Charles W. Given

Correlates of community service attitudes among family caregivers

This article examines caregiver and care recipient characteristics associated with community service attitudes. Using Community Service Attitude Inventory subscales that were refined for use across populations, the relationship between caregiver gender, age, relationship, type of medical diagnosis, and scores on attitude subscales were investigated in a sample of 562 family caregivers. Attitudes toward services were found to be associated with caregiver gender, age, and diagnosis. Implications for research and practice are presented.

Primary malignant brain tumor incidence and Medicaid enrollment.

Background: The relationship between socioeconomic status and health care disparities in the incidence of brain tumors is unclear. Objective: To identify the associations between age, sex, and Medicaid enrollment and the incidence of primary malignant brain tumors in Michigan in 1996 and 1997. Methods: Records were obtained from the Michigan Cancer Surveillance Program on the 1,006 incident cases during this period and cross-checked with Medicaid enrollment files. Results: Persons enrolled in Medicaid were more likely than non-enrolled persons to develop a malignant brain tumor of any type, a glioblastoma multiforme, and an astrocytoma for certain subgroups. In addition, incidence rates for malignant brain tumors in persons enrolled in Medicaid peaked at a younger age. Conclusion: Sociodemographic status may be associated with cerebral malignancy and should be considered when targeting treatment and educational interventions at persons at risk.

A web-based program to engage informal caregivers to support patients through chemotherapy.

90 Background: Most interventions to improve cancer symptoms rely on patient self-management, which can be challenging for some. Cancer CarePartners is a system designed to engage informal caregivers to support patients quality of life as they receive chemotherapy. The system provides weekly, automated telephonic symptom assessment to patients, and symptom alerts plus tailored advice to their caregivers. We conducted a randomized control trial to test the efficacy of this program in controlling symptoms and improving adherence to chemotherapy.nnnMETHODSnConsenting patients with solid tumors undergoing chemotherapy that reported any symptom at ³3 (out of 10) and had a consenting caregiver were randomly assigned to 10 w of either Cancer CarePartners or an attention control. Arms were balanced for lung cancer and caregiver type. Subjects were surveyed at 0, 10, and 14 weeks; charts were reviewed at 14 weeks. We tracked patient and caregiver use of the system.nnnRESULTSn834 patients were referred to the study and 371 (45%) met eligibility criteria. Among the 151 (41%) patients who consented, 91% entered the study and 82% completed the trial. Patients completed assessments for most weeks on study (mean 7.7 intervention vs. 8.3 control). Intervention caregivers logged into the Website an average of 4.1 times over 10 weeks (range 0-10). At 10 weeks, intervention patients experienced lower summed symptom severity than controls (mean 19.5 vs. 23.2), but this was not statistically significant after adjusting for baseline symptoms (P = 0.107). They also experienced fewer inpatient stays (mean 0.19 vs. 0.34, P = 0.1814) and phone calls with providers (mean 0.46 vs. 0.62, P = 0.3019) than controls did. They received more chemotherapy (# agents per cycle 3.6 vs. 3.1 P = 0.0395; # agents per infusion 2.2 vs. 2.0 P = 0.0054). Intervention caregivers reported less depression (CESD Coef -1.08, P = 0.094, 95% CI -2.35 to 0.19), and similar burden as controls.nnnCONCLUSIONSnCancer CarePartners enhances caregiver support for patients and improves their symptom management and adherence with chemotherapy as a result, while adding little burden to the caregiver. One limitation of the study is that recruitment was less than expected.nnnCLINICAL TRIAL INFORMATIONnIIR 08-309.