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Biomedical subjects

V Mor

Publications and source records attributed to V Mor.

At least 163 records · Page 9Linked to original sources
PubMed1988

Lung, breast, and colorectal cancer: the relationship between extent of disease and age at diagnosis.

We examined the relationship between age and extent of disease at initial diagnosis as part of a population-based, prospective study documenting the patterns of care received by over 1500 newly diagnosed lung, breast, and colorectal cancer patients identified in nine Rhode Island hospitals. For each cancer site examined, no age by extent of disease relationship was observed; however, analysis by sex among lung cancer patients indicated an inverse age relationship for men. The absence of an age effect for breast cancer patients is in contrast to earlier research findings that identify a positive association between extent of disease and age at diagnosis. Past results may reflect age-related differences in patient and physician screening behavior characteristic of earlier time periods.

Age Factors↗
PubMed1988

Clinical symptoms and length of survival in patients with terminal cancer.

Planning terminal care for patients with malignant neoplasms is difficult, in part, because accurate measures of prognosis have not been defined. Using data from the National Hospice Study, we examined the correlation of 14 easily assessable clinical symptoms with survival in patients with terminal cancer. Performance status was the most important clinical factor in estimating survival time, but five other symptoms had independent predictive value as well (shortness of breath, problems eating or anorexia, trouble swallowing, dry mouth, and weight loss). We generated four parametric accelerated time survival models to estimate survival in patients with combinations of these symptoms and validated the log-normal model on the entire data set. This model was unaffected by patient age, sex, primary tumor type, or site. Our findings illustrate the value of biologically "soft" clinical data in predicting survival in patients with terminal cancer. The prevalence of similar symptoms among patients with cancer of various primary and metastatic sites also supports the concept of a common final clinical pathway in patients with advanced malignant neoplasms.

Aged↗
PubMed1987

Cancer patients' quality of life over the disease course: lessons from the real world.

We examined the correlates of the Quality of Life Index (QLI) in three samples of cancer patients: newly diagnosed (N = 397), recipients of chemotherapy (N = 194), and terminal (N = 2046). The relative importance of physical, emotional, social, and disease symptom characteristics in predicting the QLI was compared across samples. Despite differences in data collection approaches (telephone, personal interview, or paper and pencil) and differences in patient characteristics, the QLI was a robust construct with its central organizing principle being physical functioning. In all samples, functioning, symptoms, depression, and social support were significant predictors of the QLI, while age and cancer type were only minimally related. The QLI significantly differentiated between patients at different disease phases and measured more than physiological functioning. However analyses suggested that the dominant factor constraining the range of human psychosocial functioning was physical condition.

Aged↗
PubMed1987

Physicians' use of health resources for terminal cancer patients: clinical setting versus physician specialty.

A large proportion of all Medicare reimbursements (22%) are made for terminally ill patients. Alternative methods of care for such patients (for example, hospice care) may be more appropriate and less costly. The role of physician characteristics in determining use of resources for terminal patients is compared with that of care setting (type of facility), using data from the National Hospice Study. Multiple logistic regression reveals a stronger relationship between care setting and resource utilization than between physician "aggressiveness" and utilization. Physician specialty has little effect on utilization. These findings suggest that care setting may influence physician practice behavior. This may be due to self-selection of particular types of physicians or patients, or to a characteristic of the facility itself.

Health Resources↗
PubMed1986

An alternative in terminal care: results of the National Hospice Study.

Hospice is a program of supportive services for terminally ill patients and their families, provided either at home or in designated inpatient settings, which is purported to improve patient and family quality of life at lower cost than conventional terminal care. The National Hospice Study was a multi-site, quasi-experimental study to compare the experiences of terminal cancer patients and their families in hospices with those of similar patients and families receiving conventional terminal care. The results indicate that, although care is different in hospices, e.g. lesser utilization of aggressive interventional therapy and diagnostic testing, patients' quality of life is similar in the hospice and conventional care systems with the exception of pain and symptom control, which may be better in the inpatient hospice setting. Hospice patients are more likely to die at home and their families are satisfied with that outcome. Otherwise, no consistent superiority of family outcome was associated with the hospice approach. The cost of hospice care is less than that of conventional terminal care for patients in hospices without inpatient facilities, but the cost of hospice appears to be equivalent to conventional care for patients in hospices having beds.

Adult↗
PubMed1986

The effect of treatment setting and patient characteristics on pain in terminal cancer patients: a report from the National Hospice Study.

Debilitating pain is the symptom most often associated with cancer by the general public. The National Hospice Study (NHS) evaluated pain control among terminal cancer patients served in hospital based (HB) and home based (HC) hospices, and in conventional care settings (CC) such as outpatient clinics and oncology units. Pain was reported by the patient when able to respond and by the patients' primary care person (PCP) during repeated interviews until death. Patient and PCP pain reports were correlated at 0.43. PCPs reported that around 16% of patients were pain free in the last weeks of life while 18% were in persistent pain. Statistically adjusting for differences in the CC, HB, and HC samples, HB patients were less likely to report having persistent pain than either CC or HC patients, although there were no differences in the proportion of patients who were pain free. Age was negatively correlated with the level of pain. As expected, brain and bone metastases were related to pain in opposite directions, with more pain among those with bone involvement and less among those with brain involvement. Conclusions about whether HB hospices really are superior at pain control must be made cautiously in view of the relationship between age and pain and the greater age of hospice patients in our study.

Adult↗
PubMed1986

Analgesic use in terminal cancer patients: report from the National Hospice Study.

Little systematic research has been reported on analgesic use in terminal cancer patients. This paper presents data from the National Hospice Study on the use of analgesics by a sample of terminal cancer patients served in home based and hospital based hospice programs as well as conventional oncological settings. Patients in hospital based hospice programs were more likely than other patients to have an analgesic prescription and to have consumed analgesics. Patients in hospice settings were more likely to consume analgesia orally and less likely to have "prn" (as needed) analgesic prescriptions. The amount of analgesic consumption was inversely related to age. The paper discusses the implications of these and other findings for the treatment of pain in terminal cancer patients.

Adult↗
PubMed1986

Secondary morbidity among the recently bereaved.

Discussions of the health consequences of bereavement have appeared with increasing frequency in the literature in recent years. Capitalizing on one of the largest samples of bereaved subjects to date, the authors analyzed National Hospice Study bereavement interview data regarding the rate of medical care use and short-term secondary morbidity. Results suggest that physician visit rates were somewhat higher but hospitalization rates lower among the recently bereaved than age- and sex-adjusted national norms. Multivariate analyses revealed that previous health problems and having been married to the deceased were consistently the strongest predictors of morbidity and health care use.

Adolescent↗
PubMed1986

Dyspnea in terminally ill cancer patients.

To determine the epidemiology of dyspnea in terminal cancer patients, we examined data from the National Hospice Study, which followed up patients during their last six weeks of life. The incidence of dyspnea in these patients was 70.2 percent, with prevalence rates generally exceeding 50 percent at any of three measurements. In addition to lung or pleural involvement by the tumor, the presence of underlying lung disease or cardiac and low performance on the Karnofsky scale were significantly associated with dyspnea. Lung, colorectal, and breast carcinomas were the most common tumor sites in our dyspneic patients and accounted for almost 60 percent of cancer diagnoses in these patients. In 23.9 percent of dyspneic terminal cancer patients, neither lung or pleural involvement nor underlying lung or heart disease could be identified as risk factors.

Aged↗
PubMed1986

Simulating the impact of case-mix adjusted hospice rates.

The Medicare hospice benefit prospectively reimburses hospices based on the inpatient status of the patient, whether or not the patient is at home, and whether the patient is receiving round-the-clock nursing. Using national Hospice Study data, two case-mix adjusters based on patient functioning and living arrangement were found to be significantly related to per diem cost. These were tested by simulating their impact on hospice revenues. Increasing per diem reimbursements 35 percent for nonambulatory patients living alone only increases hospice revenues by 4 percent; hospices with sicker patients benefit the most.

Analysis of Variance↗
PubMed1986

Nausea and vomiting in terminal cancer patients.

Using data from the National Hospice Study, nausea and vomiting in terminal cancer patients and physician response to these symptoms were studied. Nausea and vomiting developed in 62% of terminal cancer patients with prevalence rates of at least 40% during the last six weeks of life. Stomach and breast cancer were significantly more likely to be associated with nausea and vomiting; lung and brain primary sites were significantly less likely to have this association. Although women and younger patients reported higher rates, no relationship could be demonstrated between these symptoms and the Karnofsky level or chemotherapy during the last six weeks of life. In the subsample for whom medication use was known, 32% of nauseated patients received antiemetic prescriptions. Physicians were less likely to prescribe antiemetics for elderly patients and those with serious mental impairment. When prescribed, 72% of nauseated patients consumed antiemetics.

Antiemetics↗