J. C. Kurtz

The interaction of age, symptoms, and survival status on physical and mental health of patients with cancer and their families.

Background. During the course of cancer treatment and as the disease progresses, symptoms may worsen and physical status may deteriorate. The interaction of age, symptoms, and nearness to death on the physical and mental health of patients and family members has not been examined.

Psychological and sexual well-being, philosophical/spiritual views, and health habits of long-term cancer survivors.

The results of a survey on various aspects of quality of life for 191 women who were long-term cancer survivors are presented. We explored six areas--somatic concerns, health habits, psychological state, sexual satisfaction, social/emotional support giving, and philosophical/spiritual view--and whether differences existed in them among the women on the basis of age, educational level, income level, length of survival, location of residence (urban, suburban, or rural), cancer site, and whether a recurrence of the cancer had been experienced. Generally, the women reported good psychological states and relative satisfaction with their sexual lives. However, women who had experienced a recurrence of their cancer, were longer term survivors, or suffered from breast cancer all reported higher levels of somatic concerns. Women with higher levels of education or income and those who had had a recurrence of their cancer indicated a greater willingness to provide social and emotional support to other women newly diagnosed with cancer. Women who had a positive philosophical/spiritual outlook were more likely to have good health habits and be supportive of others. There was no statistically significant variation among the women in either health habits or psychological state for any of the factors considered.

Physical functioning and depression among older persons with cancer

PURPOSE The purpose of this study was to help identify factors to assess which elderly patients are likely to experience problems with physical and psychological functioning in association with cancer or its treatment. DESCRIPTION OF STUDY A study was undertaken with a sample of 420 patients with cancer who were between the ages of 65 and 98 years and had received an incident diagnosis of breast, colon, lung, or prostate cancer. An analysis of covariance technique was used to determine how cancer site, treatment type, stage of disease, gender, age, comorbidity, symptom severity, and pre-diagnosis levels of physical functioning were related to physical functioning deficit, and how all of these in turn influenced patient depressive symptomatology. RESULTS Pre-diagnosis physical functioning, symptom severity, and days since surgery were significant predictors of physical functioning deficit. Patients who had been treated only with surgery experienced greater physical functioning deficits than did patients who had received both surgery and adjuvant therapy. This apparent anomaly was partly explained by the time interval from surgery to interview. Higher levels of symptom severity, lower levels of prior physical functioning, and greater physical functioning deficits all predicted higher levels of depressive symptomatology. CLINICAL IMPLICATIONS In the care of elderly patients with cancer, it is important for healthcare providers to consider the pre-diagnosis levels of physical functioning of patients with cancer to understand and anticipate the physical and psychological consequences of cancer and its treatment. Equally important is the proper management of patient symptoms in maximizing both the physical and psychological quality of life.

Symptomatology and Loss of Physical Functioning Among Geriatric Patients with Lung Cancer

In this study of 129 geriatric patients with lung cancer, we investigated how symptom severity varied according to treatment type, stage of disease, and gender; how change in physical functioning (prediagnosis versus post-hospital discharge) was predicted by symptomatology, prior physical functioning, comorbidity, and age; and whether differences exist according to stage of disease, treatment status, or gender. Data were gathered through patient interviews and audits of patient records. Analysis of variance (ANOVA) techniques revealed that there were no significant differences in average symptom severity scores by gender, treatment categories, or stages of disease. Significant predictors of loss of physical functioning were symptom severity, prior physical functioning and patient age. Characteristics of a profile for elderly lung cancer patients at high risk of suffering substantial losses in physical functioning include higher prior levels of physical functioning, higher levels of current symptomatology, and lower age.

Loss of physical functioning among geriatric cancer patients: relationships to cancer site, treatment, comorbidity and age

This study investigated differences in physical functioning and physical role limitations according to cancer site and treatment modality in a sample of 590 patients 65 years and older diagnosed with breast, colon, lung or prostate cancer. Analysis of covariance procedures were utilised to test for differences in levels of physical functioning and physical role limitations according to cancer site and treatment modality, adjusting for differences in age, comorbid conditions and retrospective physical functioning. Physical functioning and physical role limitations were measured using two subscales of the Medical Outcomes Studies MOS 36-item Short Form Health Survey (SF-36). Physical functioning prior to diagnosis, and to a lesser degree comorbidity, contributed significantly to current levels of physical functioning and physical role limitations. Patients with lung cancer reported lower physical functioning and physical role limitation scores than patients with prostate cancer, and patients treated with surgery only reported lower physical functioning and physical role limitation scores than patients treated with neither surgery nor radiation. No gender differences were observed among the reduced sample consisting of patients with colon or lung cancer. It is important not only that physicians and oncologists are cognizant of the fact that some cancers (particularly lung cancer) may be more physically debilitating than others, but that the patients history of comorbid conditions and pre-existing physical limitations may be important factors in predicting current physical functioning.

Relationships of barriers and facilitators to breast self-examination, mammography, and clinical breast examination in a worksite population.

The American Cancer Society recommends a regimen for breast cancer screening that includes mammograms, clinical breast examination, and breast self-examination. Compliance with breast cancer screening guidelines has been linked to a number of barriers and facilitators. These barriers and facilitators seem to lie within the cognitive framework and generalized beliefs of women, and in the situational contexts in which they lead their lives. A comprehensive study was designed to investigate variables related to breast cancer screening behaviors (breast self-examination, mammography, and clinical breast examination) of working women ≥ 35 years of age at their worksite environments. A factor analysis identified similar sets of composite variables related to each of the screening modalities, and a discriminant analysis was performed for each screening technique to identify those variables that were most significant in predicting compliance with screening guidelines. The variables discomfort, perceived efficacy, and desire for control over health were significant for all three screening behaviors. Perceived importance was identified as a fourth variable for mammography and clinical breast examination, and lack of knowledge was a fourth variable for breast self-examination. Effective breast cancer screening programs involve all three screening techniques. In the design of education and intervention programs at worksites, it is critical to emphasize the commonalities of the variables that emerged in this study as important for each screening technique.

Predictors of use of health care services among elderly lung cancer patients: the first year after diagnosis

In this study, we investigated predictors of utilization of physician, hospital, and emergency room services in a sample of 277 elderly patients during the first year following a diagnosis of lung cancer. Data were obtained by a combination of patient interview and patient self-administered questionnaire at four intervals: baseline (wave 1), 3 months (wave 2), 6 months (wave 3), and 12 months (wave 4). Of the 277 patients, 242 provided data at wave 1, 209 at wave 2, 157 at wave 3, and 115 at wave 4. Symptomatology was assessed with the Symptom Experience Scale (simple count of symptoms present, chosen from a list of 37 cancer-related symptoms), and physical functioning was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey. Analysis of covariance models were implemented separately for the active treatment period (0–6 months) and the continuing care period (6–12 months) to determine how age, gender, comorbidity, length of survival, treatment status, stage of disease, cancer site, physical functioning, and symptom count were related to physician visits, nights in hospital, and emergency room visits. During the active treatment period, patients with worse physical functioning reported more hospital nights (p=0.002) and more emergency room visits (p=0.013), while men reported more frequent emergency room visits (p=0.032) and more nights in hospital (p=0.006) than women. Patients reporting more symptoms also reported more physician visits (p=0.020). During the continuing care period, physical functioning had a similar relation to hospital nights (p=0.005) and emergency room visits (p=0.003), and patients with late-stage disease reported more physician visits than patients with early-stage disease (p=0.003).

Sources of Information on the Health Effects of Environmental Tobacco Smoke Among African- American Children and Adolescents

PURPOSE To determine the common sources of information regarding the effects of smoking on health and their relationship to knowledge, attitudes, and preventative efforts regarding exposure to environmental tobacco smoke (ETS) among urban African-American children and adolescents. METHODS All students who were enrolled in Grades 5-12 in an urban public school district located in the greater metropolitan area of Detroit, Michigan were surveyed using a structured, written questionnaire that assessed sources of information on the health effects of smoking, as well as knowledge, attitudes, and preventive efforts with respect to exposure to ETS. The primary analytic procedures utilized in the study were correlation analysis and analysis of variance. RESULTS The African-American students surveyed in this study received information regarding the health effects of smoking from many sources, most notably television, family, and teachers. Second, students who received information on the effects of smoking on health from family and external sources (teacher, parents friend, and religious leader) had higher overall knowledge, attitude, and preventive efforts scores than students who received information from other sources (friends, electronic media, and printed media). Finally, family influence was greater when parents were not smokers, and influenced elementary students more than middle school or high school students. CONCLUSIONS The active involvement of teachers, religious leaders, parents, and other influential adults should be elicited in tobacco education and prevention efforts to maximize their effectiveness.

Predictors of physical functioning among geriatric patients with small cell or non-small cell lung cancer 3 months after diagnosis.

Abstract This study investigated how treatment options, symptom severity, prediagnosis levels of physical functioning, comorbidity, gender, and age predicted current physical functioning in geriatric patients with small-cell or non-small-cell lung cancer, 12 weeks after their diagnosis. The study involved 146 patients aged 65 years and over with an incident diagnosis of lung cancer. Analysis of covariance revealed no significant differences in physical functioning according to treatment type, small-cell versus non-small-cell classification or gender. Significant predictors of current physical functioning were symptom severity and prior physical functioning. The characteristics of a high-risk profile for disruption in physical functioning of elderly lung cancer patients 12 weeks after their diagnosis would include pre-existing physical impairment and high levels of symptomatology.

Nigerian Urban Married Women's Perceptions of Exposure to Secondary Tobacco Smoke

We investigated urban, married Nigerian womens knowledge of the health risks associated with secondary tobacco smoke, their attitudes toward this problem, and the preventive efforts they took when they or their children were exposed involuntarily to secondary tobacco smoke. Two hundred forty-nine women were surveyed with a structured, written questionnaire. The results indicated that these predominantly well-educated and professionally employed Nigerian women had only a fair knowledge of the adverse health effects of exposure to secondary tobacco smoke. Although their attitudes toward exposure to secondary tobacco smoke were generally quite good, they were reluctant to take preventive measures in public. The most prominent factors relating to knowledge and attitudes were age, educational level, and smoking status. Attitudes proved to be a stronger predictor of preventive efforts than knowledge.