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81.
Davis K Yount S Del Ciello K Whalen M Khan S Bass M Du H Eton D Masters G Hensing T Cella D 《The journal of supportive oncology》2007,5(8):381-387
Treatment for advanced lung cancer is not curative; therefore, the primary goals of its care are to maximize symptom management and minimize treatment toxicity. Increasingly, patient-reported symptoms and health-related quality of life (HRQL) outcomes have been accepted as important endpoints; several validated measures have gained wide acceptance in research, but their use in practice has been limited. Computer technology increasingly is used to reduce patient and administrative burden in conducting assessments to produce a real-time presentation of symptom and HRQL data.This paper describes a technology-based monitoring system developed for patients with advanced lung cancer who were starting chemotherapy. Among the 90 participants, compliance with the weekly symptom survey was 92%. Patient acceptability of the system was high, as evidenced by 30 patients who elected to complete an additional monitoring interval beyond the 12-week study period. Of patients who reported discussing their responses with a provider (95%), a majority (69%) stated that the questionnaire helped them to focus on issues to be discussed with their physicians. The system also was favorably reviewed by physicians, who indicated that the report helped them to compare patients' responses over time. Next steps will include a randomized trial to test the system's efficacy in improving symptom management. 相似文献
82.
Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice 总被引:1,自引:0,他引:1
Butt Z Wagner LI Beaumont JL Paice JA Peterman AH Shevrin D Von Roenn JH Carro G Straus JL Muir JC Cella D 《Journal of pain and symptom management》2008,35(1):20-30
Fatigue, pain, distress, and anorexia are four commonly encountered symptoms in cancer. To evaluate the usefulness of a single-item screening for these symptoms, 597 ambulatory outpatients with solid tumors were administered a self-report screening instrument within the first 12 weeks of chemotherapy. Patients rated the severity of each symptom on a 0-10 scale, at its worst over the past three days, with higher ratings associated with higher symptom levels. From this sample, 148 patients also completed a more comprehensive assessment of these symptoms. Two criteria were used to determine optimal cut-off scores on the screening items: 1) the sensitivity and specificity of each screening item to predict clinical cases using receiver-operating characteristics analysis and 2) the proportion of patients at each screening score who reported that some relief of the target symptom would significantly improve their life. Optimal cut-off scores ranged from 4 to 6 depending on the target symptom (area under the curve range=0.68-0.88). Use of single-item screening instruments for fatigue, pain, distress, and anorexia may assist routine clinical assessment in ambulatory oncology practice. In turn, such assessments may improve identification of those at risk of morbidity and decreased quality of life due to excess symptom burden. 相似文献
83.
Elizabeth B Lynch Zeeshan Butt Allen Heinemann David Victorson Cindy J Nowinski Lori Perez David Cella 《Journal of rehabilitation medicine》2008,40(7):518-523
BACKGROUND: Stroke is a leading cause of long-term disability in the USA; however, we have an incomplete understanding of how stroke affects long-term quality of life. METHODS: We report here findings from focus groups with 9 long-term stroke survivors and 6 caregivers addressing patients' post-stroke quality of life. RESULTS: Key themes identified by patients were: social support, coping mechanisms, communication, physical functioning and independence. Role changes in patients were important to caregivers. Much of the discussion with patients and caregivers described specific ways in which the stroke altered social relationships. CONCLUSION: These findings are consistent with prior research indicating the importance of social factors to quality of life following stroke. Our findings suggest that measures of stroke-related quality of life should include assessment of social function and social support. 相似文献
84.
85.
Cornella C Brustia M Lazzarich E Cofano F Ceruso A Barbé MC Fenoglio R Cella D Stratta P 《Transplantation proceedings》2008,40(6):1865-1866
Kidney transplantation not only drastically improves the life-expectancy of hemodialyzed patients, but it also affords psychological and social advantages with improvements in short- and long-term personal and working lives. Quality of life (QoL) is one of the parameters of psychological well-being. There is an improvement of QoL from pre- to posttransplant, but it is not to the level of healthy samples. The aim of this study was to examine QoL in older renal transplant recipients. All recipients older than age 60 were included, with a minimum follow-up of 12 months. To measure QoL, the nationally standardized ShortForm-36 (SF-36) questionnaire was administered. The SF-36 responses by our patients were compared with national age- and gender-appropriate norms, and also between genders. The enrolled population included 19 women (36.5%) and 33 men (63.5%), with a mean age of 66.8 years (range, 60-73 years). Enrolled women reported significant limitations compared to gender- and age-matched norms in social activities (42.11 vs 70.58), perception of pain (22.11 vs 59.17), and general health perception (39.58 vs 48.69). Enrolled men reported significant limitations compared to gender- and age-matched norms in social activities (46.59 vs 78.35), perception of pain (18.18 vs 73.62), psycho-physical energy (50.15 vs 67.88), and general health perception (37.33 vs 61.66). No significant differences were noted between the genders. This study clearly showed how the psychological state was not as good as the clinico-physical recovery following renal transplantation in older recipients. 相似文献
86.
Locker GY Mansel R Cella D Dobrez D Sorensen S Gandhi SK;ATAC Trialists' Group 《Breast cancer research and treatment》2007,106(2):229-238
Background This study evaluated the cost-effectiveness of anastrozole versus generic tamoxifen for primary adjuvant treatment of postmenopausal
women with hormone receptor-positive (HR+) early breast cancer (EBC), from a US healthcare perspective.
Methods A probabilistic Markov model was developed using the 5-year completed treatment analysis of the ATAC (‘Arimidex’, Tamoxifen
Alone or in Combination) trial (ISRCTN 18233230) to project outcomes for anastrozole and tamoxifen to 25 years. Resource utilization
data were obtained primarily from published literature and a physician survey (including expert opinion from ATAC Steering
Committee members). Drug costs were taken from published wholesale acquisition costs (anastrozole $6.56/day, generic tamoxifen
$1.33/day). Other unit costs ($US 2003–4) were from standard sources. Utility estimates of relevant health states, used to
compute quality-adjusted life-years (QALYs), were collected using the standard gamble technique in a cross-sectional sample
of 44 patients. Costs and benefits were discounted 3% annually.
Results In a cohort of 1000 postmenopausal women with HR+ EBC, the model showed anastrozole treatment (versus tamoxifen) would lead
to 257 QALYs gained (0.26 QALYs gained per patient), at an additional cost of $5.21 million over 25 years ($5,212 per patient).
The estimated incremental cost-effectiveness ratio (ICER) of anastrozole compared with tamoxifen was $20,246 per QALY gained
($23,541 per life-year gained). Cost-effectiveness acceptability curves indicated a >90% probability that the cost per QALY
gained with anastrozole would be <$50,000. Results were robust in a sensitivity analysis.
Conclusion Anastrozole is a cost-effective alternative to tamoxifen for the primary adjuvant treatment of postmenopausal women with HR+
EBC. 相似文献
87.
D Cella M D Michaelson A G Bushmakin J C Cappelleri C Charbonneau S T Kim J Z Li R J Motzer 《British journal of cancer》2010,102(4):658-664
Background:
In a randomised phase III trial, sunitinib significantly improved efficacy over interferon-α (IFN-α) as first-line therapy for metastatic renal cell carcinoma (mRCC). We report the final health-related quality of life (HRQoL) results.Methods:
Patients (n=750) received oral sunitinib 50 mg per day in 6-week cycles (4 weeks on, 2 weeks off treatment) or subcutaneous IFN-α 9 million units three times weekly. Health-related quality of life was assessed with nine end points: the Functional Assessment of Cancer Therapy–General and its four subscales, FACT–Kidney Symptom Index (FKSI-15) and its Disease-Related Symptoms subscale (FKSI-DRS), and EQ-5D questionnaire''s EQ-5D Index and visual analogue scale. Data were analysed using mixed-effects model (MM), supplemented with pattern-mixture models (PMM), for the total sample and the US and European Union (EU) subgroups.Results:
Patients receiving sunitinib reported better scores in the primary end point, FKSI-DRS, across all patient populations (P<0.05), and in nine, five, and six end points in the total sample, in the US and EU groups respectively (P<0.05). There were no significant differences between the US and EU groups for all end points with the exception of the FKSI item ‘I am bothered by side effects of treatment'' (P=0.02). In general, MM and PMM results were similar.Conclusion:
Patients treated with sunitinib in this study had improved HRQoL, compared with patients treated with IFN-α. Treatment differences within the US cohort did not differ from those within the EU cohort. 相似文献88.
Synergistic effect of growth hormone-releasing hormone (GHRH) and clonidine in stimulating GH release in young and old dogs 总被引:1,自引:0,他引:1
The effect of acute administration of growth hormone-releasing hormone (GHRH), clonidine (CLO), an alleged GHRH releaser, or GHRH and clonidine given simultaneously was studied in young and old dogs. Simultaneous administration of CLO induced in young dogs an additive effect on GH release and potentiated in old dogs the GHRH-induced GH release, with the GH response being clearly higher than the sum of the GH responses to GHRH or CLO alone. These data suggest that CLO promotes GH release in the dog also by inhibition of somatostatin release. 相似文献
89.
Brian E Saelens James F Sallis Denise E Wilfley Kevin Patrick John A Cella Richard Buchta 《Obesity research》2002,10(1):22-32
OBJECTIVE: This study evaluates the post-treatment and short-term follow-up efficacy of, as well as participant satisfaction for, a 4-month behavioral weight control program for overweight adolescents initiated in a primary care setting and extended through telephone and mail contact. RESEARCH METHODS AND PROCEDURES: 44 overweight adolescents were randomly assigned to either a multiple component behavioral weight control intervention (Healthy Habits [HH]; n = 23) or a single session of physician weight counseling (typical care [TC]; n = 21). Weight, height, dietary intake, physical activity, sedentary behavior, and problematic weight-related and eating behaviors and beliefs were assessed before treatment, after the 4-month treatment, and at 3-month follow-up. Participant satisfaction and behavioral skills use were measured. RESULTS: HH adolescents evidenced better change in body mass index z scores to post-treatment than TC adolescents. Body mass index z scores changed similarly in the conditions from post-treatment through follow-up. Behavioral skills use was higher among HH than TC adolescents, and higher behavioral skills use was related to better weight outcome. Energy intake, percentage of calories from fat, physical activity, sedentary behavior, and problematic weight-related or eating behaviors/beliefs did not differ by condition or significantly change over time independent of condition. The behavioral intervention evidenced good feasibility and participant satisfaction. DISCUSSION: A telephone- and mail-based behavioral intervention initiated in primary care resulted in better weight control efficacy relative to care typically provided to overweight adolescents. Innovative and efficacious weight control intervention delivery approaches could decrease provider and participant burden and improve dissemination to the increasing population of overweight youth. 相似文献
90.
Psychological adjustment to survival from Hodgkin's disease 总被引:4,自引:0,他引:4