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Mahumud RA, Shahjalal M, Dahal PK, Mosharaf MP, Mistry SK, Koly KN, Chowdhury SH, Renzaho AMN, Gow J, Alam K, Wawryk O. Emerging burden of post-cancer therapy complications on unplanned hospitalisation and costs among Australian cancer patients: a retrospective cohort study over 14 years. Sci Rep 2025; 15:4709. [PMID: 39922897 PMCID: PMC11807139 DOI: 10.1038/s41598-025-89247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/04/2025] [Indexed: 02/10/2025] Open
Abstract
Cancer treatment using systemic therapy and radiotherapy may cause post-therapy complications, resulting in increased unplanned hospitalisation. The evidence on such complications, their impact on unplanned hospitalisations, and associated costs is scant in Australia. We aimed to estimate the prevalence of post-therapy complications, evaluate their impact on unplanned hospitalisation, length of stay (LOS) and investigate the associated medical costs. A retrospective cohort study was conducted among 8,633 cancer patients (1.03 million emergency hospital admissions) in Victoria, Australia from July 2006 to June 2020, from the Australian healthcare system perspective. Multivariate generalised linear regression models were employed to estimate the adjusted association between post-therapy complications and clinical characteristics with hospital LOS and associated hospitalisation medical costs. Approximately 52% of patients were male with an average patient age of 59.9 years. Annually, post-therapy complications leading to unplanned hospitalisations increased by 7.25%, outpacing the growth in overall hospitalisation admissions, which was 5.66% for overall hospitalisation admissions. A significant proportion of patients (71%) experienced multiple complications, with the most common being anemia (26%), sepsis (15%), nausea and vomiting (14%), and neutropenia (11%). Patients undergoing combined systemic and radiotherapy exhibited higher odds of post-therapy complications (OR = 8.24, 95%CI: 7.48 to 9.08) compared with those who only received systemic therapy. Mean hospital stay among patients who experienced post-therapy complications was 2.23 days per admission (360 days per patient), an extra 1.72 days per admission [95%CI: 1.68 to 1.76; 354 days per patient, 95%CI: 336 to 371 days] longer than patients without complications (0.51 days per admission and 6.48 days per patients). Overall, per-admission medical hospitalisation costs among patients with post-therapy complications were $8,791 higher than for patients who did not experience complications ($11,418 vs. $2,627 per admission, 95%CI: $8,685 to $8,897). Per-patient costs for unplanned hospitalisation due to post-therapy complications were significantly $1.82 million higher among patients than those without complications ($1.86 million vs. $33,599 per patient, 95%CI: $1.71 million to $1.94 million). The cost and hospitalisation stay (in days) varied by the type of therapy and cancer type. The study results indicate that post-therapy complications in cancer patients varied by the type of cancer and increased over the study period, leading to longer unplanned hospital stays and higher hospitalisation medical costs. The results highlight the need for better-customized treatment delivery strategies to address this burden and optimise resources in cancer care.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Health Technology Assessment Unit, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Md Shahjalal
- Global Health Institute, Department of Public Health, North South University, Dhaka 1229, Bangladesh.
| | - Padam Kanta Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Sydney, NSW, Australia
| | - Md Parvez Mosharaf
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Sabuj Kanti Mistry
- School of Population Health, University of New South Wales, Sydney, Australia
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Kamrun Nahar Koly
- Health System and Population Studies Division, Urban Health, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Andre M N Renzaho
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Jeff Gow
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
- School of Health, University of Sunshine Coast, Sippy Downs, QLD, 4556, Australia
| | - Khorshed Alam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Olivia Wawryk
- Department of General Practice, Victorian Comprehensive Cancer Centre, Data Connect, University of Melbourne, Parkville, VIC, Australia
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Hematopoiesis, Inflammation and Aging-The Biological Background and Clinical Impact of Anemia and Increased C-Reactive Protein Levels on Elderly Individuals. J Clin Med 2022; 11:jcm11030706. [PMID: 35160156 PMCID: PMC8836692 DOI: 10.3390/jcm11030706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/27/2023] Open
Abstract
Anemia and systemic signs of inflammation are common in elderly individuals and are associated with decreased survival. The common biological context for these two states is then the hallmarks of aging, i.e., genomic instability, telomere shortening, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Such aging-associated alterations of hematopoietic stem cells are probably caused by complex mechanisms and depend on both the aging of hematopoietic (stem) cells and on the supporting stromal cells. The function of inflammatory or immunocompetent cells is also altered by aging. The intracellular signaling initiated by soluble proinflammatory mediators (e.g., IL1, IL6 and TNFα) is altered during aging and contributes to the development of both the inhibition of erythropoiesis with anemia as well as to the development of the acute-phase reaction as a systemic sign of inflammation with increased CRP levels. Both anemia and increased CRP levels are associated with decreased overall survival and increased cardiovascular mortality. The handling of elderly patients with inflammation and/or anemia should in our opinion be individualized; all of them should have a limited evaluation with regard to the cause of the abnormalities, but the extent of additional and especially invasive diagnostic evaluation should be based on an overall clinical evaluation and the possible therapeutic consequences.
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Barca-Hernando M, Muñoz-Martin AJ, Rios-Herranz E, Garcia-Escobar I, Beato C, Font C, Oncala-Sibajas E, Revuelta-Rodriguez A, Areses MC, Rivas-Jimenez V, Ballaz-Quincoces A, Moreno-Santos MA, Lopez-Saez JB, Gallego-Gallego I, Elias-Hernandez T, Asensio-Cruz MI, Chasco-Eguilaz L, Garcia-Gonzalez G, Estevez-Garcia P, Marin-Barrera L, Otero-Candelera R, Lopez-Ruz S, Lima-Alvarez J, Sanchez-Diaz JM, Real-Dominguez M, Borrego-Delgado MC, Marin-Romero S, Jara-Palomares L. Case-Control Analysis of the Impact of Anemia on Quality of Life in Patients with Cancer: A Qca Study Analysis. Cancers (Basel) 2021; 13:2517. [PMID: 34063886 PMCID: PMC8196564 DOI: 10.3390/cancers13112517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/03/2021] [Accepted: 05/16/2021] [Indexed: 01/22/2023] Open
Abstract
Anemia is a common condition in cancer patients and is associated with a wide variety of symptoms that impair quality of life (QoL). However, exactly how anemia affects QoL in cancer patients is unclear because of the inconsistencies in its definition in previous reports. We aimed to examine the clinical impact of anemia on the QoL of cancer patients using specific questionnaires. We performed a post-hoc analysis of a multicenter, prospective, case-control study. We included patients with cancer with (cases) or without (controls) anemia. Participants completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaire version 3.0 (EORTC QLQ-C30) and Euro QoL 5-dimension 3-level (EQ-5D-3L) questionnaire. Statistically significant and clinically relevant differences in the global health status were examined. From 2015 to 2018, 365 patients were included (90 cases and 275 controls). We found minimally important differences in global health status according to the EORTC QLQ-C30 questionnaire (case vs. controls: 45.6 vs. 58%, respectively; mean difference: -12.4, p < 0.001). Regarding symptoms, cancer patients with anemia had more pronounced symptoms in six out of nine scales in comparison with those without anemia. In conclusion, cancer patients with anemia had a worse QoL both clinically and statistically.
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Affiliation(s)
- Maria Barca-Hernando
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Andres J. Muñoz-Martin
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (A.J.M.-M.); (I.G.-G.); (G.G.-G.)
| | - Eduardo Rios-Herranz
- Hematology and Hemotherapy Department, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain;
| | - Ignacio Garcia-Escobar
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Carmen Beato
- Medical Oncology Department, Hospital Virgen de la Macarena, 41009 Sevilla, Spain;
| | - Carme Font
- Medical Oncology Department, DIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clínic, 08036 Barcelona, Spain;
| | | | | | | | - Victor Rivas-Jimenez
- Medical Oncology Department, Hospital de Jerez de la Frontera, 11407 Cádiz, Spain;
| | - Aitor Ballaz-Quincoces
- Respiratory Department, Hospital de Galdakao-Usansolo, 48960 Bizkaia, Spain; (A.B.-Q.); (L.C.-E.)
| | | | | | - Iria Gallego-Gallego
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (A.J.M.-M.); (I.G.-G.); (G.G.-G.)
| | - Teresa Elias-Hernandez
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Maria Isabel Asensio-Cruz
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Leyre Chasco-Eguilaz
- Respiratory Department, Hospital de Galdakao-Usansolo, 48960 Bizkaia, Spain; (A.B.-Q.); (L.C.-E.)
| | - Gonzalo Garcia-Gonzalez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, 28009 Madrid, Spain; (A.J.M.-M.); (I.G.-G.); (G.G.-G.)
| | | | - Lucia Marin-Barrera
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Remedios Otero-Candelera
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Sergio Lopez-Ruz
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Jorge Lima-Alvarez
- Respiratory Department, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain;
| | - Jose Maria Sanchez-Diaz
- Medical Surgical Unit of Respiratory Diseases, Pharmacy, Respiratory Department, Hospital Virgen del Rocio, 41013 Sevilla, Spain;
| | - Macarena Real-Dominguez
- Department of Preventive Medicine and Public Health, Universidad de Málaga, 29071 Málaga, Spain;
| | - Maria Carmen Borrego-Delgado
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Samira Marin-Romero
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
| | - Luis Jara-Palomares
- Medical Surgical Unit of Respiratory Diseases, Respiratory Department, Hospital Virgen del Rocio, CIBERES, 41013 Sevilla, Spain; (M.B.-H.); (T.E.-H.); (M.I.A.-C.); (L.M.-B.); (R.O.-C.); (S.L.-R.); (M.C.B.-D.); (S.M.-R.)
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Loh KP, Lam V, Webber K, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Castillo DA, DiGiovanni G, Mohile SG, Walter LC, Wong ML. Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults. J Natl Compr Canc Netw 2021; 19:1055-1062. [PMID: 33857918 DOI: 10.6004/jnccn.2020.7684] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult-specific and non-older adult-specific studies were compared using the Fisher exact test. RESULTS We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult-specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics. CONCLUSIONS Functional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).
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Affiliation(s)
- Kah Poh Loh
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Vivian Lam
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Katey Webber
- 3School of Public Health, University of California, Berkeley, Berkeley, California
| | - Simran Padam
- 4Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Mina S Sedrak
- 4Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Vivek Musinipally
- 5Department of Adult and Family Medicine, Kaiser Permanente, San Francisco, California
| | - Madison Grogan
- 6Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Carolyn J Presley
- 6Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Janice Grandi
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Chandrika Sanapala
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Daniel A Castillo
- 7Edward G. Miner Library, University of Rochester School of Medicine and Dentistry, Rochester, New York; and
| | - Grace DiGiovanni
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Supriya G Mohile
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Louise C Walter
- 8Division of Geriatrics, University of California, San Francisco, and.,9San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Melisa L Wong
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.,8Division of Geriatrics, University of California, San Francisco, and.,9San Francisco Veterans Affairs Medical Center, San Francisco, California
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Liu J, Chen S, Ye X. The effect of red blood cell transfusion on plasma hepcidin and growth differentiation factor 15 in gastric cancer patients: a prospective study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:466. [PMID: 31700902 DOI: 10.21037/atm.2019.08.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Hepcidin and growth differentiation factor 15 (GDF-15) have been reported to be highly expressed in various cancers. Serum hepcidin and GDF-15 levels were demonstrated to be potential prognostic markers in cancers. This study aims to evaluate the effect of red blood cell (RBC) transfusion on plasma hepcidin and GDF-15 in gastric cancer patients. Methods In this prospective study, 40 patients with gastric cancer were eligible for this study. Peripheral blood samples were obtained before and within 24 h after RBC transfusion. A routine blood test was performed before transfusion and within 24 h post-transfusion. Plasma hepcidin, GDF-15, interleukin 6 (IL-6) and erythropoietin were determined by ELISA. Results In patients with metastasis, plasma hepcidin (P=0.02), and GDF-15 (P=0.01) levels were higher than without metastasis. Plasma hepcidin was increased after RBC transfusion (P=0.001), while plasma erythropoietin was decreased after transfusion (P=0.03). However, RBC transfusion did not affect plasma GDF-15 (P=0.32) and IL-6 (P=0.12). The effect of RBC transfusion on variables did not differ between metastatic and non-metastatic patients. The mean percentage change of hepcidin in transfusion volume 4 unit (U) was more than 2 U. Conclusions RBC transfusion could increase plasma hepcidin and have no effect on plasma GDF-15 in gastric patients.
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Affiliation(s)
- Jingfu Liu
- Department of Blood Transfusion, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Shan Chen
- Department of Blood Transfusion, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China
| | - Xianren Ye
- Department of Blood Transfusion, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China.,Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou 350014, China
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Lavdaniti M, Zyga S, Vlachou E, Sapountzi-Krepia D. Quality of Life in Elderly Cancer Patients Undergoing Chemotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 989:291-295. [PMID: 28971438 DOI: 10.1007/978-3-319-57348-9_27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION As life expectancy increases, it is expected that 60% of all cases of cancer will be detected in elderly patients in the next two decades. Cancer treatment for older persons is complicated by a number of factors, thus negatively affecting patients' quality of life. PURPOSE The purpose of this study is to investigate quality of life in elderly cancer patients undergoing chemotherapy. MATERIAL AND METHOD This study was descriptive and non-experimental. It was conducted in one large hospital in a major city of Northern Greece. The sample was convenience comprising 53 elderly cancer patients undergoing cycle 3 chemotherapy. The data was collected using the Functional Assessment of Cancer Therapy scale and included questions related to demographic and clinical characteristics. RESULTS The majority of participants were men (n = 27, 50.9%) who were married (n = 32, 79.5%). Their mean age was 70.07 ± 3.60. Almost half of the sample (n = 30, 56.6%) had colon cancer. There was a statistical significant difference between men and women pertaining to physical wellbeing (p = 0.004) and overall quality of life (p < 0.001). When comparing each subscale with the patients' marital status it was found that there was a statistical difference with respect to social/family wellbeing (p = 0.029), functional wellbeing (p = 0.09) and overall quality of life (p < 0.001). Moreover, the type of cancer affected overall quality of life (p < 0.001) and social/family wellbeing (p = 0.029). CONCLUSIONS These findings call attention to quality of life and its related factors in elderly cancer patients. It is highly recommended to envisage measures for improving quality of life in this group of cancer patients.
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Affiliation(s)
- Maria Lavdaniti
- Nursing Department, Research Laboratory "Care in Adult Cancer Patients", Alexander Technological Educational Institute of Thessaloniki, P.O. Box 141, GR-574 00, Thessaloniki, Greece.
| | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | - Eugenia Vlachou
- Nursing Department, Technological Educational Institute of Athens, Egaleo, Greece
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Shahid S. Review of hematological indices of cancer patients receiving combined chemotherapy & radiotherapy or receiving radiotherapy alone. Crit Rev Oncol Hematol 2016; 105:145-55. [PMID: 27423975 DOI: 10.1016/j.critrevonc.2016.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 01/18/2023] Open
Abstract
We observed the outcomes of chemotherapy with radiotherapy (CR) or radiotherapy (RT) alone for cancer patients of larynx, breast, blood and brain origins through complete blood count (CBC). Following were more depressed in CR patients: mean corpuscular hemoglobin-MCH & lymphocytes-LYM, hematocrit, mean corpuscular hemoglobin concentration-MCHC, hemoglobin-HB and red blood cells-RBC. In RT patients, following were more depressed: LYM, MCH and MCHC. Overall, in all cancer patients, the lymphocytes were depressed 52%. There existed a significant difference between white blood cells and RBC in both CR and RT patients. A significant moderate negative correlation is found in HB with the dose range 30-78 (Gray) given to the CR cancer patients. More number of CBC parameters affected in patients treated with CR and RT; but in less percentage as compared to patients who treated with RT alone. The cancer patients suffered from anemia along with immune modulations from the treatments.
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Affiliation(s)
- Saman Shahid
- Department of Sciences and Humanities, National University of Computer and Emerging Sciences (NUCES)-Foundation for Advancement of Science and Technology (FAST), Lahore, Pakistan.
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Evaluating the utility of existing patient-reported outcome scales in novel patient populations with pancreatic cancer, lung cancer, and myeloproliferative neoplasms using medicare current beneficiary survey data. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 6:189-200. [PMID: 23828691 PMCID: PMC3751268 DOI: 10.1007/s40271-013-0018-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND While there are validated patient-reported outcomes (PRO) instruments for use in specific cancer populations, no validated general instruments exist for use in conditions common to multiple cancers, such as muscle wasting and consequent physical disability. The Medicare Current Beneficiary Survey (MCBS), a survey in a nationally representative sample of Medicare beneficiaries, includes items from three well known scales with general applicability to cancer patients: Katz activities of daily living (ADL), Rosow-Breslau instrumental ADL (IADL), and a subset of physical performance items from the Nagi scale. OBJECTIVE This study evaluated properties of the Katz ADL, Rosow-Breslau IADL, and a subset of the Nagi scale in patients with pancreatic cancer, lung cancer, and myeloproliferative neoplasms (MPN) using data from MCBS linked with Medicare claims in order to understand the potential utility of the three scales in these populations; understanding patient-perceived significance was not in scope. METHODS The study cohorts included Medicare beneficiaries aged ≥65 years as of 1 January of the year of their first cancer diagnosis with one or more health assessments in a community setting in the MCBS Access to Care data from 1991 to 2009. Beneficiaries had at least two diagnoses in de-identified Medicare claims data linked to the MCBS for one of the following cancers: pancreatic, lung, or MPN. The Katz ADL, Rosow-Breslau IADL, and Nagi scales were calculated to assess physical functioning over time from cancer diagnosis. Psychometric properties for each scale in each cohort were evaluated by testing for internal consistency, test-retest reliability, and responsiveness by comparing differences in mean scale scores over time as cancer progresses, and differences in mean scale scores before and after hospitalization (for lung cancer cohort). RESULTS The study cohorts included 90 patients with pancreatic cancer, 863 with lung cancer, and 135 with MPN. Among each cancer cohort, the Katz ADL, Rosow-Breslau IADL, and Nagi scales had acceptable internal consistency (Cronbach's alpha generally between 0.70 and 0.90) and test-retest reliability for consecutive surveys before diagnosis and consecutive surveys after diagnosis (when patients' functioning was more stable). Compared with mean scale scores at the survey 1-2 years before cancer diagnosis (baseline), mean scale scores at the first survey after cancer diagnosis were significantly higher (P < 0.05), indicating worsening, for Katz ADL, Rosow-Breslau IADL, and Nagi scales (items scored 0-1) (0.54 vs. 1.45, 1.15 vs. 2.20, and 2.29 vs. 3.08, respectively, for pancreatic cancer; 0.73 vs. 1.24, 1.29 vs. 2.01, and 2.41 vs. 2.85 for lung cancer; and 0.44 vs. 0.86, 0.87 vs. 1.36, and 1.87 vs. 2.32 for MPN). Among lung cancer patients, scale scores increased significantly following a hospitalization, suggesting a worsening of functional status. CONCLUSIONS The Katz ADL, Rosow-Breslau IADL, and Nagi scales collected in the MCBS demonstrate acceptable internal consistency and test-retest reliability among patients with pancreatic cancer, lung cancer, and MPN, and are consistent with clinical worsening following diagnosis or hospitalization. These results suggest that using retrospective data may allow researchers to conduct preliminary assessments of existing PRO instruments in new populations of interest and generate useful exploratory disease information before embarking on de novo PRO development.
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