2.50
Hdl Handle:
http://hdl.handle.net/10755/151805
Type:
Presentation
Title:
Studies in Cancer Care: Mortality and Outcomes
Abstract:
Studies in Cancer Care: Mortality and Outcomes
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:June, 2001
Author:Hodgson, Nancy
P.I. Institution Name:Johns Hopkins University
Objective: The overall purpose of this paper is to examine specific sociodemographic characteristics and comorbid conditions associated with non-definitive treatment and mortality in the older population with cancer and to discuss the implications for the US policy debate over reimbursement barriers to community-based care. Design: Secondary analysis of Data from the Family Home Care for Cancer study. Population, Sample, Setting, Years: The sample consisted of 1200 patients 65 years of age and older with an incident cancer of the four leading types (lung, breast, prostate, colorectal) recruited from 24 community hospitals and affiliated medical and radiation oncology centers within the lower peninsula of Michigan and from a cancer center in Indiana between 1993 and 1997. Subjects were recruited during initial follow-up visit after biopsy, or within two weeks of initiating either radiation or chemotherapy to document the impact of initial diagnosis, and to determine the patient’s status prior to initiating primary therapy for the disease. Concept or Variables Studied: Mortality is conceptualized as the end point of a process that is influences by several sets of interrelated risk factors. Sociodemographic factors, including age, gender, level of education and marital status are posited to be distal influences on cancer mortality. Intervening factors, including the adequacy of treatment and the extent of comorbidity and disability, can be theoretically argued to be the proximate influences on the length of survival. Methods: Survival time was computed as the number of days between date of diagnosis and date of last follow-up or death. Multivariate proportional hazards regressions were fit to the overall sample and each cancer site separately. Logistic regression models were then estimated to determine which comorbid conditions and sociodemographic characteristics contributed to the receipt of non-definitive treatment. Findings: Results show that there is wide variation in the risk of cancer mortality between the leading sites of cancer, with those with lung cancer suffering the highest risks and those with breast cancer experiencing the lowest risks. Within each site of cancer the definitiveness of treatment and stage at the point of diagnosis are the leading risk factors for mortality. Preexisting level of disability as well as certain comorbid conditions impact whether individuals receive definitive treatment. The differentials in the receipt of definitive treatment also vary by several important sociodemographic characteristics, namely marital status and level of education. Conclusions: These analyses provide a beginning foundation for future examination of clinical, demographic, socioeconomic variables and mortality trajectories of older persons affected by cancer. Study findings underscore that general efforts to promote definitive treatment and early detection of cancer in the elderly will have a beneficial impact regardless of age or extent of disability. Implications: Over the next decades, special concerns will be generated by the rapid rise in the number and proportion of older persons in our society with cancer. Stage at diagnosis and choice of treatment clearly affect survival. Thus, the importance of early diagnosis and appropriate treatment does not diminish with age. There continues to be an urgent need to better understand the influence of aging on the early detection and optimal treatment of cancer. Given that compliance with treatment and screening recommendations decrease with age, cancer control will be improved by identifying and removing those barriers.
Repository Posting Date:
26-Oct-2011
Date of Publication:
Jun-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleStudies in Cancer Care: Mortality and Outcomesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151805-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Studies in Cancer Care: Mortality and Outcomes</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">June, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Hodgson, Nancy</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Johns Hopkins University</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">nhodgson@kjsph.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: The overall purpose of this paper is to examine specific sociodemographic characteristics and comorbid conditions associated with non-definitive treatment and mortality in the older population with cancer and to discuss the implications for the US policy debate over reimbursement barriers to community-based care. Design: Secondary analysis of Data from the Family Home Care for Cancer study. Population, Sample, Setting, Years: The sample consisted of 1200 patients 65 years of age and older with an incident cancer of the four leading types (lung, breast, prostate, colorectal) recruited from 24 community hospitals and affiliated medical and radiation oncology centers within the lower peninsula of Michigan and from a cancer center in Indiana between 1993 and 1997. Subjects were recruited during initial follow-up visit after biopsy, or within two weeks of initiating either radiation or chemotherapy to document the impact of initial diagnosis, and to determine the patient&rsquo;s status prior to initiating primary therapy for the disease. Concept or Variables Studied: Mortality is conceptualized as the end point of a process that is influences by several sets of interrelated risk factors. Sociodemographic factors, including age, gender, level of education and marital status are posited to be distal influences on cancer mortality. Intervening factors, including the adequacy of treatment and the extent of comorbidity and disability, can be theoretically argued to be the proximate influences on the length of survival. Methods: Survival time was computed as the number of days between date of diagnosis and date of last follow-up or death. Multivariate proportional hazards regressions were fit to the overall sample and each cancer site separately. Logistic regression models were then estimated to determine which comorbid conditions and sociodemographic characteristics contributed to the receipt of non-definitive treatment. Findings: Results show that there is wide variation in the risk of cancer mortality between the leading sites of cancer, with those with lung cancer suffering the highest risks and those with breast cancer experiencing the lowest risks. Within each site of cancer the definitiveness of treatment and stage at the point of diagnosis are the leading risk factors for mortality. Preexisting level of disability as well as certain comorbid conditions impact whether individuals receive definitive treatment. The differentials in the receipt of definitive treatment also vary by several important sociodemographic characteristics, namely marital status and level of education. Conclusions: These analyses provide a beginning foundation for future examination of clinical, demographic, socioeconomic variables and mortality trajectories of older persons affected by cancer. Study findings underscore that general efforts to promote definitive treatment and early detection of cancer in the elderly will have a beneficial impact regardless of age or extent of disability. Implications: Over the next decades, special concerns will be generated by the rapid rise in the number and proportion of older persons in our society with cancer. Stage at diagnosis and choice of treatment clearly affect survival. Thus, the importance of early diagnosis and appropriate treatment does not diminish with age. There continues to be an urgent need to better understand the influence of aging on the early detection and optimal treatment of cancer. Given that compliance with treatment and screening recommendations decrease with age, cancer control will be improved by identifying and removing those barriers.</td></tr></table>en_GB
dc.date.available2011-10-26T11:14:17Z-
dc.date.issued2001-06en_GB
dc.date.accessioned2011-10-26T11:14:17Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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