOL in LGG patients diagnosed on average 6 years prior to assessment (T1, N=195) with a follow-up in stable patients on average 12 years after diagnosis (T2, N=65). We present a final follow-up of LGG survivors (T3), now decades after diagnosis. MATERIAL AND METHODS We invited patients who participated in our previous assessment (N=65), regardless of disease status. Patients completed questionnaires to assess HRQOL, fatigue, and depressive symptoms: Short Form-36 Health Survey (SF-36), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Tumour Module (EORTC BN20), Checklist Individual Strength (CIS), and the Center for Epidemiological Studies Depression Scale (CES-D). Changes over time (T1-T2-T3) on group level and participant level were assessed. RESULTS Of the 65 patients, 18 (27.7%) were deceased, 3 (4.6%) experienced tumour progression to WHO III, 7 (10.8%) declined, and 3 (4.6%) could not be contacted. Thirty-four patients (52.3%) participated. Of these, 2 had missing HRQOL data, with 32 patients included in analysis. Survivors were M=52.0 (sd=11.3) years old and diagnosed M=26.2 (sd=3.7, range 19–35) years prior. On group level, a statistically significant (but not clinically relevant) improvement in mental health (p=0.049), and a clinically relevant (but not statistically significant) decline in emotional role functioning was found. No other group-level changes over time in HRQOL were found. Minimal detectable change in HRQOL scale scores over time was observed in individual participants (28.1% only improvement; 25.0% only decline; 21.9% both improvement and decline) with 25.0% remaining completely stable. At T3, 25.0% of survivors scored above the cut-off for high risk of clinical depression (≥16 CES-D), and 53.1% of survivors classed as severely fatigued (≥35 CIS). CONCLUSION In this cohort of LGG survivors, assessed decades after diagnosis and treatment, HRQOL does not appear to be greatly impacted during survivorship. However, depressive symptoms and fatigue remain relatively common. Findings can help inform patients, their families, and clinicians and can serve as a benchmark for treatment trials evaluating interventions that can have very long-term effects.

La valutazione RM della sclerosi tuberosa

2003 ◽  
Vol 16 (3) ◽  
pp. 547-550
Author(s):  
C. Uggetti
Keyword(s):  
Tuberous Sclerosis ◽  
Neoplastic Transformation ◽  
Pathogenetic Mechanism ◽  
Clinical Correlations ◽  
Asymptomatic Subjects ◽  
Changes Over Time ◽  
Over Time ◽  
Subependymal Nodules ◽  
Rule Out

The myriad brain abnormalities characterising tuberous sclerosis are all the result of the same pathogenetic mechanism, a genetic impairment of the germinative matrix. MR scanning plays a major role in the diagnosis and follow-up of patients who must be monitored up to the age of twenty to rule out the possible neoplastic transformation of subependymal nodules. MR scans should also be offered to the parents of children with tuberous sclerosis to disclose asymptomatic subjects. Starting from a total of 36 scans in a personal series of 24 patients, we describe the best sequences for brain investigation, the different MR findings and their changes over time with possible clinical correlations.

Natural history of untreated syringomyelia in pediatric patients

2011 ◽  
Vol 31 (6) ◽  
pp. E13 ◽  
Author(s):  
Ash Singhal ◽  
Tim Bowen-Roberts ◽  
Paul Steinbok ◽  
Doug Cochrane ◽  
Angela T. Byrne ◽  
...  
Keyword(s):  
Natural History ◽  
Pediatric Patients ◽  
Nonoperative Treatment ◽  
Motor Deficits ◽  
Axial Diameter ◽  
History Of ◽  
Clinical Changes ◽  
Changes Over Time ◽  
Over Time

Object The natural history of syringomyelia in pediatric patients remains uncertain. Although symptomatic and operative cases of syringomyelia are well studied, there are fewer articles in the literature on the nonoperative syrinx and its clinical and radiological course. The purpose of this research was to analyze the natural history of untreated syringomyelia in pediatric patients presenting with minimal neurological symptoms. Methods A review of the neurosurgery database at British Columbia's Children's Hospital identified all pediatric patients (< 18 years of age) with syringes identified on MR imaging. Patients were included in this study if they had at least 2 MR images of the spine, at least 1 year apart, while receiving nonoperative treatment. Magnetic resonance imaging was used to determine changes in the size of the syrinx over time. Clinic notes were analyzed to establish demographic and clinical features and to determine any clinical changes over time. Results A total of 17 patients were included in the study. Symptoms at presentation were often mild and included limb numbness (3 cases), headaches (2 cases), mild sensory deficits (2 cases), mild motor deficits (3 cases), and intermittent incontinence (7 cases). The consultant neurosurgeon believed that the syrinx was not contributing to the symptoms in these 17 patients. The syrinx either remained unchanged (7 cases) or diminished in size (8 cases) in a total of 15 patients (88%). In the remaining 2 patients the authors noted an increase in syrinx size, in 1 of whom the clinical course also worsened. Both of these patients had a Chiari malformation and subsequently underwent craniocervical decompression. Overall, the mean change was −0.7 mm of maximal axial diameter (range −2.6 to +2.7 mm). Sixteen patients (94%) exhibited no worsening of symptoms over time. Conclusions Syringomyelia often remains stable in patients receiving nonoperative treatment. However, given that 2 (12%) of 17 syringes in this series enlarged, it is likely appropriate to include periodic imaging in the follow-up of these cases.

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