scholarly journals Patient-reported comorbidity and survival in older adults with cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10033-10033
Author(s):  
Grant Richard Williams ◽  
Allison Mary Deal ◽  
Jennifer Leigh Lund ◽  
YunKyung Chang ◽  
Hyman B. Muss ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trials ◽  
Functional Limitation ◽  
Mortality Data ◽  
Comorbid Condition ◽  
Cancer Type ◽  
Comorbid Conditions ◽  
Risk Of Death ◽  
The North ◽  
Patient Reported

10033 Background: Our ability to optimize the care of older adults with cancer and comorbid illnesses is insufficient as most clinical trials lack systematic measurement of comorbidities. The primary purpose of this study was to evaluate the prevalence and impact of patient-reported comorbidity on survival using various comorbidity scoring algorithms. Methods: We utilized a unique linkage of the Carolina Senior Registry, an institutional registry (NCT01137825) that contains geriatric assessment data, with the North Carolina Central Cancer Registry to obtain mortality data. Comorbidity was assessed using a patient-reported version of the Older Americans Resources and Services Questionnaire (OARS) Physical Health subscale that includes information regarding 13 specific comorbid conditions and the degree to which each impairs function (“not at all” to “a great deal”). Multivariable Cox proportional hazard regression models were used to evaluate the association between comorbidities and all-cause mortality. Results: 539 patients were successfully linked to mortality data. Median age 72, 72% female, 85% Caucasian, 47% breast cancer, and 12% lung cancer. 92% of participants reported at least one comorbid condition, mean of 2.7 conditions (range 0-10), with arthritis and hypertension the most common (52 and 50%, respectively). 62% of patients with a comorbid illness reported a functional limitation related to comorbidity. Both the presence of 3 or more total comorbidities (hazard ratio (HR) 1.44, CI 1.08-1.92) and 2 or more comorbidities impacting function (HR 1.46, CI 1.09-1.95) increased mortality. After adjusting for age, cancer type, and stage, the risk of death increased 12% for each comorbid condition impacting function (HR 1.12, CI 1.02-1.24), but did not significantly increase for the number of comorbid conditions alone (HR 1.07, CI 0.99-1.15). Conclusions: Comorbid conditions in older adults with cancer are highly prevalent, frequently impair function, and impact survival. Comorbid conditions that impair function have a greater impact on survival than the presence of comorbidity alone. Comorbidity assessment should be incorporated in clinical trials and can be measured via a simple one-page patient-reported questionnaire.

Financial distress amongst older adults with gastrointestinal (GI) malignancies.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 517-517 ◽  
Author(s):  
William Varnado ◽  
Kelly Kenzik ◽  
Andrew Michael McDonald ◽  
Mariel Parman ◽  
Ravi Kumar Paluri ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Financial Distress ◽  
Daily Living ◽  
Adult Population ◽  
Comorbid Condition ◽  
Cancer Type ◽  
Chi Square ◽  
Related Factors ◽  
Patient Reported

517 Background: Many patients with cancer report financial distress (FD); however, the magnitude of FD in the growing number of older adults with cancer remains less clear, particularly in those with GI malignancies. The purpose of this study was to evaluate the proportion of older adults with GI malignancies reporting FD and to characterize geriatric assessment (GA) and cancer-related factors associated with FD. Methods: Older adults ( ≥ 60yrs) seen in the GI oncology clinic at the University of Alabama Birmingham (UAB) were asked to fill out a patient-reported GA, entitled the Cancer & Aging Resilience Evaluation (CARE), at their visit. The CARE includes questions pertaining to patient’s independence in Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), falls, physical function, polypharmacy, and comorbidity. A single item question regarding FD from the patient satisfaction questionnaire (PSQ-18) was included. FD was defined as agreement with the phrase “Do you have to pay for more medical care than you can afford.” Demographic and GA characteristics were compared between those with and without FD using Chi-square and t-tests. Results: 233 patients completed the CARE a median of 71 days after diagnosis. Median age 68y (60-96); 54.5% male and 76.0% non-Hispanic white. Most common cancer types included colorectal (39.1%) and pancreatic cancers (20.6%). A total of 62 patients (26.6%) had FD. Patients with FD were more likely to be younger (68.1 vs. 70.1y, p = 0.04), of black race (37.1% vs. 15.8%, p = 0.007), have low education ( ≤ high school: 74.2% vs. 59.6%, p = 0.02), have one or more falls (31.5% vs. 19.9%, p = 0.077), to be limited a lot in walking 1 block (54.4% vs. 27.4%, p = 0.0003), take more than 4 medications (88.3% vs. 70.8%, p = 0.007), to have more than one comorbid condition (93.1% vs. 82.6%, p = 0.052), to report impaired IADLs (61.3% vs. 43.9%, p = 0.055), and impaired ADL (27.4% vs. 14.6%, p = 0.069). No associations were found with GI cancer type or stage, marital status, time from diagnosis, or hearing/vision impairments. Conclusions: Over a quarter of the older adult population with GI malignancies report FD. Several GA and demographic factors were associated with FD that may help identify older patients at risk for FD.

Is care coordination associated with improved care quality for comorbid conditions in cancer survivors?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6026-6026
Author(s):  
Claire Frances Snyder ◽  
Kevin D. Frick ◽  
Robert J. Herbert ◽  
Amanda L. Blackford ◽  
Bridget A. Neville ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Care Coordination ◽  
Risk Index ◽  
Care Quality ◽  
Comorbid Condition ◽  
Cancer Type ◽  
Fee For Service ◽  
Comorbid Conditions ◽  
Source Of Care

6026 Background: Many cancer survivors have comorbid conditions, adding complexity to their already complicated care and requiring greater care coordination. We assessed the role of care coordination in comorbid condition care for cancer survivors. Methods: Using SEER-Medicare, we examined 7 published indicators of quality comorbid condition care in survivors of loco-regional breast, prostate, or colorectal cancer who were diagnosed in 2004, in fee-for-service Medicare, and survived ≥3 years. Comorbid condition care was evaluated during the transition from initial cancer treatment to survivorship (i.e. days 366-1095 post-diagnosis). Coordination risk was categorized as Likely, Possible, or Unlikely using an index developed and tested as part of the ACG case-mix adjustment and predictive modeling tool. The index factors in the number of unique providers, number of specialties, the percentage majority source of care, and generalist visits. We tested the hypothesis that lower coordination risk would be associated with better comorbid condition care using logistic regression, adjusting for socio-demographics, cancer type, and comorbidity. Results: The sample included 8661 survivors (53% prostate, 22% breast, 26% colorectal; mean age 75; 65% male, 85% white). Our hypothesis was not supported. Compared to patients with Unlikely coordination issues, patients with Likely coordination issues were more likely to receive appropriate care on 4 indicators and less likely on 1. Possible coordination issues were associated with better care on 1 indicator and worse care on 1 indicator. To explore this finding further, we conducted post-hoc analyses examining the role of each component of the coordination risk index. Having more unique providers was generally associated with better comorbid condition care, in contrast to the calculation of the index which considers more unique providers a greater risk for coordination issues. Conclusions: These findings suggest that traditional metrics of care coordination may not be valid for survivors of cancer. Understanding the role of care coordination in cancer survivorship care requires development and application of alternative coordination measures.

scholarly journals Assessment of clinical profile and factors affecting outcome of COVID-19 patient in Chhattisgarh state

2021 ◽  
Vol 8 (8) ◽  
pp. 3989
Author(s):  
Nirmal Verma ◽  
Alok Shukla ◽  
Neha Shrivastava ◽  
Swapnil Shinkar
Keyword(s):  
Data Collection ◽  
Treatment Strategies ◽  
Clinical Profile ◽  
Local Context ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Factors Affecting ◽  
Risk Of Death ◽  
Patient Will ◽  
Male Preponderance

Background: India is in the grab of COVID pandemic, understanding the clinical profile, comorbid condition, vaccine status of COVID patient, will help in better prevention, treatment strategies, especially in local context, therefore present study is designed to describe, the clinical profile, comorbid conditions and factors determining the death and recovery of patient both in home and hospital setting.Methods: It is a retrospective record based study of COVID-19 patient from September 2020 to May 2021 who underwent treatment either home or at hospital. Results: Majority 90% patient were hospitalised, with male preponderance, 96.4% patient were non vaccinated at the time of data collection, risk of death about 83% were more >45years age, with associated breathlessness and comorbidity.Conclusions: Higher age, comorbidity, non -vaccinated status was associated with risk of death among COVID-19 patient. 

scholarly journals Evaluating quality of overall care among older adults with diabetes with comorbidities in Ontario, Canada: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033291
Author(s):  
Yelena Petrosyan ◽  
Kerry Kuluski ◽  
Jan Barnsley ◽  
Barbara Liu ◽  
Walter P Wodchis
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Continuity Of Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Comorbid Condition ◽  
Delphi Panel ◽  
Process Of Care ◽  
Comorbid Conditions

ObjectivesThis study aimed to: (1) explore whether the quality of overall care for older people with diabetes is differentially affected by types and number of comorbid conditions and (2) examine the association between process of care measures and the likelihood of all-cause hospitalisations.DesignA population-based, retrospective cohort study.SettingThe province of Ontario, Canada.ParticipantsWe identified 673 197 Ontarians aged 65 years and older who had diabetes comorbid with hypertension, chronic ischaemic heart disease, osteoarthritis or depression on 1 April 2010.Main outcome measuresThe study outcome was the likelihood of having at least one hospital admission in each year, during the study period, from 1 April 2010 to 3 March 2014. Process of care measures specific to older adults with diabetes and these comorbidities, developed by means of a Delphi panel, were used to assess the quality of care. A generalised estimating equations approach was used to examine associations between the process of care measures and the likelihood of hospitalisations.ResultsThe study findings suggest that patients are at risk of suboptimal care with each additional comorbid condition, while the incidence of hospitalisations and number of prescribed drugs markedly increased in patients with 2 versus 1 selected comorbid condition, especially in those with discordant comorbidities. The median continuity of care score was higher among patients with diabetes-concordant conditions compared with those with diabetes-discordant conditions, and it declined with additional comorbid conditions in both groups. Greater continuity of care was associated with lower hospital utilisation for older diabetes patients with both concordant and discordant conditions.ConclusionsThere is a need for focusing on improving continuity of care and prioritising treatment in older adults with diabetes with any multiple conditions but especially in those with diabetes-discordant conditions (eg, depression).

The State of the Science in Patient-Reported Outcomes for Patients with Lung Cancer

2020 ◽  
Vol 41 (03) ◽  
pp. 377-385
Author(s):  
Canhua Xiao ◽  
Newton Hurst ◽  
Benjamin Movsas
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Clinical Decision Making ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Patient Reported Outcome ◽  
Cancer Clinical Trials ◽  
Cancer Type ◽  
Patient Reported ◽  
State Of The Science

AbstractTraditionally, clinicians have assumed the primary responsibility for evaluating disease- and treatment-related outcomes. In the past few decades, however, a series of recommendations and standards promulgated by professional societies and regulatory agencies have resulted in increased use of patient-reported outcome (PRO) measures in cancer clinical trials. PROs, such as quality of life (QOL) measures, are important in establishing overall treatment effectiveness in cancer clinical trials, and they can inform clinical decision making. This article discusses the current state of the science in PRO research for patients with lung cancer, the cancer type with the highest incidence rate and the lowest survival rate worldwide. The discussion focuses on (1) PRO and survival; (2) electronic PRO reporting and interventions; (3) PROs and immunotherapy; (4) PRO, biomarkers, and precision health; (5) key issues in applying PROs in clinical trials; and (6) future directions for research.

scholarly journals Association Between Chronologic Age and Geriatric Assessment–Identified Impairments: Findings From the CARE Registry

2021 ◽  
Vol 19 (8) ◽  
pp. 922-927
Author(s):  
Smith Giri ◽  
Mustafa Al-Obaidi ◽  
Alice Weaver ◽  
Kelly M. Kenzik ◽  
Andrew McDonald ◽  
...  
Keyword(s):  
Older Adults ◽  
Geriatric Assessment ◽  
Statistical Significance ◽  
Screening Tools ◽  
Cancer Type ◽  
Deficit Accumulation ◽  
Cross Sectional ◽  
Gastrointestinal Malignancies ◽  
Comorbidity Burden ◽  
Patient Reported

Background: The NCCN Guidelines for Older Adult Oncology recommend that, when possible, older adults with cancer undergo a geriatric assessment (GA) to provide a comprehensive health appraisal to guide interventions and appropriate treatment selection. However, the association of age with GA-identified impairments (GA impairments) remains understudied and the appropriate age cutoff for using the GA remains unknown. Patients and Methods: We designed a cross-sectional study using the Cancer and Aging Resilience Evaluation (CARE) registry of older adults with cancer. We included adults aged ≥60 years diagnosed with gastrointestinal malignancy who underwent a patient-reported GA prior to their initial consultation at the gastrointestinal oncology clinic. We noted the presence of GA impairments and frailty using Rockwood’s deficit accumulation approach. We studied the relation between chronologic age and GA impairments/frailty using Spearman rank correlation and chi-square tests of trend. Results: We identified 455 eligible older adults aged ≥60 years with gastrointestinal malignancies; the median age was 68 years (range, 64–74 years) and colorectal (33%) and pancreatic (24%) cancers were the most common cancer type. The correlation between chronologic age and number of geriatric impairments was weak and did not reach statistical significance (Spearman ρ, 0.07; P=.16). Furthermore, the prevalence of domain-specific impairments or frailty was comparable across the 3 age groups (60–64 years, 65–74 years, ≥75 years) with the exception of comorbidity burden. Notably, 61% of patients aged 60 to 64 years had ≥2 GA impairments and 35% had evidence of frailty, which was comparable to patients aged 65 to 74 years (66% and 36%, respectively) and ≥75 years (70% and 40%, respectively). Conclusions: Using chronologic age alone to identify which patients may benefit from GA is problematic. Future studies should identify screening tools that may identify patients at high risk of frailty and GA impairments.

Patient related outcomes in cancer patients in Croatia.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS6650-TPS6650
Author(s):  
Dragan Trivanovic ◽  
Irena Hrstic ◽  
Anuska Budisavljevic ◽  
Boris Kopic ◽  
Bruno Nincevic
Keyword(s):  
Quality Of Life ◽  
Cancer Treatment ◽  
Cancer Care ◽  
Cox Regression ◽  
Prospective Trial ◽  
Cancer Type ◽  
Risk Of Death ◽  
Patient Reported ◽  
Clinic Visits

TPS6650 Background: Accurate evaluation of symptom intensities is essential for optimal cancer care and improving the quality of life of patients. An inappropriate interpretation of symptoms may lead to treatment outcomes failure, overdose of medication, or may leave the patients undertreated. However, the perception of symptoms can vary between the treating physician and patient. Physicians appear to underestimate the patient symptoms. And this variation in the perception of side effects can lead to wrong assumptions and subsequent treatment changes, affecting treatment effectiveness and quality of life. There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, leaving open the question of whether the benefits of systems to reveal self-reports outweigh their added cost. There are several tools for assessment of symptoms in oncology. In cancer treatment clinical trials, the standard source of adverse symptom data is clinician reporting by use of items from PRO-CTCAE, developed by NCI. To address these questions, we conducted a single-center prospective trial to test whether systematic tablet computer-based collection of patient-reported symptoms during chemotherapy treatment, with automated alerts to clinicians for severe adverse events (grade 3-4) will change in questionnaire score at 6 months compared with baseline. Secondary endpoints will include difference in unscheduled clinic visits frequency, and survival. Methods: Patients initiating chemotherapy at General Hospital Pula Oncology Clinic for advanced or metastatic gastrointestinal, lung, breast, genitourinary, or gynecologic cancers will be enrolled in a nonblinded, prospective trial of self-reporting of symptoms, compare with usual care. Patients receiving chemotherapy and their clinicians will be independently asked on the same day to complete 10 symptoms (including fatigue, pain, nausea, vomiting, diarrhea, dysgeusia, appetite, sleep disturbance, fever and hair loss). Participants will remain on study until discontinuation of cancer treatment, withdrawal, or death. All participants will provide written informed consent and followed for up to 28 months or until death. To compare how patient’s vs clinician’s reports relate to clinical events, a time-dependent Cox regression model adjusted for covariates including cancer type, age, sex, and education level will be used to measure associations between reaching particular grade severity thresholds with the risk of death and unscheduled clinic visits. Clinical trial information: 2019-000855-15.

scholarly journals Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults

2021 ◽  
Author(s):  
Nancy W Glynn ◽  
Theresa Gmelin ◽  
Sharon W Renner ◽  
Yujia Susanna QiaoScM ◽  
Robert M Boudreau ◽  
...  
Keyword(s):  
Older Adults ◽  
Prognostic Indicator ◽  
Underlying Disease ◽  
Registration System ◽  
Civil Registration ◽  
Risk Of Death ◽  
Validated Questionnaire ◽  
Patient Reported ◽  
Cox Proportional Hazard Models

Abstract Background Perceived physical fatigability is highly prevalent in older adults and associated with mobility decline and other health consequences. We examined the prognostic value of perceived physical fatigability as an independent predictor of risk of death among older adults. Methods Participants (N = 2,906), mean age 73.5 [SD, 10.4] years, 54.2% women, 99.7% white enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017) with 2.7 [SD, 1.0] years follow-up. The Pittsburgh Fatigability Scale (PFS), a 10-item, self-administered validated questionnaire (score range 0-50, higher=greater fatigability) measured perceived physical fatigability at Visit 2. Deaths post-Visit 2 through December 31, 2019 were identified by: family members notifying field centers, reporting during another family member’s annual phone follow-up, an obituary, or Civil Registration System (Denmark). We censored all other participants at their last contact. Cox proportional hazard models predicted mortality by fatigability severity, adjusted for family relatedness and other covariates. Results Age-adjusted PFS Physical scores were higher for those who died (19.1 [SE, 0.8]) compared to alive (12.2, [SE, 0.4]) overall, as well as across age strata (P<.001), except for those 60-69 years (P=.79). Participants with the most severe fatigability (PFS Physical scores ≥25) were over twice as likely to die (HR, 2.33 [95% CI, 1.65 to 3.28]) compared to those with less severe fatigability (PFS Physical scores <25) after adjustment. Conclusions This work underscores the utility of the PFS as a novel patient-reported prognostic indicator of phenotypic aging that captures both overt and underlying disease burden that predicts death.

Impact of patient reported functional limitation on overall survival in older adults undergoing autologous hematopoietic cell transplant (AutoHCT).

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 10030-10030 ◽  
Author(s):  
Mariam T. Nawas ◽  
Charalambos Andreadis ◽  
Thomas G. Martin ◽  
Jeffrey Lee Wolf ◽  
Weiyun Z. Ai ◽  
...  
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Functional Limitation ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Patient Reported

Incremental Effects of Comorbidity on Quality of Life in Patients with Psoriatic Arthritis

2013 ◽  
Vol 40 (8) ◽  
pp. 1349-1356 ◽  
Author(s):  
Janice A. Husted ◽  
Arane Thavaneswaran ◽  
Vinod Chandran ◽  
Dafna D. Gladman
Keyword(s):  
Quality Of Life ◽  
Psoriatic Arthritis ◽  
Short Form ◽  
Statistical Significance ◽  
Sociodemographic Factors ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Physical And Mental Health ◽  
Patient Reported

Objective.To assess the added effect of comorbidity on quality of life (QOL) in psoriatic arthritis (PsA).Methods.Between 2006 and 2012, 631 patients were recruited from the University of Toronto PsA Clinic. Using the clinical database, we ascertained the frequency of 15 comorbidities. The Medical Outcomes Study Short Form-36 (SF-36) physical (PCS) and mental component (MCS) summary scales were used to assess QOL. Linear regression analyses were conducted to estimate the magnitude of the association between number and type of comorbidities and PCS and MCS scores, after adjustment for disease-related and sociodemographic variables.Results.Prevalence of comorbidity was high, with 42% of patients having 3 or more comorbid conditions. After adjustment for inflammatory disease–related and sociodemographic factors, a history of 3 or more comorbid conditions accounted for only 2% and 1% of the R2 value explained in PCS and MCS scores, respectively. In terms of added burden, type of comorbid condition was more significant than number of comorbidities. After adjustment for disease-related and sociodemographic factors, fibromyalgia (FM), neurological disorders, and obesity jointly accounted for 6% of R2 value explained in PCS scores, while FM and depression/anxiety jointly accounted for about 9% of the R2 explained in MCS scores. The point decrease in PCS and MCS scores associated with each of these disorders was clinically significant. The 11 other comorbid conditions failed to achieve statistical significance in the models.Conclusion.The added effect of comorbidity on patient-reported physical and mental health in PsA was more related to type of comorbidity than number of comorbidities.

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