Julia H. Rose

Age differences in care practices and outcomes for hospitalized patients with cancer

OBJECTIVE: To identify age group differences in care practices and outcomes for seriously ill hospitalized patients with malignancy.

Family caregiver engagement in a coping and communication support intervention tailored to advanced cancer patients and families.

We describe family caregiver (FCG) participation in a tailored coping and communication support intervention for advanced cancer patients and families. Preliminary descriptive data on characteristics and patterns of early engagement in the intervention for 132 FCGs are presented. Engagement assessed at an initial in-person meeting and the following 6 weeks includes problems raised, strategies used, and initiation, frequency, and mode of contact. A sizable proportion of FCGs were male, African American, and nonspouse. The FCGs had modest scores on a standard survey measure of burden yet volunteered caregiving demands as their primary problem. Other problems raised initially by more than 40% of the sample included psychological, practical, and communication with healthcare providers. Few reported physical and psychosocial difficulties. Engagement preferences expressed at the initial meeting largely mapped with actual engagement during the 6 weeks of intervention. Most FCGs were actively engaged during follow-up. Some (14%) did not opt for coping and communication support during this early treatment phase. This intervention is expected to affect quality of care and quality-of-life outcomes for FCGs over time from patient diagnosis to end of life. Findings will guide modification and dissemination of this intervention primarily in cancer clinics for the underserved.

Relationships Among Caregivers' Demographic Characteristics, Social Support Ratings, and Expectations of Computer-Mediated Support Groups

Computer-mediated support groups (CMSG) for family caregivers are proliferating; however, actual social support needs of potential CMSG users and their expectations regarding CMSG use have not been studied. The authors used path analysis to investigate how the responses of 118 family caregivers to scales measuring the importance to them of four dimensions of social support (CASS-I), their expectations regarding three dimensions of CMSG technology (CATS-E) and their demographic characteristics were interrelated. Caregiver gender and race were related to two of four CASS-I scores; caregiver education, gender, and race were directly related to two of the three CATS-E scores; and gender and race also were indirectly related to two of three CATS-E scores through their impact on CASS-I scores. Results suggest that CASS-I and CATSE assessments might be helpful in customizing CMSG to meet particular subgroup needs, in understanding and influencing patterns of CMSG use, and in evaluating impacts of CMSG use.

Providing All-Inclusive Care for Frail Elderly Veterans : Evaluation of Three Models of Care

Frail elderly veterans aged 55 and older who met state nursing home admission criteria were enrolled in one of three models of all‐inclusive long‐term care (AIC) at three Veterans Affairs (VA) medical centers (n=386). The models included: VA as sole care provider, VA‐community partnership with a Program of All‐inclusive Care for the Elderly (PACE), and VA as care manager with care provided by PACE. Healthcare use was monitored for 6 months before and 6 to 36 months after enrollment using VA, DataPACE, and Medicare files. Hospital and outpatient care did not differ before and after AIC enrollment. Only 53% of VA sole‐provider patients used adult day health care (ADHC), whereas all other patients used ADHC. Nursing home days increased, but permanent institutionalization was low. Thirty percent of participants died; of those still enrolled in AIC, 92% remained in the community. VA successfully implemented three variations of AIC and was able to keep frail elderly veterans in the community. Further research on providing variations of AIC in general is warranted.

Primary care physicians' involvement in the cancer care of older long-term survivors

Objective: This study investigated survivors’ reports of primary care physicians’ (PCPs) involvement in three key cancer survivorship activities: discussing cancer history, whether the PCP initiated discussions, and whether discussions led to tests/procedures. Method: The sample included 215 older survivors whose health care was maintained in primary care. Logistic regression explored predictors of the three activities, including demographics, cancer characteristics, survivor/PCP association characteristics, health characteristics, and psychosocial well-being. Results: Nearly two thirds of survivors indicated discussing cancer history; most said discussions were PCP initiated and nearly half said discussions resulted in tests/procedures. Predictors of discussing cancer history were African American race and more comorbid conditions. PCP-initiated discussions were related to older age, surviving breast cancer, more years in the PCP’s practice, and having less general health worry. The tests/procedures model was not significant. Conclusions: As older survivors focused more on other health concerns, PCPs remained attentive to cancer issues, prompting discussions about history and ordering tests.

The longitudinal relationship between quality of life and survival in advanced stage cancer

Quality of Life (QoL) at baseline is frequently found to be a prognostic factor in cancer studies. However, little is known about the relationship of the trajectory of QoL and survival in patients with advanced cancer. This study evaluates the effects of both level and change of QoL on survival to explore the potential of utilizing longitudinal information of QoL for prognosis.

An exploration of the relative influence of patient's age and cancer recurrence status on symptom distress, anxiety, and depression over time

Past research suggests that psychosocial responses to advanced or recurrent cancer vary by age. This study compares the relative influences of patients’ age and recurrence status on indicators of symptom distress, anxiety, and depression following a diagnosis of advanced cancer. A prospective study of advanced cancer support provided patient outcome data reported at baseline, 3-, and 6-month intervals. Cohorts were defined by age group and recurrence status and latent growth curves fit to anxiety, depression, and symptom distress outcomes. Middle-age recurrent patients reported the highest symptom distress, depression, and anxiety across time points. Older recurrent patients fared worse at baseline than older nonrecurrent patients, but outcome scores converged across time points. Recurrent cancer presents a distinct challenge that, for middle-age patients, persists across time. It may be beneficial to develop targeted educational and support resources for middle-age patients with recurrent disease.