Rob J. de Leeuw

A prospective study on quality of life of laryngeal cancer patients treated with radiotherapy

The aim of this study was to describe prospectively quality of life and mood before and after radiotherapy for laryngeal cancer.

Quality of life in elderly patients with head and neck cancer one year after diagnosis

Little is known about quality of life (QOL) in elderly patients.

Elderly patients with head and neck cancer: the influence of comorbidity on choice of therapy, complication rate, and survival.

Purpose of reviewComorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival. Recent findingsSeveral retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy. SummaryIf severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.

Elderly patients with head and neck cancer: physical, social and psychological aspects after 1 year.

Objective Elderly patients with head and neck cancer often receive non-standard treatment for reasons other than comorbidity. In this prospective study we investigated how elderly patients fare 1 year after treatment in comparison with their younger counterparts. Material and Methods Seventy patients aged 45–60 years and 51 patients aged ≥70 years with cancer of the oral cavity, pharynx (stage II–IV) or larynx (stage III–IV) participated in the study before treatment and 1 year later. Each patient was interviewed and given a questionnaire concerning physical functioning, social contacts, depressive symptoms, satisfaction with treatment and future expectations. Results At 12 months, patients in both age groups reported significantly more depressive symptoms and less social support than before treatment, and their Karnofsky Performance Score was lower. However, there were no differences between elderly and younger patients. Approximately 90% of those in both age groups said that they would choose the same treatment again, and there was no age difference regarding the impact of treatment or expectations for the future. Conclusion This study shows that the impact of treatment on quality of life did not differ between elderly and younger patients with head and neck cancer. Therefore, standard treatment should be considered in elderly patients if no severe contraindications exist.

Role of alcohol and smoking in diagnostic delay of head and neck cancer patients

Conclusions This study shows that heavy drinking is a risk factor for prolonged delay in presenting with head and neck cancer and for presenting with a large tumour in the head and neck region. Excessive smoking is only a risk factor for being diagnosed with a large tumour, although there is a weak association between smoking and prolonged diagnostic delay. Objective It is reasonable to assume that prolonged delay in presenting with head and neck cancer is associated with an advanced stage of cancer at diagnosis. In this study we analysed the effects of drinking and smoking habits on diagnostic delay and the T stage of the tumour at diagnosis. Material and methods A total of 427 patients with newly diagnosed head and neck carcinomas were eligible for this study. Of these, 306 (72%) actually participated: 134 (77%) with an oral tumour; 117 (69%) with a larynx tumour; and 55 (65%) with a pharynx tumour. Diagnostic delay was defined as a period of >30 days between the appearance of the first tumour-related symptoms and the first visit to a physician. T3–4 tumours were defined as advanced tumours. Drinking behaviour was classified into three types: light (0–2 drinks/day); moderate (3–4 drinks/day); and heavy (>4 drinks/day). Smoking habits were classified into 4 types: never; stopped; light (0–20 cigarettes/day); and heavy (>20 cigarettes/day). Results Logistic regression showed that there were significantly more heavy than light drinkers [p=0.04; odds ratio (OR) 1.8; 95% CI 1.0–3.1] in the delay group than in the non-delay group. Light smokers showed a tendency towards prolonged delay (p=0.06; OR 2.2; 95% CI 1.0–5.0). Both heavy drinking (p=0.01; OR 2.0; 95% CI 1.2–3.6) and heavy smoking (p=0.03; OR 3.1; 95% CI 1.1–8.4) were risk factors for a patient to be diagnosed with a large tumour.

Results of a Multibehavioral Health-Promoting School Pilot Intervention in a Dutch Secondary School

PURPOSE Recent studies increasingly show adolescent health-related behaviors to be interrelated, interacting synergistically and sharing several common determinants. Therefore, research increasingly focuses on studying interventions that target a range of health behaviors simultaneously. This report describes the results of a pilot study of a secondary school-based, health-promoting intervention that simultaneously targets a range of adolescent health behaviors via a whole-school approach. METHODS We collected self-reported behavioral data via an annual online questionnaire to 336 students. We collected data before the intervention implementation and after the interventions first completed, 3-year curriculum cycle on the fourth-grade students (15- to 16-year-olds). We analyzed differences between pre- and postintervention groups. RESULTS Significant behavioral changes were reported for extreme alcohol use, smoking, sedentary time, and bullying behaviors. Certain behaviors were significantly different only in girls: namely, weekly alcohol use, ever having used cannabis, compulsive Internet or computer use score, compulsive gaming score, and recent bully victimization. Differences in several sedentary time behaviors (television watching and Internet or computer use) were significant only in boys. No changes were reported regarding body mass index; physical activity; or the time spent on, or the compulsiveness of, video game playing. In addition, the postintervention group showed significantly fewer psychosocial problems. CONCLUSIONS The intervention successfully changed student health behaviors on many accounts. It remains largely unclear as to what causes the different effects for boys and girls. Further studies regarding multiple health behavior targeting interventions for adolescents are required.

How spouses evaluate Nursing Home Placement of their demented partner: a study about the end of perseverance time

AIM This study was about the final decision by spouses to have their demented partner placed in a nursing home. The central question was whether the admission took place in the right time in their point of view. METHOD Fourteen partners of persons with dementia evaluated the nursing home placement. They were interviewed at home using a semi-structured questionnaire. Grounded theory was used to explore the process of decision-making. In addition to the interviews, quantitative data were used from a 2-year follow-up study. RESULTS Results underline that the placement decision had to be made in phases over time. The first decision is about placement of the relative on a waiting list, and the second decision is about the actual placement in a nursing home once a place becomes available. This second and final decision often had to be taken under time pressure to avoid a place in the nursing home being left empty. If they had been given more time and space to reconsider their admission decision, most partners said they could have had continued providing homecare longer. During the investigation, the following classification in timeliness of the admission emerged: Placement was at the right time, too early, too late or out of control. CONCLUSION Spouses indicated they could have kept on giving care for a longer period of time if they had been given more time and space to make their final decision about the admission of their partner. It may be helpful for informal and formal carers to focus on perseverance time in considering placement or prolonged support at home. Placement at an appropriate time may lead to a higher degree of well-being of informal carers before and especially after the admission.

E-health and health care behaviour of parents of young children : a qualitative study

Abstract Objective: Internet plays a huge role in providing information about health care problems. However, it is unknown how parents use and perceive the internet as a source of information and how this influences health care utilisation when it comes to common complaints in infants. The objective was to evaluate the perception parents have on the role of internet in providing health care information on common symptoms in infants and its effects on health care utilisation. Design: A qualitative design was chosen. Setting and subjects: Parents were recruited from a population-based birth-cohort and selected purposefully. Main outcome measures: Semi-structured interviews were used to receive information of parentsʼ ideas. Thematic coding and constant comparison were used for interview transcript analysis. Results: Ten parents were interviewed. Parents felt anxious and responsible when their child displayed common symptoms, and appeared to be in need of information. They tried to obtain information from relatives, but more so from the internet, because of its accessibility. Nevertheless, information found on the internet had several limitations, evoked new doubts and insecurity and although parents compared information from multiple sources, only the physician was able to take away the insecurity. The internet did not interfere in the decision to consult the physician. Conclusions: Parents need information about their childrenʼs symptoms and the internet is a major resource. However, only physicians could take away their symptom-related doubts and insecurities and internet information did not play a role in parental decision making. Information gathered online may complement the information from physicians, rather than replace it. Key Points Internet plays an increasing role in providing health care information but it is unknown how this influences health care utilisation. Our study suggests that: Parents need information about their children’s symptoms and the internet is a major resource. However, only physicians could take away their symptom-related doubts and insecurities. Internet information did not play a role in parental decision making.

Integrated primary care, the collaboration imperative inter-organizational cooperation in the integrated primary care field a theoretical framework

Purpose Capacity problems and political pressures have led to a rapid change in the organization of primary care from mono disciplinary small business to complex inter-organizational relationships. It is assumed that inter-organizational collaboration is the driving force to achieve integrated (primary) care. Despite the importance of collaboration and integration of services in primary care, there is no unambiguous definition for both concepts. The purpose of this study is to examine and link the conceptualisation and validation of the terms inter-organizational collaboration and integrated primary care using a theoretical framework. Theory The theoretical framework is based on the complex collaboration process of negotiation among multiple stakeholder groups in primary care. Methods A literature review of health sciences and business databases, and targeted grey literature sources. Based on the literature review we operationalized the constructs of inter-organizational collaboration and integrated primary care in a theoretical framework. The framework is being validated in an explorative study of 80 primary care projects in the Netherlands. Results and conclusions Integrated primary care is considered as a multidimensional construct based on a continuum of integration, extending from segregation to integration. The synthesis of the current theories and concepts of inter-organizational collaboration is insufficient to deal with the complexity of collaborative issues in primary care. One coherent and integrated theoretical framework was found that could make the complex collaboration process in primary care transparent. This study presented theoretical framework is a first step to understand the patterns of successful collaboration and integration in primary care services. These patterns can give insights in the organization forms needed to create a good working integrated (primary) care system that fits the local needs of a population. Preliminary data of the patterns of collaboration and integration will be presented.

An internet based platform for people with psychotic vulnerability and their informal and professional caretakers

Introduction: Starting in 2008 an internet based platform: personal control and rehabilitation (PCR) has been developed for people with psychotic vulnerability, and is evaluated at two mental health institutions in the south of Holland. The Trimbos Institute and the Julius Center are evaluating the implementation and the effects of PCR on patients, informal caregivers and professionals. Aims of the study: It was expected that the communication between patients and the (informal) caregivers will be facilitated by using PCR. Communication no longer depends on the hours that the caregivers are available. The aim of the study is: Patients • • – monitoring self management – improving social participation/empowerment – reducing healthcare needs Informal caregivers • • – decrease sense of burden Professionals • • – less workload – greater job satisfaction Methods: The development and implementation of PCR is followed by an effect and process evaluation. The process of implementation of PCR is evaluated with interviews, validated questionnaires and focus group discussions. The questionnaires measure quality of life, empowerment, satisfaction with care, and social functioning (patients), sense of burden (informal caregivers), job satisfaction and workload (professionals) before the implementation of PCR, three and six months later. Results: Preliminary results show that patients and informal caregivers are satisfied with the use of PCR: more insight in their treatment goals and easier communication with each other and (in)formal caregivers. Formal caregivers use PCR mainly as an email function. These and additional results will be presented and discussed. Conclusions: The use of PCR is appreciated by patients, although professionals have to get more involved. In June 2011 the final results of the study will be published.