Biomedical subjects

Neil K Aaronson

Publications and source records attributed to Neil K Aaronson.

24 records · Page 2Linked to original sources

PubMed2003

Psychosocial issues in cancer genetics--current status and future directions.

Diagnostic tests are now available that allow genetic testing for several types of cancer. The aim of genetic counseling and testing for cancer is to educate individuals about cancer risk and cancer prevention, which it is hoped will lead to a reduction in morbidity and mortality. However, at this relatively early stage in the development of genetic counseling and testing programs, information is needed on the psychosocial impact of such programs on both the individual counselee and his/her family. This paper reviews the findings obtained during the past decade on the uptake of genetic testing, reasons for undergoing genetic testing, and the impact of genetic counseling and testing on feelings of distress and guilt. Specific attention is paid to experiences with prophylactic mastectomy and oophorectomy and the effectiveness of the uptake of and satisfaction with these risk-reducing procedures. In addition, the possible impact of genetic testing on insurance, work and future plans is discussed. Suggestions are given for translating research findings into psychosocial services and future research efforts.

Attitude to Health↗

PubMed2003

Health related quality of life in men with prostate cancer.

PURPOSE: Quality of life is of great concern to patients considering treatment options for prostate cancer. In the absence of clinical trial data clearly demonstrating that a particular treatment is superior to another for localized prostate cancer, in terms of cause specific survival, patients may value quality of life as much as quantity of life. The goal of this review is to familiarize the reader with the methodology of quality of life research and to review the recent literature on quality of life outcomes in prostate cancer. MATERIALS AND METHODS: A structured MEDLINE review of literature on health related quality of life in prostate cancer for the years 1995 to 2001 was performed, and was augmented with highly relevant articles from additional selected journals. RESULTS: In the case of advanced or metastatic disease, where the goal of treatment is palliation and symptom-free survival, quality of life often becomes the primary desired outcome. In localized disease all treatments affect health related quality of life, although the impact of each therapy on sexual, urinary and bowel function is unique. CONCLUSIONS: Although a highly personal and subjective entity, health related quality of life can be assessed using rigorous and scientifically stringent methods from the field of psychometric test theory. A substantial amount of literature exists regarding the use of established and validated instruments for assessing the impact of prostate cancer and its treatment on health related quality of life. This information is of critical importance when counseling men with newly diagnosed prostate cancer regarding treatment choices and is also helpful in setting appropriate expectations for men with metastatic disease.

Humans↗

PubMed2002

Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial.

CONTEXT: There has been increasing interest in the use of health-related quality-of-life (HRQL) assessments in daily clinical practice, yet few empirical studies have been conducted to evaluate the usefulness of such assessments. OBJECTIVE: To evaluate the efficacy of standardized HRQL assessments in facilitating patient-physician communication and increasing physicians' awareness of their patients' HRQL-related problems. DESIGN: Prospective, randomized crossover trial. SETTING: Outpatient clinic of a cancer hospital in the Netherlands. PARTICIPANTS: Ten physicians and 214 patients (76% women; mean age, 57 years) undergoing palliative chemotherapy who were invited to participate between June 1996 and June 1998. INTERVENTION: At 3 successive outpatient visits, patients completed an HRQL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). The responses were computer scored and transformed into a graphic summary. Physicians and patients received a copy of the summary before the consultation. MAIN OUTCOME MEASURES: Audiotapes of the consultations were content analyzed to evaluate patient-physician communication. Physicians' awareness of their patients' health problems was assessed by comparing physicians' and patients' ratings on the Dartmouth Primary Care Cooperative Information Functional Health Assessment (COOP) and the World Organisation Project of National Colleges and Academics (WONCA) charts. RESULTS: The HRQL-related issues were discussed significantly more frequently in the intervention than in the control group (mean [SD] communication composite scores: 4.5 [2.3] vs 3.7 [1.9], respectively (P =.01). Physicians in the intervention group identified a greater percentage of patients with moderate-to-severe health problems in several HRQL domains than did those in the control group. All physicians and 87% of the patients believed that the intervention facilitated communication and expressed interest in its continued use. CONCLUSION: Incorporating standardized HRQL assessments in daily clinical oncology practice facilitates the discussion of HRQL issues and can heighten physicians' awareness of their patients' HRQL.

Communication↗

PubMed2002

Quality of life after curative radiotherapy in Stage I non-small-cell lung cancer.

PURPOSE: The aim of this study was to investigate changes in quality of life (QOL) among medically inoperable Stage I non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy. PATIENTS AND METHODS: The study sample was composed of 46 patients irradiated for Stage I NSCLC. Quality of life was assessed before, during, and after radiotherapy using the European Organization for the Research and Treatment of Cancer QLQ-C30 and QLQ-LC13. Changes in symptom and QOL scores over time were evaluated with a repeated measurement analysis of variance using the mixed effect modeling procedure, SAS Proc Mixed. Twenty-seven patients were treated only at the primary site, whereas for 19 patients, the regional lymph nodes were included in the target volume as well. RESULTS: The median follow-up time of patients alive was 34 months. The median survival was 19.0 months. None of the locally treated patients developed regional recurrence. A significant, gradual increase over time was observed for dyspnea, fatigue, and appetite loss. A significant, gradual deterioration was observed also for role functioning. No significant changes were noted for the other symptoms or the functioning scales. Significantly higher levels of dysphagia, which persisted up to 12 months, were observed in those in which the regional lymph nodes were treated, as compared to the locally treated patients. Radiation-induced pulmonary changes assessed with chest radiograph were more pronounced in the group treated with locoregional radiotherapy. CONCLUSIONS: After curative radiotherapy for Stage I medically inoperable NSCLC, a gradual increase in dyspnea, fatigue, and appetite loss, together with a significant deterioration of role functioning, was observed, possibly because of pre-existing, slowly progressive chronic obstructive pulmonary disease and radiation-induced pulmonary changes. Taking into account the low incidence of regional recurrences after local irradiation, the higher incidence and severity of radiation-induced changes, and the higher levels of dysphagia persisting up to 12 months, local irradiation of the primary tumor without elective irradiation of the regional lymph nodes may be the most appropriate treatment for patients with small, peripherally located tumors.

Adult↗

PubMed2002

Changes in physical functioning and quality of life in patients with cancer: response shift and relative evaluation of one's condition.

This study examined the hypothesis that patients' persistence in comparing themselves with others who are perceived as being worse off might induce a response shift in self-reported quality of life (QL). Specifically, we tested whether patients' ratings of how they are doing compared to others (i.e., relative evaluation) moderates the link between physical deterioration and decline in self-reported QL. Two hundred forty patients with various cancer diagnoses who were undergoing palliative chemotherapy rated their physical functioning and QL (i.e., emotional functioning and global quality of life) twice with an interval of 3 months. In addition, a significant other and a research assistant rated the physical condition of the patients. Consistent with the buffering model of response shift, patients who felt that they were better off than others appeared to be able to sustain their quality of life in the face of a worsening physical condition. In contrast, those who felt the same or worse off than others could not.

Adult↗

PubMed2002

The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease.

Health-related quality of life (HRQL) studies sometimes rely, in part, on proxy information obtained from patients' significant others (spouse or close companion) or health care providers. This review: (1) provides a quantitative analysis of the results that have been reported in recent studies assessing the level of agreement between patient and proxy HRQL ratings, and (2) addresses a number of key methodological issues surrounding the use of proxy raters in HRQL research. This review concentrates on 23 studies, published between 1991-2000, that describe patient-proxy agreement for a number of well-known multidimensional HRQL instruments. In general, moderate to high levels of patient-proxy agreement were reported. Lower levels of agreement were found predominantly in studies employing a small sample size (approximately 50 patient-proxy pairs or less). In larger studies comparing patients and their significant others, median correlations were between 0.60-0.70 for physical HRQL domains and about 0.50 for psychosocial domains. Mixed results were reported in studies comparing patients and their health care providers, but most of these studies employed a relatively small sample size. Proxy raters tended to report more HRQL problems than patients themselves, but the magnitude of observed differences was modest (median standardized differences of about 0.20). Based on the current evidence, we conclude that judgements made by significant others and health care providers about several aspects of patients' HRQL are reasonably accurate. Substantial discrepancies between patient and proxy ratings occur in a minority of cases. We recommend that future studies focus on: (a) the reliability and validity of proxy ratings according to common psychometric methods, and (b) the balance between information bias due to proxy ratings and potential selection bias due to exclusion of important patient subgroups from HRQL studies.

Caregivers↗