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Diana Sarfati MBChB MPH PhD Bogda Koczwara BMBS MBioethics Christopher Jackson MBChB 《CA: a cancer journal for clinicians》2016,66(4):337-350
Answer questions and earn CME/CNE Comorbidity is common among cancer patients and, with an aging population, is becoming more so. Comorbidity potentially affects the development, stage at diagnosis, treatment, and outcomes of people with cancer. Despite the intimate relationship between comorbidity and cancer, there is limited consensus on how to record, interpret, or manage comorbidity in the context of cancer, with the result that patients who have comorbidity are less likely to receive treatment with curative intent. Evidence in this area is lacking because of the frequent exclusion of patients with comorbidity from randomized controlled trials. There is evidence that some patients with comorbidity have potentially curative treatment unnecessarily modified, compromising optimal care. Patients with comorbidity have poorer survival, poorer quality of life, and higher health care costs. Strategies to address these issues include improving the evidence base for patients with comorbidity, further development of clinical tools to assist decision making, improved integration and coordination of care, and skill development for clinicians. CA Cancer J Clin 2016;66:337‐350. © 2016 American Cancer Society. 相似文献
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Laura Ashley PhD Claire Surr PhD Rachael Kelley RMN PhD Mollie Price PhD Alys Wyn Griffiths PhD Nicole R. Fowler MHSA PhD Dana E. Giza MD Richard D. Neal MBChB FRCGP PhD Charlene Martin PhD Jane B. Hopkinson RGN PhD Anita O’Donovan PhD William Dale MD PhD Bogda Koczwara BMBS MBioethics Katie Spencer MB BChir FRCR PhD Lynda Wyld MBChB FRCS PhD 《CA: a cancer journal for clinicians》2023,73(3):320-338
As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families. 相似文献
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Robin Z. Hayeems PhD Fiona A. Miller PhD Yvonne Bombard PhD Denise Avard PhD June Carroll MD Brenda Wilson MBChB MSc MRCP FFPH Julian Little PhD Pranesh Chakraborty MD Jessica Bytautas BA Yves Giguere MD PhD Judith Allanson MD Renata Axler MBioethics 《Health expectations》2015,18(3):419-429
Objectives
Newborn bloodspot screening (NBS) panels have expanded to include conditions for which treatment effects are less certain, creating debate about population‐based screening criteria. We investigated Canadian public expectations and values regarding the types of conditions that should be included in NBS and whether parents should provide consent.Methods
Eight focus groups (FG; n = 60) included education, deliberative discussion and pre‐/post‐questionnaires. Data were analysed quantitatively and qualitatively.Results
Quantitatively, the majority supported NBS for serious disorders for which treatment is not available (95–98, 82%). A majority endorsed screening without explicit consent (77–88%) for treatable disorders, but 62% supported unpressured choice for screening for untreatable disorders. Qualitatively, participants valued treatment‐related benefits for infants and informational benefits for families. Concern for anxiety, stigma and unwanted knowledge depended upon disease context and strength of countervailing benefits.Conclusions
Anticipated benefits of expanded infant screening were prioritized over harms, with information provision perceived as a mechanism for mitigating harms and enabling choice. However, we urge caution around the potential for public enthusiasm to foster unlimited uptake of infant screening technologies. 相似文献5.
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Breast cancer screening—opportunistic use of registry and linked screening data for local evaluation 下载免费PDF全文
David Roder DDSc MPH BDS Gelareh Farshid MBBS MD FRCPA FFSc Grantley Gill MBBS MD FRACS Jim Kollias MB BS FRACS Bogda Koczwara BM BS FRACP MBioethics Chris Karapetis MBBS FRACP MMedSc Jacqui Adams MBBS PhD FRACP MRCP Rohit Joshi MB BS MD FRACP Dorothy Keefe PSM MBBS MD FRACP FRCP Kate Powell BA.Bus Kellie Fusco BHlth Sci DipBiomedSc Marion Eckert MPH DNurs MN DipAppSc Kerri Beckmann PhD MPH BSc 《Journal of evaluation in clinical practice》2017,23(3):508-516
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Lisa Beatty B Psych Melissa Oxlad M Psych PhD Bogda Koczwara BM BS FRACP MBioethics Tracey D. Wade M Psych PhD 《Health expectations》2008,11(4):331-342
Objective To qualitatively identify the concerns and needs of Australian women recently diagnosed with breast cancer. Background Breast cancer diagnosis can lead to impairment in multiple areas of psychosocial well‐being, including physical, social and emotional functioning. Research has therefore begun to focus on identifying and addressing survivors’ concerns and needs, with most research examining the time of treatment completion. However diagnosis and treatment are also key times of psychological need, and less is known about the psychosocial concerns and needs at these times. Research design Seven focus group interviews were conducted examining three categories of participants: (i) patients diagnosed with early‐stage breast cancer within the past 12 months, (ii) oncology nurses, and (iii) volunteers who work with cancer patients. Sampling was discontinued when informational redundancy was achieved. Setting and participants Thirty‐four participants took part in one of seven focus group meetings held in a hospital patient resource room. Results A wide variety of psychosocial concerns and needs were discussed, and five specific areas of concern were identified: (i) coping with side‐effects; (ii) dealing with self‐concept change; (iii) stress and adjustment reactions; (iv) having to manage others’ unhelpful beliefs, expectations and emotions; and (v) issues with survival and growth. There was a large degree of consistency in the concerns and needs identified by the different group categories. Conclusion In general, the concerns and needs expressed were consistent with survivorship issues previously identified in the literature; however, several new insights were obtained. Clinical implications of these findings are discussed. 相似文献
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Assessing impact of organised breast screening across small residential areas—development and internal validation of a prediction model 下载免费PDF全文
G. Farshid MBBS MD FRCPA FFSc G. Gill MBBS MD FRACS J. Kollias FRACS MD B. Koczwara BM BS FRACP MBioethics C. Karapetis MBBS FRACP MMedSc J. Adams MBBS PhD FRACP MRCP R. Joshi MBBS MD FRACP D. Keefe PSM MBBS MD FRACP FRCP T. Niyonsenga MSC PhD K. Powell BABus K. Fusco BHlth Sci DipBiomedSc M. Eckert MPH DNurs MN DipAppSc K. Beckmann PhD MPH BSc D. Roder DDSc MPH BDS 《European journal of cancer care》2017,26(4)
Monitoring screening mammography effects in small areas is often limited by small numbers of deaths and delayed effects. We developed a risk score for breast cancer death to circumvent these limitations. Screening, if effective, would increase post‐diagnostic survivals through lead‐time and related effects, as well as mortality reductions. Linked cancer and BreastScreen data at four hospitals (n = 2,039) were used to investigate whether screened cases had higher recorded survivals in 13 small areas, using breast cancer deaths as the outcome (M1), and a risk of death score derived from TNM stage, grade, histology type, hormone receptor status, and related variables (M2). M1 indicated lower risk of death in screened cases in 12 of the 13 areas, achieving statistical significance (p < .05) in 5. M2 indicated lower risk scores in screened cases in all 13 areas, achieving statistical significance in 12. For cases recently screened at diagnosis (<6 months), statistically significant reductions applied in 8 areas (M1) and all 13 areas (M2). Screening effects are more detectable in small areas using these risk scores than death itself as the outcome variable. An added advantage is the application of risk scores for providing a marker of screening effect soon after diagnosis. 相似文献
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