Patterns In Cancer Patients Research Articles

Use of general practice, diagnostic investigations and hospital services before and after cancer diagnosis - a population-based nationwide registry study of 127,000 incident adult cancer patients.

BackgroundKnowledge of patterns in cancer patients’ health care utilisation around the time of diagnosis may guide health care resource allocation and provide important insights into this groups’ demand for health care services. The health care need of patients with comorbid conditions far exceeds the oncology capacity and it is therefore important to elucidate the role of both primary and secondary care. The aim of this paper is to describe the use of health care services amongst incident cancer patients in Denmark one year before and one year after cancer diagnosis.MethodsThe present study is a national population-based case–control (1:10) registry study. All incident cancer patients (n = 127,210) diagnosed between 2001 and 2006 aged 40 years or older were identified in the Danish Cancer Registry. Data from national health registries were provided for all cancer patients and for 1,272,100 controls. Monthly consultation frequencies, monthly proportions of persons receiving health services and three-month incidence rate ratios for one year before and one year after the cancer diagnosis were calculated. Data were analysed separately for women and men.ResultsThree months before their diagnosis, cancer patients had twice as many general practitioner (GP) consultations, ten to eleven times more diagnostic investigations and five times more hospital contacts than the reference population. The demand for GP services peaked one month before diagnosis, the demand for diagnostic investigations one month after diagnosis and the number of hospital contacts three months after diagnosis. The proportion of cancer patients receiving each of these three types of health services remained more than 10% above that of the reference population from two months before diagnosis until the end of the study period.ConclusionsCancer patients’ health service utilisation rose dramatically three months before their diagnosis. This increase applied to all services in general throughout the first year after diagnosis and to the patients’ use of hospital contacts in particular. Cancer patients’ heightened demand for GP services one year after their diagnosis highlights the importance of close coordination and communication between the primary and the secondary healthcare sector.

Abstract 5511: Cancer care-seeking patterns in Kumasi, Ghana

Abstract Background and Objective: Data from each of the 32 sentinel hospitals within the 10 regions of Ghana indicate that cancer is among the top ten causes of death in the country and it also appears to be on the rise. Barriers that delay detection and treatment of cancer compound the untoward consequences of this rising incidence. Over 80% of cancer patients at Komfo Anokye Teaching Hospital (KATH) in Kumasi present to the hospital in Stage III or later, and data indicate that even those relatively rare patients who are identified through detection and screening in Ghana still present late to the hospital. Thus, understanding and addressing the causes of delayed or dropped treatment appears to be important steps that will guide policies for early detection and treatment. We conducted this study to identify the care-seeking and referral patterns of cancer patients before arriving at and within KATH to reach specialized cancer treatment. Methods: Semi-structured interviews with cancer patients were conducted between June-July 2011 at the Oncology Directorate at KATH, which is one of Ghana's two National Centers for Radiotherapy and Nuclear Medicine. Patients were asked about their care-seeking patterns from the beginning of their symptoms until their arrival at the Oncology Directorate, and about the barriers they faced during their care-seeking process. Abstraction of relevant clinical data from patient medical records was done to complement and validate data from the interviews. Preliminary Results: We attempted 224 interviews, with a final eligible sample size of 216 completed interviews. Over 56% of those interviewed were new patients first seen in the Oncology Directorate in 2011. Nearly 78% of the patients were females, consistent with the gender distribution of the Directorate. The most common cancers in our sample were: cervical and uterine (32.71%), breast (27.10%), head and neck (16.36%) and prostate (4.67%), approximately reflecting the different tumor types diagnosed in the Directorate overall. Patients interviewed came from all ten regions of Ghana, with 65.7% from the Ashanti region in which KATH is located. Patients reported visiting an average of 2 facilities before arriving at KATH, with an average time between initial symptoms and the first point of care being 4 months and a range of less than one month to over 6.5 years. Conclusions: Preliminary results suggest that the care-seeking patterns of cancer patients in Ghana might differ from what is commonly believed, with approximately 7% of the respondents reporting that they visited the facility of a traditional healer, herbalist or faith healer. Moreover, system-related delays may play a larger role in delayed care compared to patient-related delays. Further analysis from this study are ongoing and will help identify factors that impact the delay between the onset of cancer symptoms and presentation to treatment facilities and also factors that are amenable to modification within the Ghanaian health system. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5511. doi:1538-7445.AM2012-5511

Why Do Patients Seek an Alternative Channel? The Effects of Unmet Needs on Patients' Health-Related Internet Use

Breast cancer is the most common form of cancer found among women in the United States. During the course of the illness, women diagnosed with breast cancer need information and support to cope with the illness. To understand what leads women with breast cancer to consult the Internet for health-related information, we examined how unmet needs—needs that have not been satisfied—in regards to information and emotional support determine patterns of cancer patients' health-related Internet use. Using data collected from 122 women diagnosed with breast cancer, we found that the higher the unmet need for information was, the more likely individuals were to spend time in specialized health information. Likewise, the higher the unmet need for emotional support was, the more likely individuals were to spend time in social support services such as discussion groups. Implications for future research on unmet needs and the use of the Internet were discussed.

Mood and Anxiety Symptoms among Advanced Cancer Patients: Kids Matter (720)

Objectives 1. Recognize that patients with metastatic spinal cord compression have limited life span. 2. Recognize that very low percentage of patients with metastatic spinal cord compression had advanced care plan in a tertiary cancer center. 3. Discuss the urgency to initiate an earnest and close dialogue between the treating physician and his patient. I. Background. End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs). Metastatic spinal cord compression (MSCC) has a median survival time of 3e6 months; yet there is little DNR utilization data in this population. II. Research Objectives. The objective of this study was to determine DNR utilization patterns in cancer patients with MSCC. III. Methods. A retrospective database analysis (March 2003eJune 2008) of DNR data for 88 cancer patients who had MSCC and required rehabilitation consultation at M. D. Anderson Cancer Center (MDACC) was performed. IV. Results. The mean age of this patient population was 54-years-old (range 14e81). Thirty patients were female (33%), 20 patients (23%) had a living will, 27 patients (31%) had identified a healthcare proxy, and 5 patients (6%) had DNR directives. The median survival for these patients was 4.2 months. V. Conclusion. Even with strong evidence showing the median life span of MSCC patients is 3e6 months; it seems many patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-of-life palliative care and suboptimal doctor-patient communication. Using this catastrophic event to trigger communication and initiate palliative care may be beneficial. VI. Implications for Research, Policy, or Practice. Clinicians can be better equipped with evidence on cancer patients’ prognosis and apply it when initiating end-of-life conversations with cancer patients.

Utilization of Darbepoetin alfa in Relation to Cancer Patients' Hemoglobin Levels.

Background: Prevailing guidelines through 2006 recommended initiating erythropoiesis stimulating agents (ESAs) for chemotherapy-induced anemia (CIA) at hemoglobin (Hb) levels <11 g/dL, maintaining near 12 g/dL, and withholding at >13 g/dL.Objective and Purpose: To determine darbepoetin alfa (DA) administration patterns in cancer patients and selected factors related to such use.Methods: A retrospective ESA administration-level analysis of Varian Medical Systems electronic medical records (EMRs), which includes 122,985 cancer patients across 13 states and 82 physical sites of care. The study period was 1/1/2005 – 11/30/2006. All DA administrations were recorded with the most recent Hb (day of or up to 7 days prior to administration). The proportion of DA administrations at Hb ≥ 12 and Hb ≥ 13 g/dL were the primary outcome measures. Utilization by Hb level was analyzed for all administrations, stratifying by year, gender, and anemia type. The types of anemia assessed were CIA, anemia of cancer (AOC), and myelodysplastic syndrome (MDS).Results: During the 23 month period, there were 33,923 DA administrations associated with Hb results in 5,252 patients. The proportion of all DA administrations given at Hb≥12 was 7.7%, for Hb≥13 g/dL it was 1.1%; proportions for CIA, AOC, and MDS were 8.1 /1.2% (N = 25,638 administrations), 7.5 /1.0% (N = 7,054), and 2.3 /0.2% (N = 1,231) for Hb ≥12 and ≥13 g/dL respectively. The difference across all three indications was statistically significant (P < 0.005) for both Hb thresholds. Overall, the proportion of all DA administrations at Hb ≥12 g/dL and ≥13 g/dL declined from 8.6% to 7.1% (p<.0001) and from 1.3% to 1.0% (p<.06) respectively in 2005 vs. 2006.Conclusions: In this population, DA administration at Hb ≥ 12 and Hb ≥ 13 occurred in approximately 7.7% and 1.1% of administrations, respectively. The results suggest that for the majority of administrations the prevailing guidelines at the time were adhered to by clinicians. Further research is required to understand dose titrations at Hb from 12 – 13 g/dL.

DNR patterns in cancer patients (pts) 16 years after the Patient Self Determination Act (PSDA)

6582 Background: In 1991, the PSDA required institutions receiving federal funding to inform pts about the right to refuse life prolonging treatments such as CPR. Studies conducted around 1991 suggest that most DNR orders are written by oncologists less than 3 days prior to death in hospitalized pts, raising ethical concerns. 16 years later, are oncology clinicians writing DNR orders earlier in cancer pts’ hospital course compared to non-cancer pts? Methods: We conducted a chart review of 284 of the 296 total adult deaths during 2005 at Indiana University Hospital. Demographic, diagnostic, and attending service info was collected from hospital billing records. Pts’ DNR status, timing of DNR orders, and presence of a written advanced directive (AD) were assessed through chart review. Results: 76 of 284 (26.8%) patients had cancer diagnoses. Of these, 59 had documented DNR orders. There was no difference in presence or absence of DNR orders at the time of death for cancer vs. non-cancer pts (77.6 vs 72.7%, p=0.35). Mean time from writing of the DNR order to death was 3.51 ± 4.61 days for cancer pts compared to 3.26 ±3.81 days for non-cancer pts (p=0.40), however, the majority of DNR orders written by oncologists were written less than 2 days prior to death. We calculated a ratio of the time between DNR order writing and death to the overall length of stay for cancer and non-cancer pts, excluding pts with very short lengths of stay ( = 5 days). In univariate analyses, this ratio trended toward statistical significance (p=0.08). In multivariate analyses, cancer pts had a higher ratio of the time between DNR order and death to LOS (0.30 vs 0.21, p=0.05). Existence of an AD had no significant impact on this ratio. Surgical specialists wrote DNR orders less frequently (64.2 vs 77.3%, p=0.02) and later than non-surgical specialists (mean 21 vs 10 days from admission, p=0.0008). Conclusions: In this study, DNR ordering patterns among hospitalized cancer and non-cancer pts have changed little since the PSDA. Although cancer pts on average had DNR orders written relatively earlier in their terminal hospital stay than non-cancer pts, the timing varied little from pts in prior studies. Although the majority of hospitalized pts in this sample died with DNR orders, these orders were written very late in their hospital stay. No significant financial relationships to disclose.

Cancer testing in a large German hospital with special reference to immunoglobulin E (IgE) and amino acid patterns in cancer patients.

Cancer testing in a large German hospital with special reference to immunoglobulin E (IgE) and amino acid patterns in cancer patients.