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Alexander de Graeff

Publications and source records attributed to Alexander de Graeff.

8 recordsLinked to original sources
PubMed2007

Application of adenosine 5'-triphosphate (ATP) infusions in palliative home care: design of a randomized clinical trial.

BACKGROUND: Palliative care in cancer aims at alleviating the suffering of patients. A previous study in patients with advanced non-small-cell lung cancer showed that adenosine 5'-triphosphate (ATP) infusions had a favourable effect on fatigue, appetite, body weight, muscle strength, functional status and quality of life. The present study was designed 1. To evaluate whether ATP has favourable effects in terminally ill cancer patients, 2. To evaluate whether ATP infusions may reduce family caregiver burden and reduce the use of professional health care services, and 3. To test the feasibility of application of ATP infusions in a home care setting. METHODS/DESIGN: The study can be characterized as an open-labelled randomized controlled trial with two parallel groups. The intervention group received usual palliative care, two visits by an experienced dietician for advice, and regular ATP infusions over a period of 8 weeks. The control group received palliative care as usual and dietetic advice, but no ATP. This paper gives a description of the study design, selection of patients, interventions and outcome measures. DISCUSSION: From April 2002 through October 2006, a total of 100 patients have been randomized. Follow-up of patients will be completed in December 2006. At the time of writing, five patients are still in follow up. Of the 95 patients who have completed the study, 69 (73%) have completed four weeks of follow-up, and 53 (56%) have completed the full eight-week study period. The first results are expected in 2007.

Adenosine Triphosphate↗
PubMed2006

Does age matter in palliative care?

PURPOSE: To assess whether age has an impact on symptoms, problems and needs of hospitalized advanced cancer patients. PATIENTS AND METHODS: A prospective analysis of 181 patients referred to a Palliative Care Team was done using a standardized list of symptoms, problems and needs. Differences between 3 age groups (<60; 60-70; > or =70) were analyzed. RESULTS: Patients > or =70 years had a significantly different prevalence of depressed mood (48% versus 13% of patients 60-70 years and 24% of patients <60 years, p=0.002), urinary tract problems (20% versus 3% versus 8%, p=0.024) and drowsiness (18% versus 42% versus 25%, p=0.039). They expressed more problems with a shortage of informal caregivers (45% versus 42% versus 17%, p<0.001) and less need for support in coping (40% versus 61% versus 63%, p=0.043), relational support (3% versus 8% versus 14%, p=0.019) and support in communication (0% versus 8% versus 11%, p=0.013). CONCLUSION: Fewer differences than expected were found. Elderly cancer patients admitted to a hospital have more or less the same symptoms, problems and needs as their younger counterparts. Despite these findings, age-specific assessment of symptoms, problems and needs ought to be part of optimal symptom management.

Adaptation, Psychological↗
PubMed2006

Prognostic significance of symptoms of hospitalised advanced cancer patients.

PURPOSE: To assess the prognostic value of symptoms in hospitalised advanced cancer patients. PATIENTS AND METHODS: A prospective analysis was performed of 181 hospitalised patients referred to a Palliative Care Team. Comprehensive symptom questionnaire, functional status, estimated life expectancy and survival were assessed. Using a Cox regression model, a predictive survival model was built. RESULTS: Median survival: 53 d. Median number of symptoms: 4; 20 symptoms occurred in 10%. Multivariate analysis showed nausea, dysphagia, dyspnoea, confusion and absence of depressed mood as independent prognostic factors for survival (p<0.05) with relative risks of dying of 1.96, 1.81, 1.79, 2.35 and 1.79, respectively. Patients with 2, 3 or 4 of these factors at the same time had a relative risk of dying of 2.7, 2.1 and 9.0, respectively. CONCLUSION: A cluster of factors comprising nausea, dysphagia, dyspnoea, confusion and absence of depressed mood may be used to accurately predict survival in hospitalised advanced cancer patients.

Adolescent↗
PubMed2005

The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care.

This study aimed at developing a shortened version of the EORTC QLQ-C30, one of the most widely used health-related quality of life questionnaires in oncology, for palliative care research. The study included interviews with 41 patients and 66 health care professionals in palliative care to determine the appropriateness, relevance and importance of the various domains of the QLQ-C30. Item response theory methods were used to shorten scales. Patients and health care professionals rated pain, physical function, emotional function, fatigue, global health status/quality of life, nausea/vomiting, appetite, dyspnoea, constipation, and sleep as most important. Therefore, these scales/items were retained in the questionnaire. Four scales were shortened without reducing measurement precision. Important dimensions not covered by the questionnaire were identified. The resulting 15-item EORTC QLQ-C15-PAL is a 'core questionnaire' for palliative care. Depending on the research questions, it may be supplemented by additional items, modules or questionnaires.

Activities of Daily Living↗
PubMed2005

Item response theory was used to shorten EORTC QLQ-C30 scales for use in palliative care.

BACKGROUND AND OBJECTIVE: The goal was to develop a shortened version of the EORTC QLQ-C30 for use in palliative care. We wanted to keep as few items as possible in each scale while still being able to compare results with studies using the original scales. We examined the possibilities of shortening the physical functioning, cognitive functioning, fatigue, and nausea and vomiting scales. STUDY DESIGN AND SETTING: The shortening was based on 2,366 (physical functioning) and 10,815 (three other scales) observations, respectively. We used item response theory to construct scoring algorithms for predicting scores on the original scales. RESULTS: Evaluations showed that a three-item physical scale, a two-item fatigue scale, and a one-item nausea or vomiting scale predicted the scores on the original scales with excellent agreement and had measurement abilities similar to the original scales with no loss or only a little loss in power to detect group differences. The results of the cognitive functioning scale indicated problems when predicting scores from a shortened version. CONCLUSION: Given the favorable results for the physical functioning, fatigue, and nausea or vomiting scales we expect that the shortened versions of these scales will be included in the abbreviated version of the EORTC QLQ-C30 for palliative care.

Cognition↗
PubMed2005

Euthanasia and depression: a prospective cohort study among terminally ill cancer patients.

PURPOSE: To study the association between depression and the incidence of explicit requests for euthanasia in terminally ill cancer patients. PATIENTS AND METHODS: A prospective cohort study was conducted on 138 consecutive cancer patients with an estimated life expectancy of 3 months or less, in the period between September 1999 and August 2003. At inclusion, participants completed the Hospital Anxiety and Depression Scale. To identify "depressed mood" we used a cutoff score of 20. Kaplan-Meier curves and Cox regression analyses were used to assess the association between depressed mood and the risk of a request for euthanasia. RESULTS: Of 138 patients, 32 patients had depressed mood at inclusion. Thirty patients (22%) made an explicit request for euthanasia. The risk to request euthanasia for patients with depressed mood was 4.1 times higher than that of patients without depressed mood at inclusion (95% CI, 2.0 to 8.5). CONCLUSION: Depression in cancer patients with an estimated life expectancy of less than 3 months is associated with a higher likelihood to request for euthanasia. The question of whether depressed mood can adequately be treated in this terminally ill population, and if so, whether it would lower the incidence of requests for euthanasia needs further investigation.

Adult↗