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Clifford Ko

Publications and source records attributed to Clifford Ko.

8 recordsLinked to original sources
PubMed2006

Understanding cancer patients' experience and outcomes: development and pilot study of the Cancer Care Outcomes Research and Surveillance patient survey.

GOALS OF WORK: The National Cancer Institute's Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is conducting a population-based study of newly diagnosed patients with lung and colorectal cancer to describe the experience of persons living with cancer and to understand which barriers present the most significant obstacles to their receipt of appropriate care. The keystone to this effort is the baseline patient survey administered approximately 4 months after diagnosis. PATIENTS AND METHODS: We developed a survey to obtain information from patients newly diagnosed with lung and colorectal cancer about their personal characteristics, decision making, experience of care, and outcomes. We conducted a pilot study to evaluate the feasibility of a lengthy and clinically detailed interview in a convenience sample of patients within 8 months of diagnosis (n=71). MAIN RESULTS: The median length of the interviews was 75 min for patients with lung cancer (range 43-130) and 82 min for patients with colorectal cancer (range 46-119). Most patients had received some form of treatment for their cancer: 66.1% had undergone surgery, 28.2% had received radiation therapy, and 54.9% were treated with chemotherapy. In addition, 26.7% reported their overall health was less than 70 on a 0-100 scale, demonstrating that patients with substantial health impairment were able to complete the survey. CONCLUSIONS: A clinically detailed survey of newly diagnosed lung and colorectal cancer patients is feasible. A modified version of this survey is being fielded by the CanCORS Consortium and should provide much needed population-based data regarding patients' experiences across the continuum of cancer care and their outcomes.

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PubMed2003

What predicts serious complications in colorectal cancer resection?

Virtually all volume-outcome studies use mortality as their outcome measure, yet most general surgical procedures have low in-patient death rates. We examined whether hospital surgical volume impacts other colorectal cancer resection outcomes and complications. Colorectal cancer (CRC) resections from 1996 to 2000 were identified using the California hospital discharge database. Comorbidity was graded using a modified Charlson index. Hospital CRC resection volume was calculated. Serious medical complications were defined as life-threatening cardiac or respiratory events, renal failure, or shock. Serious surgical complications were defined as vascular events, need for reoperation, or bleeding. Multivariate logistic regression analyses were performed to estimate the impact of predictors on complications. We identified 56,621 resections. Median age was 70 to 74 years. Eighty-one per cent of patients were white. Most had localized (57%) versus distant (22%) disease. Serious medical (17.5%) and surgical (9.8%) complications were not infrequent. In multivariate analyses, greater annual CRC surgical volume predicted lower odds of serious complication, but patient characteristics (age, comorbidity, and acuity of surgery) were more important. Although patients receiving CRC resection at lower-volume hospitals have greater odds of complication than patients treated at higher-volume institutions, patient factors remain the most important determinants of complication.

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PubMed2002

The need for a multidisciplinary approach to cancer care.

BACKGROUND: Treatment of the cancer patient is multifaceted. In addition to treating the cancer itself, there are additional important, "noncancer" issues to consider concomitantly, such as the patient's coexistent diseases, their health behaviors, and preventive care measures. While the need for coordination among surgeons, oncologists, and radiation oncologists has been well documented for treatment of the cancer, little attention has been paid to the importance of "noncancer" issues. In an attempt to characterize such issues, we performed a study to describe the prevalence of comorbid diseases as well as other "noncancer" issues (i.e., presence of poor health habits and use of preventive care measures) for four common, surgically related cancers. Finally, we describe the use of provider resources for these cancer patients. METHODS: Using a large population-based, nationwide patient survey, a cross-sectional analysis of lung, prostate, breast, and colon cancer patients who were less than 3 years from their diagnosis was performed. Prevalence of comorbid disease, health behaviors, receipt of preventive health care services, and contact with the health care system were characterized. Comparisons were made with a cohort of age-matched controls without cancer. RESULTS: Three hundred one cancer patients (29 lung, 88 prostate, 119 breast, 65 colon) and 6745 control patients were analyzed. Among the cancer patients, 81% had a coexistent disease, with 59% reporting cardiovascular comorbidity and 17% reporting pulmonary comorbidity. The range of comorbidities was substantial: hypertension (24-48%), coronary disease (8-24%), angina (4-10%), myocardial infarction (8-31%), arrhythmia (8-19%), stroke (3-8%), emphysema (4-10%), asthma (5-12%), diabetes (8-18%), bronchitis (8-13%), renal insufficiency (3-6%), severe arthritic symptoms (34-57%). Of note, 27-39% of cancer patients continued to smoke tobacco (P = 0.03 vs controls), of whom 85% continued to smoke daily. Finally, the rates of preventive care influenza vaccinations in high-risk individuals for the cancer cohort was no higher than the rate in controls, even though the cancer patients saw a health professional significantly more often. Of note, the frequency of "specialists" and surgeon visits was significantly higher for the cancer cohort. CONCLUSION: To optimize cancer outcomes, successful treatment of both the cancer and the "noncancer" issues is required. This study demonstrates that the burden of coexistent diseases is considerable. We also found the prevalence of continued poor health behaviors (i.e., use of tobacco) as well as suboptimal performance of preventive care measures to be notable. Since cancer patients see specialists twice as often as controls, it appears paramount that specialists (surgeons included) maintain diligence in addressing patient comorbidities, health habits, and other "noncancer" measures. If the substantial rates of smoking and suboptimal performance of preventive care measures are an indication of the "noncancer" quality of care that is being provided to the typical cancer patient, then a more concerted effort by all providers needs to be made regarding these and other "noncancer" issues.

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