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Biomedical subjects

P A Ganz

Publications and source records attributed to P A Ganz.

At least 73 records · Page 4Linked to original sources
PubMed1995

Translation and validation of a quality of life instrument for Hispanic American cancer patients: methodological considerations.

The increasing diversity of the US population has drawn attention to the need for the development of quality of life tools that are appropriate for special populations, including Hispanic Americans, Asian Pacific Islanders, and Native Americans. The Hispanics are one of the fastest growing of these special populations, and this group includes persons who have lived in the USA for many generations, as well as recent immigrants. Both language and culture are important to consider when developing a quality of life tool for Hispanics. The initial aims of this study were to develop a Spanish translation of the CAncer Rehabilitation Evaluation System (CARES), perform content and construct validation of the Spanish CARES in Spanish-speaking and bilingual patients with cancer, and provide descriptive data on the rehabilitation needs and quality of life of these patients. However, in performing this study we encountered a number of methodological problems that had not been previously described in the literature, including the need for idiomatic translations, lack of familiarity with questionnaires, low acculturation and low literacy rates among Hispanic cancer patients in the southwestern USA. We suggest a number of practical considerations for future investigators planning to develop quality of life tools for this special population.

Hispanic or Latino↗
PubMed1995

Impact of quality of life outcomes on clinical practice.

This paper reviews the current status of translation of quality of life outcomes from research to clinical practice. A major barrier in this process is the lack of mature results from quality of life studies in phase III randomized controlled trials. As more trials are completed, we can expect the diffusion of those results into clinical practice and decision making. Further, as quality of life measurement tools are used more widely and become more user-friendly, we can anticipate their adoption in the routine clinical assessment of patients in the oncologist's practice.

Clinical Trials, Phase III as Topic↗
PubMed1994

Long-range effect of clinical trial interventions on quality of life.

Phase III randomized clinical trials have been designed primarily to answer questions of clinical efficacy. Although the primary outcome for most clinical trials is improved survival or disease free survival, recent studies have also compared the efficacy of treatments with no anticipated effects on survival but with different toxicities or rehabilitation outcomes. By identifying treatments with less morbidity, clinical trials have contributed to improving the quality of life of patients with cancer. This paper will highlight several clinical trials that have produced outcomes with quality-of-life implications, including limb-salvage therapy in patients with bone tumors, conservation surgery for patients with breast cancer, and conservation treatment for patients with bladder and laryngeal cancers. Although quality of life has rarely been measured explicitly in these trials, the demonstration that more conservative treatments are equally efficacious permits the discussion of these less radical treatments with patients. However, conservation treatment does affect quality of life, in that combined modality treatment is usually more complex and may not lead to improvement in quality of life in all patients. In the future, we can expect the explicit incorporation of patient-rated quality-of-life assessments in Phase III clinical trials, especially when maintenance of or improvement in quality of life is a specific objective of the trial.

Bone Neoplasms↗
PubMed1994

Quality of life and the patient with cancer. Individual and policy implications.

This article reviews the developments during the past decade that have led to a better definition and conceptualization of the term "quality of life." There is growing consensus regarding the dimensions of quality of life, along with an expansion of the number of tools appropriate for measuring quality of life in patients with cancer. Quality of life increasingly is being used as an outcome in research, especially clinical trials. However, there remain some areas of controversy, including the application of economic analyses (utility and cost-effectiveness studies) and the potential conflict between the needs of the individual versus society. In the future, we can expect development of a theoretical framework for quality of life research. Clinicians may begin to routinely evaluate quality of life in their patients and use these evaluations as part of the clinical decision making process in individual patients. Ultimately, policy decisions also may incorporate some form of quality of life assessment.

Health Policy↗
PubMed1994

Quality of life in adult survivors of lung, colon and prostate cancer.

In a cross-sectional study design, a disease free sample of 57 lung, 117 colon, and 104 prostate cancer survivors who represented short, intermediate and long-term survivors completed a detailed assessment of quality of life (QOL) and rehabilitation needs using the CAncer Rehabilitation Evaluation System (CARES). Demographic and medical data, social support, and a global QOL rating were also assessed. Lung cancer patients showed no differences in QOL with respect to their period of survival. QOL improved for survivors of colon cancer as they lived for longer periods, but declined with time for survivors of prostate cancer. The best predictor of QOL for all groups was KPS, although other variables such as type of hospital, gender, and work status were predictive for survivors of colon cancer. For survivors of prostate cancer comorbidity with other medical illnesses, time since diagnosis and comorbidity due to psychiatric difficulties were predictive of QOL. All groups had significant rehabilitation problems in the domains of physical, psychosocial, sexual, medical interaction, and marital relationships. Lung cancer survivors had more problems than the other cancer survivors. We conclude that patients who survive cancer do not return to a state of normal health. They demonstrate a variety of difficulties with which they must cope as they continue to survive. Greater efforts need to be made early in diagnosis and treatment to understand rehabilitation problems and target interventions in the hope of reducing later sequelae.

Colonic Neoplasms↗
PubMed1994

Symbiotic relationships of quality of life, health services research and other health research.

Clinical biomedical research, the traditional research orientation of quality of life (QOL) researchers, is chiefly concerned with disease processes and assessing the impact of therapeutic interventions on improving health status and QOL outcomes. This paper suggests, however, that the biomedical paradigm limits utility of QOL research findings in terms of its ability to shape health policy and improve health-related QOL in populations at risk. This paper proposes that health services research (HSR) and other health research paradigms can be used to assess QOL from multiple perspectives. HSR and QOL research can be mutually beneficial. The models for understanding health services utilized in HSR may assist in defining major determinants of QOL and the interaction of QOL with its environment. Conversely, QOL measures may be used to establish the relevance of HSR to people's well-being. The paper first defines the domain of HSR and the domain of quality of life. In order to understand their relationship, we consider what a model or paradigm for each might be, and how they would overlap. Finally, a merging of conceptual frameworks is proposed, linking QOL research to HSR and other health research. Ultimately, expanding the QOL paradigm beyond the biomedical model will promote two objectives. First, it will permit research findings to contribute more fully to shaping national health policy by considering the broader community and the delivery system factors which influence QOL. Second, researchers will be more aware of a broader range of factors affecting patients and will incorporate this in their research.

Health Services Research↗
PubMed1994

Quality of life measures in cancer chemotherapy: methodology and implications.

Quality of life has been an implied outcome of medical care since ancient times, yet only recently have tools become available to measure quality of life in a systematic fashion. Cancer is one of the chronic diseases where quality of life outcomes have been particularly salient. Currently, there are a wide variety of generic and cancer-specific instruments that are being used to evaluate the impact of cancer chemotherapy on the patient's quality of life. Most of these instruments rely on patient self-report rather than expert evaluation. The addition of quality-of-life (QOL) assessment to pharmacological investigations of cancer chemotherapy may enhance evaluation of clinical outcomes, as well as identify unsuspected drug toxicities. Clinicians, researchers and pharmaceutical companies are more frequently incorporating these measures into the design of cancer treatment protocols. Data on the performance of these tools should become more widely available in the near future, leading to refinements in the selection and use of specific instruments for different purposes.

Forecasting↗
PubMed1993

Polychemotherapy in advanced non small cell lung cancer: a meta-analysis.

We did a meta-analysis of all published polychemotherapy vs supportive care clinical trials in patients with non-resectable non small cell lung cancer. 7 studies with more than 700 patients were selected. We used the number of deaths at 3, 6, 9, 12, and 18 months as the endpoints because we were unable to obtain all the individual data. Our analysis showed a reduction in mortality during the first 6 months with polychemotherapy. Although small, this increase in survival, together with an improved quality of life, suggests that polychemotherapy should be recommended for patients with non-resectable non small cell lung cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

Describing the health-related quality of life impact of HIV infection: findings from a study using the HIV Overview of Problems--Evaluation System (HOPES).

This study aimed to describe the results of findings from data collected with an HIV-specific health-related quality of life tool, and to examine the relationship between clinical and biological factors and health-related quality of life (HRQL). Data were collected as a cross-sectional, patient-completed assessment of health-related quality of life. Laboratory data were abstracted from the medical chart. Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%), and AIDS with cancer (18%) were receiving health services at one of the medical centres serving HIV-infected patients in the Los Angeles community, including UCLA, community physicians, Veterans Affairs Medical Centers, and a county hospital. Additional data were contributed by the Johns Hopkins University Medical Center CMV Retinitis Clinic. Symptomatic patients and patients with the lowest CD4 counts reported poorer HRQL than asymptomatic patients and patients with higher CD4 counts. However, medical and demographic variables explained only 35% of the variability of HRQL ratings in this sample of HIV-infected patients. While clinical status and Karnofsky performance status may be used to estimate the impact of HIV infection on HRQL, they are not a substitute for independent assessment of HRQL by the patient.

Activities of Daily Living↗
PubMed1993

Predicting psychosocial risk in patients with breast cancer.

Breast cancer is the most common neoplasm in North American women. The psychosocial impact of breast cancer has been extensively studied, and a number of investigators have attempted to characterize women who are at high risk for increased psychosocial morbidity. Although a detailed interview performed by a professional is the clinical standard for psychosocial assessment, such interviews are usually time-consuming and expensive, and thus are rarely performed. This study was designed to develop a strategy for the rapid identification of newly-diagnosed breast cancer patients at risk for psychosocial morbidity. A sample of 227 newly diagnosed breast cancer patients were interviewed systematically by a clinical social worker and were subsequently classified for risk of psychosocial distress in the year after diagnosis. In addition, these women completed a battery of standardized instruments designed to assess quality of life, rehabilitation needs and psychological distress. A logistic regression procedure was used to examine a wide range of variables for their ability to correctly classify the risk of psychosocial distress in this sample. The final model included the Cancer Rehabilitation Evaluation System (CARES) Psychosocial Summary Scale, the Karnofsky Performance Status score and age as the best predictors of psychosocial risk. Subsequently these three variables were used to construct a clinically usable risk prediction model. Additional research should be performed to validate this predictive model.

Adaptation, Psychological↗
PubMed1993

Characteristics of women at risk for psychosocial distress in the year after breast cancer.

PURPOSE: To provide a detailed description of rehabilitation problems of women, considered to be low risk and at risk for psychosocial morbidity, diagnosed with stage I and II breast cancer 1 month and 1 year after primary treatment. PATIENTS AND METHODS: A sample of 227 newly diagnosed breast cancer patients were systematically interviewed by a clinical social worker and classified for risk of psychosocial distress in the year after diagnosis. They completed a battery of standardized instruments to assess quality of life (QL), rehabilitation needs, and psychologic distress. The primary QL instrument, the Cancer Rehabilitation Evaluation System (CARES), provides a detailed listing of rehabilitation needs. Descriptive CARES data are presented with comparisons between the two groups. RESULTS: The at-risk women had significantly more problems with greater severity than the low-risk women in all areas (physical, psychosocial, medical interaction, sexual, and marital). While both groups showed improvement over the year following diagnosis, the at-risk group had significantly more problems 1 year later. Many physical problems subside, but problems at the local surgical site, psychologic distress, communication with marital partners, and negative body image are more persistent in the at-risk group 1 year later, while half of both groups continue to have sexual dysfunction. CONCLUSION: The detailed listing of problems provided by the CARES may be helpful to clinicians in their interactions with patients. The need for preventive and early intervention for the at-risk patients is underscored.

Anxiety↗
PubMed1993

Nutrition and breast cancer.

A range of current information links nutrition and dietary factors to the risk of developing breast cancer, as well as to survival and outcomes after a diagnosis of breast cancer. Epidemiologic and other data suggest that high-fat and low-fiber diets are associated with an increased risk of breast cancer. Several pilot intervention studies have been performed to decrease dietary fat intake in women with breast cancer. Other studies suggest that weight gain after breast cancer is common and may be detrimental to survival. Taken together, all of these data suggest that further studies should be undertaken to better understand the relationship between nutritional factors and the development of breast cancer.

Breast Neoplasms↗
PubMed1993

Age and gender as factors in cancer therapy.

Cancer is already a disease of the elderly, and this will be increasingly the case as US population demographics continue to shift. The existing patterns of care for older cancer patients must be changed to improve the current cancer survival statistics. High technology innovations are not a prerequisite to improve our current results. The current best standards of care for cancer screening and treatment must be applied to the older woman. Although older patients may seem more comfortable (at least to a physician) with a paternalistic style of practice than younger patients, it is not in their best interest to exclude them from participation in their care. The health professional's assessment of the older patient's quality of life may miss the mark, denying them curative treatments as a result. Health care providers must learn to take the time to include older patients in their medical care and to educate them about the benefits of screening and cancer treatment.

Aged↗
PubMed1992

Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?

Women with a breast cancer diagnosis often are given a choice between breast conservation or mastectomy as the primary treatment for their cancer. Despite the high frequency of this cancer, there is little systemic information about the effect of surgical treatment on the quality of life or psychological adjustment of the patient. In this study, the authors prospectively evaluated quality of life, performance status, and psychological adjustment in 109 women who had primary breast cancer treatment. During the year of follow-up, no statistically significant differences in quality of life, mood disturbance, performance status, or global adjustment were found between the two surgical groups, and both groups of patients improved significantly during the year of observation (P = 0.0001). As was predicted, patients receiving mastectomy reported more difficulties with clothing and body image; however, these results apparently did not affect the assessment of mood or quality of life. The authors conclude that patients receiving breast conservation therapy do not experience significantly better quality of life or mood than patients having mastectomy; however, patients having breast conservation surgery have fewer problems with clothing and body image. Women receiving breast conservation therapy may require more intensive psychosocial intervention in the postoperative period because of the added burden of primary radiation therapy.

Adult↗
PubMed1992

The CARES: a generic measure of health-related quality of life for patients with cancer.

In spite of the prevalence of neoplastic disorders as a cause of chronic illness, very few of the currently available generic measures of health-related quality of life or health status have been utilized with cancer patients. In this paper we reviewed our studies with the Cancer Rehabilitation Evaluation System (CARES), a cancer-specific measure of rehabilitation needs and quality of life. We present data to demonstrate that the CARES is a generic measure of health-related quality of life, suitable for use in the many different diseases called cancer. The data that form the basis for this paper were collected during a decade of research on the CARES. This paper represents the first discussion of the performance of the CARES across separate cancer sites and phases of the disease. In addition, we demonstrated that the CARES is responsive to changes in health-related quality of life over time. Finally, we will discuss the application of the CARES in clinical and research settings.

Adult↗
PubMed1992

Report from a National Cancer Institute (USA) workshop on quality of life assessment in cancer clinical trials.

To promote the inclusion of quality of life (QOL) end-points in clinical research on cancer, the National Cancer Institute (USA) sponsored a workshop on QOL assessment in cancer clinical trials in July, 1990. Experts in clinical trials and QOL research formed four working groups to identify current areas of cancer treatment in which QOL end-points are most important; to discuss methodologic problems in QOL assessment; to address common problems in implementing clinical studies with QOL end-points; and to consider statistical issues in design, implementation, and data analysis. Recommendations made by the working groups are summarized in this paper.

Clinical Trials as Topic↗