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Biomedical subjects

P A Ganz

Publications and source records attributed to P A Ganz.

At least 91 records · Page 5Linked to original sources
PubMed1992

Assessing the needs and quality of life of patients with HIV infection: development of the HIV Overview of Problems-Evaluation System (HOPES).

OBJECTIVE: To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool. DESIGN: Cross-sectional, patient completed written surveys and interviews. SETTING: The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic. PATIENTS: Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites. MEASUREMENTS: The patients self-administered the newly developed instrument, the HOPES (HIV Overview of Problems-Evaluation System), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification. MAIN RESULTS: The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity. CONCLUSIONS: The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer.

This paper explores the relationship between age, psychosocial status and quality of life in a community based sample (n = 229) of newly-diagnosed breast cancer patients. A casement display methodology is used to examine the influence of demographic and medical variables on the outcome variables of interest (psychosocial status and quality of life) and their relationship to age. Based on the literature, a positive relationship between age and psychosocial status was predicted, but the relationship between age and quality of life was uncertain. For the whole sample, a weakly positive relationship between age and measures of psychosocial status and quality of life was observed. In the exploratory studies using the casement plots, the positive relationship between age and quality of life was most strong and significant in married women and in women who had received segmental mastectomy. Among sub-groups examined according to marital status and type of surgery, a positive relationship between age, psychosocial status and quality of life was observed only in married women who received segmental mastectomy. Additional preliminary observations were made about the relationship of household income and age to the outcome variables being studied. The casement plot methodology permits the simultaneous evaluation of multiple variables as a preliminary step before hypothesis development and should be considered when complex clinical problems are being evaluated.

Adolescent↗
PubMed1992

Does (or should) chronologic age influence the choice of cancer treatment?

With rare exceptions, age alone should not determine the diagnostic and therapeutic plan for the management of cancer. Unfortunately, a number of studies show that older individuals have more advanced stages of certain cancers than younger persons, and that this is probably the result of less intensive screening in the elderly. For example, fewer elderly women receive regular breast palpation, mammograms, and pelvic examinations, even though older women are at higher risk for breast and gynecologic cancers. In addition, several studies suggest that older persons may not be treated as appropriately as younger persons, even taking into account complicating medical conditions. In brief, there seems to be considerable age bias by physicians in offering cancer screening and treatment to elderly patients. In addition, elderly persons sometimes contribute to these difficulties by failing to obtain screening tests that are recommended.

Aged↗
PubMed1991

CAncer Rehabilitation Evaluation System--short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument.

The CAncer Rehabilitation Evaluation System (CARES) (CARES Consultants, Santa Monica, CA) a rehabilitation and quality of life instrument with well-documented reliability and validity, has been shortened. This report describes the development and psychometric properties of the new instrument, the CAncer Rehabilitation Evaluation System--Short Form (CARES-SF). The data from four existing samples of cancer patients demonstrate that the CARES-SF is highly related to the CARES (r = 0.98), has excellent test-retest reliability (86% agreement), concurrent validity with related measures, and acceptable internal consistency of summary scales (alpha = 0.85 to 0.61). In a new sample of breast cancer patients evaluated at three points in time (1 month, 7 months, and 13 months after diagnosis) the instrument appears to be sensitive to change and is highly related to the Functional Living Index--Cancer (FLIC), an existing quality of life instrument. The authors conclude that the CARES-SF has excellent potential as a quality of life instrument for use in clinical trials.

Data Collection↗
PubMed1991

Quality of life assessment. An independent prognostic variable for survival in lung cancer.

Improved quality of life has long been the goal of cancer treatment, but only recently have investigators begun to include a systematic assessment of quality of life in clinical trials. The major interest for its inclusion in clinical trials has been to assess treatment outcome. An evaluation of the relationship between patient-rated quality of life and survival is reported in a homogeneous sample of patients with advanced metastatic lung cancer participating in a clinical trial. Under the Cox proportional-hazards model (with quality of life, marital status, and their interaction in the model), a statistically significant relationship was observed between initial patient-rated quality of life and subsequent survival. In addition, being married led to a significantly improved survival. These findings suggest that nonmedical factors, such as quality of life assessment and marital status, play a role in survival and that they should be evaluated and described as potential predictors of survival in cancer patients in clinical trials.

Adult↗
PubMed1991

Quantitative and qualitative assessment of a case management program for cancer patients.

An oncology social work case management model of intervention is described quantitatively and qualitatively. Sixty-nine newly diagnosed breast cancer patients followed by telephone for one year required 374 hours of the social worker's time in providing reassurance, information, and referral to existing community resources. This process took less than one-half hour per patient per month. Case examples provide insight into the clinical aspects of the social worker's efforts. This telephone-based model was found to be highly effective and cost-efficient in addressing the rehabilitation needs of cancer patients. It also is a generic model that can be used with cancer patients with any disease site or phase of illness.

Adult↗
PubMed1990

Clinical trials. Concerns of the patient and the public.

This paper reviews what is known about attitudes toward clinical trials among patients and the public, the use of surrogates (physicians and patients) to determine whether a clinical trial is acceptable, and other empiric data available on this issue. Other concerns related to the conduct of clinical trials are explored including strategies for assuring the best quality of care for patients involved in these studies. The author suggests several actions to improve public understanding and participation in clinical trials including the development of new educational strategies for presenting information to the public, development of mechanisms for documenting and communicating the quality of care received by patients in clinical trials, and the implementation of quality-of-life assessments in clinical trials to provide an additional outcome measure for clinical situations in which the survival differences between treatments are insignificant. The limited information that is available suggests that the concerns of patients and the public must be addressed if clinical trials are to be successful in recruitment of adequate numbers of subjects to answer important clinical research questions.

Attitude↗
PubMed1990

Current issues in cancer rehabilitation.

Many patients with cancer enjoy long-term survival and are cured; others may live for extended periods while receiving specific treatment for cancer. This has been accomplished with increasingly complex and multimodal therapy, along with heightened toxicity and longer treatment. Cancer has become a chronic disease for many patients. Contemporary cancer rehabilitation provides a coordinated approach that addresses the physical, psychosocial, vocational, and economic concerns of the patient. Key components of a cancer rehabilitation program should include initial needs assessment with periodic reassessments, direct provision of specific interventions, and referrals to appropriate community resources. Almost all patients with cancer can benefit from a rehabilitation assessment and intervention. Important rehabilitation issues include the physical toxicity of treatment, psychosocial concerns, sexual dysfunction, diet and nutritional concerns, pain management, and vocational and economic problems. Patient groups with unique rehabilitation problems include patients with head and neck cancer or breast cancer, and patients who have undergone osteotomies or amputations. Long-term cancer survivors also have special rehabilitation needs that relate to the delayed effects of treatment on normal tissues, gonadal dysfunction, second neoplasms, employment discrimination, and difficulties obtaining health and life insurance coverage. Rehabilitation assessment and intervention should be incorporated into the routine health care of patients with cancer.

Chronic Disease↗
PubMed1990

Assessing the quality of life--a study in newly-diagnosed breast cancer patients.

Quality of life (QL) assessment is an increasingly important component of clinical research, especially with cancer patients. The literature strongly supports the view that QL should be assessed by the patient rather than the clinician. While clinical parameters such as performance status or toxicity ratings may bear some relationship to QL, they are not a substitute for its measurement. In spite of these observations, clinicians have been reluctant to accept the need for patient-rated measures of QL. In this paper, data from a sample of 109 newly-diagnosed breast cancer patients were used to examine the relationship between expert-rated measures and a patient-rated measure of QL; to determine whether the Cancer Rehabilitation Evaluation System (CARES), an instrument for assessing the rehabilitation needs of cancer patients, is a measure of QL; to explore whether there are any medical, social or demographic variables which the clinician can use to predict how patients assess their QL; and to determine which variables (expert-rated scales, medical, social or demographic variables, or rehabilitation needs) have the most effect on how patients evaluate their QL. In this sample, patient ratings of QL were widely distributed and were only moderately correlated with the expert-rated Karnofsky Performance Status (r = 0.53) and Global Adjustment to Illness Scale (r = 0.59). In addition, there were no significant correlations between important clinical variables (axillary node status, type of surgery, receipt of chemotherapy) and patient-rated QL. Among the clinical variables and instruments studied, the Global CARES score demonstrated the best correlation (r = -0.74) with the patient-rated assessment of QL. A stepwise multiple linear regression procedure was performed with QL as the dependent variable in order to identify which factors accounted for the most variance in patient assessment of QL. The potential predictor variables used in this procedure were chosen from among those that would be available to a clinician. The Global CARES score was the best single predictor of QL, accounting for 55% of the variance, followed by Karnofsky Performance Status, the Medical Interaction and Sexual summary scales of the CARES, and the patient's educational status. Data from the CARES provided additional descriptive information about the type and frequency of rehabilitation problems experienced by these patients in relation to their ratings of QL.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed1990

Assessing problems of cancer patients: psychometric properties of the cancer inventory of problem situations.

Evaluated the psychometric properties of the Cancer Inventory of Problem Situations (CIPS), a cancer-specific survey instrument designed to assess day-to-day problems and rehabilitation needs of cancer patients. A heterogeneous group of 479 cancer patients participated in the research. The substructure of the CIPS was investigated using factor-analytic techniques. The CIPS was factored into 31 clinically useful subscales. Further analyses led to five higher order factors representing the physical, psychosocial, medical interaction, marital, and sexual problem areas characteristic of cancer and its treatment. Internal consistency of all the scales was high (mean alpha = .81). The test-retest reliability and validity of the instrument were also studied in a sample of 120 patients. Analyses of items, subscales, higher order factors, and total CIPS scores suggest excellent reliability. The pattern of correlations of the CIPS with other measures (psychological distress; physical, marital, and sexual functioning; and quality of life) provided preliminary evidence of concurrent, discriminant, and convergent validity. The CIPS appears to have sound psychometric properties and fills an important gap in the assessment of cancer patients for both clinical and research purposes.

Adaptation, Psychological↗
PubMed1989

Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer. Does chemotherapy make a difference?

Current chemotherapy treatment of metastatic non-small cell lung cancer has demonstrated some objective responses, but is still largely palliative. This report reviews the results of a randomized trial in patients with advanced metastatic non-small cell lung cancer which compared treatment with supportive care (treatment with palliative radiation, psychosocial support, analgesics, nutritional support) to supportive care plus combination chemotherapy with cisplatin and vinblastine. Although the patients receiving combination chemotherapy had a slightly longer median survival (20.43 weeks versus 13.57 weeks), it was not statistically significant (P = 0.09). In addition, the patients receiving chemotherapy experienced serious toxicity, and showed no significant benefit in terms of quality of life as measured by Karnofsky performance status score. The authors conclude that contemporary combination chemotherapy provides only modest survival benefit to patients with advanced metastatic non-small cell lung cancer and should not be considered standard therapy. Future investigations of chemotherapy in patients with unresectable non-small cell lung cancer should continue to utilize control arms which provide high-quality supportive care.

Aged↗
PubMed1988

Estimating the quality of life in a clinical trial of patients with metastatic lung cancer using the Karnofsky performance status and the Functional Living Index--Cancer.

Serial assessments of Karnofsky performance status (KPS) and of the Functional Living Index--Cancer (FLIC) have been used to estimate the quality of life (QOL) of patients in a prospective, randomized trial of supportive care versus supportive care given with combination chemotherapy to patients with metastatic non-small cell lung cancer. There was a good correlation between KPS and FLIC scores at study entry, thus confirming results originally reported using the FLIC. However, a number of unexpected problems were encountered in data collection and quality control with this QOL assessment instrument. This made it impossible to look for differences in treatment effect on QOL in this clinical trial. It is believed that QOL assessment should be an integral part of cancer clinical trials; however, investigators must acknowledge the difficulties in collecting this type of data. The development of new instruments and the refinement of old ones will facilitate the collection of data for this important aspect of clinical trials research.

Aged↗
PubMed1987

Rehabilitation needs and breast cancer: the first month after primary therapy.

Breast cancer is the most common neoplasm in occidental women, yet very little information is available about the rehabilitation needs of these patients. This report reviews in detail the physical, psychological, social, and financial problems identified by fifty women during the first month after primary surgical treatment. The most frequently reported problems were physical and psychological. Patients undergoing modified radical mastectomy (MRM) are compared with patients receiving segmental mastectomy and primary radiotherapy (SM). There were few differences between the two surgical treatment groups; however, patients in the MRM group reported more difficulty with clothing and body image, while the SM group had more disruption of recreation and social activities. Information about the rehabilitation problems of patients with this common neoplasm should be helpful to patients and to the members of the health care team who are helping them recover.

Adult↗
PubMed1987

Evaluation of three biochemical markers for serially monitoring the therapy of small-cell lung cancer.

A number of biochemical markers have been proposed for monitoring the therapy of small-cell lung cancer (SCLC). This report reviews the experience at a single institution using three biochemical markers, alpha-1-acid glycoprotein (AGP), carcinoembryonic antigen (CEA), and lactate dehydrogenase (LDH), for serially monitoring the therapy of patients with SCLC. AGP measurements identified limited-disease patients more frequently than LDH or CEA, and a combination of markers (AGP and LDH) improves the accuracy of correctly classifying patients with active disease. Each of the markers correctly tracked the clinical response to therapy in approximately two thirds of the subjects. The use of a combination of markers should be considered for monitoring the therapy of SCLC in future clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗