Work productivity in brain tumor survivors

OBJECTIVE: To determine the association of symptom burden to work limitation among working survivors of malignant brain tumors. METHODS: Working adults with malignant brain tumors (n = 95) and a non-cancer comparison (n = 131) group completed a web-based questionnaire. Measures of demographics, tumor type and treatment, fatigue, emotional distress, cognitive limitations, and factors that can positively impact work, including health behaviors and problem solving, were obtained. RESULTS: Survivors of malignant brain tumors reported higher levels of work limitations and time off from work than the non-cancer group. Higher levels of symptom burden, lower levels of health behaviors, and more negative problem solving orientation were characteristic of the brain tumor survivor group. These variables were not differentially associated with work limitations among brain cancer survivors or the comparison group. Depressive symptoms, fatigue, cognitive limitations, sleep, and negative problem solving orientation were independently associated with work limitations, accounting for 65% of the variance in work limitations. CONCLUSIONS: Despite higher levels of burden, poorer health behaviors, and negative problem solving coping style, modifiable factors account for most of the variance in work limitations for both groups. Efforts to modify these variables should be evaluated.     

A Scoping Review of Food Insecurity and Related Factors among Cancer Survivors

Despite growing awareness of the financial burden that a cancer diagnosis places on a household, there is limited understanding of the risk for food insecurity among this population. The current study reviewed literature focusing on the relationship between food insecurity, cancer, and related factors among cancer survivors and their caregivers. In total, 49 articles (across 45 studies) were reviewed and spanned topic areas: patient navigation/social worker role, caregiver role, psychosocial impacts, and food insecurity/financial toxicity. Patient navigation yielded positive impacts including perceptions of better quality of care and improved health related quality of life. Caregivers served multiple roles: managing medications, emotional support, and medical advocacy. Subsequently, caregivers experience financial burden with loss of employment and work productivity. Negative psychosocial impacts experienced by cancer survivors included: cognitive impairment, financial constraints, and lack of coping skills. Financial strain experienced by cancer survivors was reported to influence ratings of physical/mental health and symptom burden. These results highlight that fields of food insecurity, obesity, and cancer control have typically grappled with these issues in isolation and have not robustly studied these factors in conjunction. There is an urgent need for well-designed studies with appropriate methods to establish key determinants of food insecurity among cancer survivors with multidisciplinary collaborators.     

Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index

BackgroundOlder adult cancer survivors are at greater risk of cancer recurrence and other comorbidities that can be prevented through improved diet and weight management. The tertiary prevention needs of rural-dwelling survivors can be even greater, yet little is known about rural and urban differences in lifestyle factors among this high-risk population.ObjectivesTo compare dietary patterns of urban and rural cancer survivors and to examine associations of dietary patterns with body mass index (BMI).DesignA secondary analysis was performed of baseline data from the Reach Out to Enhance Wellness (RENEW) trial, a diet and exercise intervention among overweight, long-term (≥5 years), older survivors of colorectal, breast, and prostate cancer. Survivors in the present analysis (n=729) underwent two 45- to 60-minute telephone surveys, which included two 24-hour dietary recalls. Principal components analysis and multivariable general linear models were used to derive dietary patterns and to evaluate associations between dietary patterns and BMI, respectively.ResultsPrincipal components analysis identified three primary dietary patterns among rural dwellers (high sweets and starches, high reduced-fat dairy, cereal, nuts, and fruits, and mixed) and three among urban dwellers (high fruits and vegetables, high meat and refined grains, and high sugar-sweetened beverages). Among rural survivors, greater adherence to the high reduced-fat dairy, cereal, nuts, and fruits pattern was positively associated with lower BMI (P trend <0.05), whereas higher scores on the mixed pattern was associated with greater BMI (P trend <0.05). Greater adherence to the high fruits and vegetables pattern among urban survivors was inversely associated with BMI (P trend <0.05).ConclusionsUrban and rural differences in dietary intake behavior should be considered in designing public health interventions among the increasing population of older cancer survivors. In addition, targeting overall dietary patterns might be one approach to help reduce the burden of obesity among this population.     

Increased mortality among elderly patients with meticillin-resistant Staphylococcus aureus bacteraemia

Despite the high prevalence of meticillin-resistant Staphylococcus aureus (MRSA) infections among the elderly, outcomes of nosocomial MRSA bloodstream infections (BSI) for this patient population have not been fully examined. We performed a case-control study to compare outcomes of hospital-acquired MRSA BSI among patients >/=65 years of age (cases) with those younger than 65 years of age (controls). In a 430-bed tertiary-care teaching hospital, 100 hospitalized patients >/=18 years of age with S. aureus BSI were included in the study. Measurements obtained were: comorbidities, severity of illness at presentation, antibiotic therapy, haematogenous complications and mortality. Overall mortality was significantly higher among cases than controls [36% vs 12%; odds ratio (OR) 4.1, 95% confidence interval (CI) 1.4-14, P<0.01]. A pulmonary source was identified more frequently among elderly patients compared with younger controls (34% vs 16%; OR 2.7, 95%CI 1.1-8.1, P=0.04). On logistic regression, the following variables were independently associated with MRSA BSI among elderly patients: admission to a medical ward (OR 3.1, 95%CI 1.3-7.6, P=0.02), non-central-venous-catheter-related BSI (OR 3, 95%CI 1.2-7.6, P=0.02) and death (OR 3.7, 95%CI 1.3-11, P=0.02). Among patients who received vancomycin, more cases were treated with a reduced dose of vancomycin due to renal insufficiency compared with controls (64% vs 31%; OR 4, 95%CI 2-9, P=0.01). These data suggest that MRSA BSI is associated with significant mortality among the elderly population. Preventing MRSA acquisition among this patient population is of paramount importance.     

Mortality,Health Care Use,and Costs of Clostridioides difficile Infections in Older Adults

ObjectivesEstimate mortality, cost, and health care resource utilization for Medicare beneficiaries aged ≥65 years who suffered a primary Clostridioides difficile infection (CDI) episode only or any recurrent CDI, and understand how outcomes covary with death.DesignRetrospective observational claims analysis.Setting and ParticipantsPatients aged ≥65 years who had an inpatient or outpatient CDI diagnosis claim to Medicare and continuous enrollment in Medicare parts A, B, and D during the 12-month pre- and post-index periods.MethodsUsing 100% Medicare Fee-for-Service claims data for 2009–2017, primary (pCDI, n = 345,893) and recurrent (rCDI: n = 151,596) CDI episodes were identified. Demographic and clinical characteristics, mortality, health care resource utilization, and costs (per patient per month) were summarized for 12 months before and up to 12 months after episode start. Regression models were estimated for hospitalization risk, hospital length of stay (LOS), and cost to adjust for comorbidities.ResultsCDI-associated deaths were almost 10 times higher after recurrent CDI (25.4%) than primary CDI (2.7%). Compared with survivors, decedents were older, had higher Charlson Comorbidity Index scores, and were more likely Black. Adjusting for comorbidities, during follow-up, decedents had higher hospitalization rates [pCDI: odds ratio (OR) = 1.83, P < .001; rCDI: OR = 2.58, P < .001], and recurrent CDI decedents had more intensive care unit use (OR = 2.34, P < .001) compared with survivors. Decedents also had a longer length of stay (pCDI: +3.2 days, P < .001; rCDI: +2.6 days, P < .001), and higher total cost (pCDI: +303%, P < .001; rCDI: +297%, P < .001).Conclusions and ImplicationsCDI is an important contributing diagnosis to all-cause mortality, particularly for recurrences. Prior to death, older Medicare beneficiaries who experienced CDI received longer, more intensive, and more costly care compared with survivors. Clinicians should be particularly attentive to prevention, identification, and appropriate treatment of CDI in older adults. Better treatments to reduce primary C difficile infection and recurrences in this vulnerable population can lower both mortality and economic burden.     

Health knowledge about symptoms of heart attack and stroke in adult survivors of childhood acute lymphoblastic leukemia

PURPOSE: Children with acute lymphoblastic leukemia (ALL), the most common pediatric malignancy, have a 5-year survival rate of better than 80%. Long-term survivors of childhood ALL, however, carry an elevated risk of early mortality from cardiac events and stroke and a disproportionately high prevalence of dyslipidemia and obesity, presumably as an adverse effect of treatment. METHODS: As part of a clinical follow-up study of 70 young adult survivors of childhood ALL, we evaluated the degree to which this high-risk group differed in knowledge about symptoms of heart attack and stroke from that of a population-based comparison group frequency-matched by age, sex, and body mass index. Questions from the Behavioral Risk Factor Surveillance System were used to assess health knowledge. RESULTS: Survivors of ALL scored considerably worse on symptom knowledge than did their population counterparts. The strongest association was observed for chest pain as a symptom of heart attack: ALL survivors were 14-fold more likely than the comparison group to answer the question incorrectly. Seventy-seven percent of survivors failed to identify pain in the jaw, neck, or back as a heart attack symptom. CONCLUSIONS: These results indicate an important gap in knowledge and underscore the need for health education among survivors of childhood leukemia that includes information about symptoms of myocardial infarction and stroke.     

Breast cancer survivors at work

INTRODUCTION:: Residual symptoms such as fatigue, cognitive limitations, and emotional distress can be experienced by cancer survivors. These symptoms may impact their abilities at work. It is unclear to what degree these symptoms are associated with work in occupationally active breast cancer survivors, the most prevalent cancer survivor group. METHODS:: A sample of 100 women working part- or full-time with a history of breast cancer and a noncancer comparison group (n = 103) completed questionnaires related to physical fatigue, depression, anxiety, and cognitive limitations. Demographic variables, job stress, type of job, stage at diagnosis, treatment exposure, and health behaviors were also measured as potential confounders. RESULTS:: Four years postdiagnosis breast cancer survivors reported higher levels of age-adjusted work limitations (F = 32.708, P < 0.001). Significant group by fatigue (beta = -0.311, 95% CI = -0.545 to -0.076) and group by depression (beta = 0.331, 95% CI = 0.024 to 0.638) interactions were observed. Fatigue was more strongly related to work limitations in the cancer survivor group whereas depressive symptoms were more strongly related to limitations at work in the noncancer group. Although fatigue accounted for 22% of the variance in the model, it explained 71% of the contribution of symptom burden to the overall model. CONCLUSIONS:: Fatigue was more strongly related to work in the breast cancer survivor group after accounting for many potential confounders. There is a pressing need to better understand and effectively manage fatigue in the workplace in occupationally active breast cancer survivors.     

Risk of insomnia and hypnotics use among emergency physicians

This study investigated the risk of insomnia and hypnotics use among emergency physicians. This cross-sectional study recruited physicians working in Taiwanese hospitals in 2015 and the general population as the participants. Data from 1,097 emergency physicians obtained from the National Health Insurance Research Database were grouped into the case group, whereas 14,112 nonemergency physicians and 4,388 people from the general population were categorized into the control groups. This study used logistic regression and conditional logistic regression to compare the risks of insomnia between emergency and nonemergency physicians and between emergency physicians and the general population, respectively. The prevalence of insomnia among emergency physicians, nonemergency physicians and general population was 5.56%, 4.08%, and 1.73%, respectively. Compared with nonemergency physicians and the general population, emergency physicians had a significantly higher risk of insomnia. The proportions of emergency physicians, nonemergency physicians, and general population using hypnotics were 19.96%, 18.24%, and 13.26%, respectively. Among emergency physicians who used hypnotics, 49.77%, 25.57%, and 24.66% used only benzodiazepines, only nonbenzodiazepines, and both benzodiazepines and nonbenzodiazepines, respectively. Nonpharmacological interventions to improve insomnia and reminder of safe use of hypnotics to emergency physicians can serve as references for hospitals in developing health-promoting activities.     

Prevalence of health problems and primary care physicians' specialty referral decisions

OBJECTIVE: The researchers tested the hypothesis that the frequency with which patients present to primary care physicians with certain types of health problems is inversely related to the chances of specialty referral during an office visit. STUDY DESIGN: Cross-sectional analysis. POPULATION: The researchers used a data set composed of 78,107 primary care visits from the 1989 to 1994 National Ambulatory Medical Care Surveys. The physicians completed questionnaires after office visits. OUTCOMES MEASURED: The frequency of a health problem's presentation to primary care (practice prevalence) was defined as the percentage of all visits made to family physicians, general internists, and general pediatricians for that particular problem. The researchers estimated the correlation between a condition's practice prevalence and its referral ratio (percentage of visits referred to a specialist) and used logistic regression to estimate the effect of practice prevalence on the chances of referral during a visit. RESULTS: The practice prevalence of a condition and its referral rate had a strong inverse linear relationship (r=-0.87; P<.001). Compared with visits made for the uncommon problems, the odds of referral for those with intermediate or high practice prevalence were 0.49 (P=.004) and 0.22 (P<.001), respectively. Surgical conditions were referred more often than medical conditions, and a greater burden of comorbidities increased the odds of referral. CONCLUSIONS: Primary care physicians are more likely to make specialty referrals for patients with uncommon problems than those with common conditions This finding highlights the responsible judgment primary care physicians employ in recognizing the boundaries of their scope of practice. Practice prevalence is a defining feature of the primary care-specialty care interface.     

医学生失眠情况及相关因素分析

目的:了解医学生中失眠的现况以及探索其相关因素。方法:采用症状自评量表(SCL-90)、流调中心用抑郁量表(CES-D)及自我接纳问卷(SAQ)对医学生进行问卷调查。按症状自评量表(SCL-90)第44、64和66项3项得分将调查对象分为失眠组和非失眠组,分析两组学生精神心理症状、抑郁倾向和自我接纳等因素的分布。结果:调查对象的失眠率为65.8%;男女学生失眠率差异无统计学意义(χ2=1.843,P=0.175);中专学生失眠率(79.9%)高于本科学生(61.7%),差异有统计学意义(χ2=24.52,P<0.001);随着抑郁程度的增加,失眠率有升高趋势(趋势χ2=80.09,P<0.001);失眠组的症状自评量表(SCL-90)各因子均分皆高于非失眠组,差异有统计学意义(P值均<0.001);失眠组的自我接纳(SAQ)两因子得分均低于非失眠组,差异有统计学意义(P值均<0.001);失眠各症状均分与SCL-90总均分及9因子均分均有较高的正相关(相关系数=0.290~0.614);失眠各症状均分与SAQ各因子得分呈负相关(-0.296~-0.147)。结论:医学生中有失眠症状者较为普遍,失眠学生心理问题较多,应加强心理教育。     

Quality of Care for Chronic Diseases in a British Cohort of Long-Term Cancer Survivors

PURPOSE Previous research has shown that long-term cancer survivors with other chronic diseases may receive poorer care for those diseases compared with the general population. We sought to establish the quality of care for chronic diseases among cancer survivors in the United Kingdom.METHODS From the UK General Practice Research Database, we identified 21,366 adult patients who had survived 5 or more years after a diagnosis of breast, colorectal, or prostate cancer with a diagnosis of hypertension, coronary artery disease, diabetes, or cerebrovascular disease. For each patient, an age-sex matched noncancer control patient was selected from the same general practice and with the same chronic disease. We compared the chronic disease care in cancer survivors and their matched controls.RESULTS The proportion of patients meeting quality standards for chronic disease care was high in both cancer survivors and control patients. Although cancer survivors were slightly less likely to receive blood pressure monitoring and cholesterol tests, this difference was no longer apparent if patients who died during the study period were excluded. For instance, 93% of breast cancer survivors received blood pressure monitoring compared with 94% of matched control patients. Similarly, control of disease was comparable among all patients, with the exception of diabetic prostate cancer survivors, who had fewer cholesterol readings under the control limit (17% reduction, 95% CI, 7%–26%) and diabetic colorectal survivors, who had fewer calendar quarters of glycated hemoglobin control (12% reduction, 95% CI, 2%–23%).CONCLUSIONS Care of comorbidities is not neglected in the United Kingdom because people have had a previous diagnosis of cancer. One explanation is that in the United Kingdom, such care is provided through a robust primary care system.     

Prevalence of Psychological Symptoms in Community-Dwelling Chinese American Patients with Chronic Cancer Pain

Cancer is common among older Chinese American immigrants. Psychological distress may be associated with cancer pain, yet prior studies have not examined this relationship. We conducted a secondary analysis of 514 Chinese Americans with cancer-related pain. Patients completed validated questionnaires, including the Chinese Health Questionnaire-12 (CHQ-12). Analyses evaluated associations among sociodemographics, acculturation, psychological distress, and pain variables. Most patients had low acculturation and socioeconomic levels. Overall, 51.9% of patients reported moderate-severe psychological distress, 35.8% reported worst pain intensity ≥7/10 over the previous week and 41.2% had high pain-related distress. Higher CHQ-12 scores were associated with younger age (β?=??0.13); lower educational level (β?=??0.12); birthplace in China (β?=??0.18); lack of a caregiver (β?=??0.10); higher worst pain intensity (β?=?0.15); and higher pain-related distress (β?=?0.28; all p?<?0.05; R² =?0.23). Chinese American cancer patients with chronic pain experience high psychological distress, which is associated with pain characteristics and other social factors.

     

Recommendations for the U.S. National Occupational Research Agenda: Research on Cancer Survivorship and Musculoskeletal Disorders and Work Disability

Occupational health and safety focuses on health problems in the working population. Disability is a significant problem that results in both functional and financial consequences to the worker and society. A problem becoming more evident in the workplace is cancer. As technological advances improve in the early recognition and treatment of cancer and our working population ages, the number of survivors who face challenges returning to work and maximizing productivity while at work will increase. Research is needed to identify the barriers that affect cancer survivors at work and evaluate innovative interventions to assist these workers in both their return to work and long term success at work. Musculoskeletal disorders continue to be a leading cause of work disability in the US. Limited function, pain, lost work time, emotional distress and financial burden are many of the problems associated with musculoskeletal symptoms and disorders. We presented these areas of research needs for the coming decade at the National Occupational Research Agenda (NORA) town hall meeting. The following is our testimony given on December 5, 2005 in College Park, Maryland.     

The effects of age and gender on the prevalence of insomnia in a sample of the Saudi population

Objectives: The aim of this study was to determine the prevalence of insomnia among the Saudi adult population.

Study design: A cross-sectional insomnia survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. The presence of insomnia was defined by difficulty initiating sleep, early morning awakening, or frequent awakening, in addition to the second-day effect in the form of fatigue, tiredness, or changes in the mode because of lack of sleep.

Results: The crude prevalence of insomnia was 77.7% (95% CI?=?75.9–79.5%). The gender-adjusted prevalence of insomnia was higher for females, 88.7% (95% CI?=?86.4–90.7%) than for males, 70.4% (95% CI?=?67.8–72.9%), p-value?=?.001. The age-adjusted prevalence of insomnia was higher for the elderly, 93.7% (95% CI?=?90.6–96.0%) than for the middle aged, 79.8% (95% CI?=?77.4–82.1%), or for the young group, 64.2% (95% CI?=?59.9–68.4%), p-value?=?.001. The Chi-square analyses revealed that (1) being elderly, widowed/divorced, females, or housewives, (2) having a lack of education, and (3) excessive tea consumption were significantly associated with elevated risks for insomnia (p-values?Conclusions: Insomnia is most prevalent among Saudi females and the elderly Saudi population.     

Who tended to continue smoking after cancer diagnosis: the national health and nutrition examination survey 1999--2008

ABSTRACT: BACKGROUND: It has been estimated that there are approximately 12 million cancer survivors in the United States. Continued smoking after a cancer diagnosis is linked to adverse effects among cancer survivors on overall survival, treatment effectiveness, and quality of life. Little is known about who is more likely to quit smoking after his/her cancer diagnosis. The objective of this study is to evaluate factors associated with smoking cessation in cancer survivors, which to date has not been well studied. METHOD: The National Health and Nutrition Examination Survey (NHANES) 1999--2008 surveys were used in this study. A total of 2,374 cancer survivors aged 20 and over with valid smoking status in the NHANES 99--08 survey were included in this study. Among them, 566 cancer survivors who regularly smoked at the time of their cancer diagnosis were included in the analyses. RESULTS: Around 50.6% of cancer survivors smoked regularly prior to their cancer diagnosis and only 36.1% of them quit smoking after their cancer diagnosis. Racial disparity was observed in smoking cessation among cancer survivors. Hispanics (OR = 0.23, 95% CI = 0.10-0.57) were less likely to quit smoking than Whites after their cancer diagnosis. CONCLUSION: Two-thirds of cancer survivors continued smoking after cancer diagnosis. Our study observed that the high risk group of continued smokers among cancer survivors is made up of those who are female, younger, Hispanic, with longer smoking history, underweight or with normal weight and without smoking-related cancer. These findings suggest that smoking cessation for cancer survivors should target on the high risk subgroups.     

Cancer Screening Practices Among Amish and Non‐Amish Adults Living in Ohio Appalachia

Purpose: The Amish, a unique community living in Ohio Appalachia, have lower cancer incidence rates than non‐Amish living in Ohio Appalachia. The purpose of this study was to examine cancer screening rates among Amish compared to non‐Amish adults living in Ohio Appalachia and a national sample of adults of the same race and ethnicity in an effort to explain cancer patterns. Methods: Face‐to‐face interviews focusing on perception of risk, cancer screening behaviors, and screening barriers were conducted among Amish (n = 134) and non‐Amish (n = 154) adults living in Ohio Appalachia. Cancer screening rates were calculated and then compared to a national sample of adults. Findings: More Ohio Appalachia non‐Amish males (35.9% vs 14.5%; P= .022) and females (33.3% vs 12.5%; P= .008) reported that they would probably develop cancer in the future compared to Amish males and females. Amish adults had significantly lower prostate (13.5% vs 63.1% vs 44.6%; P < .001), colorectal (males: 10.3% vs 40.0% vs 37.2%, females: 8.6% vs 31.6% vs 42.9%; P < .001), cervical (48.0% vs 84.0% vs 80.0%; P < .001), and female breast (24.8% vs 53.7% vs 56.9%; P < .05) cancer screening rates compared to Ohio Appalachia non‐Amish participants and a national sample of adults, respectively. Barriers to cancer screening were similar among the 2 Ohio groups; however, Amish males reported that prostate cancer screening was not necessary more often than did Ohio Appalachia non‐Amish males (78.6% vs 16.7%; P= .003). Conclusions: Lower rates of cancer screening were documented among the Amish and may be a contributing factor to the reduced cancer incidence rates reported among this population.     

Apathy: prevalence, associated factors, and prognostic value among frail, older inpatients

ObjectivesThe association of apathy with Alzheimer disease and other dementias and caregiver burden has been examined in a number of studies; however, less is known about its relationship with delirium and mortality. We aimed to investigate the prevalence, relationship with delirium and dementia, and prognostic value of apathy in an elderly and frail inpatient population.Setting and ParticipantsThe cohort included 425 patients in acute geriatric wards and in 7 nursing homes in Helsinki (1999–2000). Demographic factors, physical functioning, diagnoses, and drugs were assessed with special reference for dementia, delirium, and apathy. Mortality was registered from central registers.ResultsOf the patients, 98 (23.1%) suffered from apathy, and it was more frequent among men (32% versus 21% women, P = .037 ). There was no difference in mean age, number of comorbidities, or in the mean number of medications between those with and without apathy; however, those with apathy had lower mean MMSE points (9.2 versus 14.0 without apathy, P < .001), more often severe dementia according to Clinical Dementia Rating, and higher dependence in activities of daily living (P = .001). Furthermore, patients with apathy were more often suffering from delirium (37.8% versus 21.1%, P ≤ .001). Mortality during the 1-year follow-up was 34.7% (n = 34) and 22.0% (n = 72) among individuals with and without apathy, respectively (P = .011). In the Cox proportional hazard model with age, gender, activities of daily living, and delirium as covariates, apathy significantly predicted mortality (HR 1.89, 95% CI 1.24 to 2.89; P = .003).ConclusionsApathy is a common and serious neuropsychiatric symptom associated with cognitive decline, delirium, and disability, and it also independently predicts mortality.