End-of-life care: questions and answers

6 pages.Answers typical questions that a terminally ill patient or their caregivers may have

Americans Are Living with Breast Cancer: Projects Report

https://digitalcommons.cwu.edu/government_posters/1154/thumbnail.jp

TARPTAUTINIAI SLAUGYTOJŲ IR AKUŠERIŲ METAI. Gydytojui – dešinioji ranka, pacientui – ramybės uostas: vienos seniausių profesijų prestižas tik auga

Išklausyti, užjausti, patarti – tai tik keli tikslai, kuriuos greta pagrindinių savo profesinių užduočių sau kelia šalies slaugytojai. Daugiausiai laiko šalia paciento (ir jo artimųjų) praleidžiantys slaugytojai visada buvo ypač svarbūs, tačiau šiandien jų vaidmuo dar labiau sustiprėjęs. Apie vienos seniausių pasaulyje profesijų – slaugytojų – svarbą, evoliuciją ir iššūkius specialistai kalbėjo Nacionalinio vėžio instituto ir Lietuvos operacinės slaugytojų draugijos organizuotoje konferencijoje.Išklausyti, užjausti, patarti – tai tik keli tikslai, kuriuos greta pagrindinių savo profesinių užduočių sau kelia šalies slaugytojai. Daugiausiai laiko šalia paciento (ir jo artimųjų) praleidžiantys slaugytojai visada buvo ypač svarbūs, tačiau šiandien jų vaidmuo dar labiau sustiprėjęs. Apie vienos seniausių pasaulyje profesijų – slaugytojų – svarbą, evoliuciją ir iššūkius specialistai kalbėjo Nacionalinio vėžio instituto ir Lietuvos operacinės slaugytojų draugijos organizuotoje konferencijoje

Racial differences in treatment and survival in older patients with diffuse large B-cell lymphoma (DLBCL)

<p>Abstract</p> <p>Background</p> <p>Diffuse large B-cell lymphoma (DLBCL) comprises 31% of lymphomas in the United States. Although it is an aggressive type of lymphoma, 40% to 50% of patients are cured with treatment. The study objectives were to identify patient factors associated with treatment and survival in DLBCL.</p> <p>Methods</p> <p>Using Surveillance, Epidemiology, and End Results (SEER) registry data linked to Medicare claims, we identified 7,048 patients diagnosed with DLBCL between January 1, 2001 and December 31, 2005. Patients were followed from diagnosis until the end of their claims history (maximum December 31, 2007) or death. Medicare claims were used to characterize the first infused chemo-immunotherapy (C-I therapy) regimen and to identify radiation. Multivariate analyses were performed to identify patient demographic, socioeconomic, and clinical factors associated with treatment and with survival. Outcomes variables in the survival analysis were all-cause mortality, non-Hodgkin's lymphoma (NHL) mortality, and other/unknown cause mortality.</p> <p>Results</p> <p>Overall, 84% (n = 5,887) received C-I therapy or radiation treatment during the observation period: both, 26%; C-I therapy alone, 53%; and radiation alone, 5%. Median age at diagnosis was 77 years, 54% were female, 88% were white, and 43% had Stage III or IV disease at diagnosis. The median time to first treatment was 42 days, and 92% of these patients had received their first treatment by day 180 following diagnosis. In multivariate analysis, the treatment rate was significantly lower among patients ≥ 80 years old, blacks versus whites, those living in a census tract with ≥ 12% poverty, and extra-nodal disease. Blacks had a lower treatment rate overall (Hazard Ratio [HR] 0.77; P < 0.001), and were less likely to receive treatment within 180 days of diagnosis (Odds Ratio [OR] 0.63; P = 0.002) than whites. In multivariate survival analysis, black race was associated with higher all-cause mortality (HR 1.24; P = 0.01) and other/unknown cause mortality (HR 1.35; P = 0.01), but not mortality due to NHL (HR 1.16; P = 0.19).</p> <p>Conclusions</p> <p>In elderly patients diagnosed with DLBCL, there are large differences in treatment access and survival between blacks and whites.</p

Parents' Perspectives on the School Experiences of Children with Cancer

Interviews with 59 parents of school age children with cancer indicate problems children encountered in returning to school: missing significant amounts of school due to illness and treatments, teasing by classmates and peers, and strained relations with teachers. Most parents report that despite missing much school their child was caught up with schoolwork, suggesting that academic difficulties are not paramount. Most parents also report receiving substantial help from sympathetic and competent educators. However, parents also indicate that some teachers were insensitive to their child's condition, while others were overprotective, suggesting the need for a delicate balance in defining appropriate teacher behavior. A responsive yet normalizing school environment can be facilitated by vigorous and proactive partnerships among the medical staff, family, and school system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68682/2/10.1177_027112148600500405.pd

The relationship between area poverty rate and site-specific cancer incidence in the United States

BACKGROUND The relationship between socioeconomic status and cancer incidence in the United States has not traditionally been a focus of population-based cancer surveillance systems. METHODS Nearly 3 million tumors diagnosed between 2005 and 2009 from 16 states plus Los Angeles were assigned into 1 of 4 groupings based on the poverty rate of the residential census tract at time of diagnosis. The sex-specific risk ratio of the highest-to-lowest poverty category was measured using Poisson regression, adjusting for age and race, for 39 cancer sites. RESULTS For all sites combined, there was a negligible association between cancer incidence and poverty; however, 32 of 39 cancer sites showed a significant association with poverty (14 positively associated and 18 negatively associated). Nineteen of these sites had monotonic increases or decreases in risk across all 4 poverty categories. The sites most strongly associated with higher poverty were Kaposi sarcoma, larynx, cervix, penis, and liver; those most strongly associated with lower poverty were melanoma, thyroid, other nonepithelial skin, and testis. Sites associated with higher poverty had lower incidence and higher mortality than those associated with lower poverty. CONCLUSIONS These findings demonstrate the importance and relevance of including a measure of socioeconomic status in national cancer surveillanc

Experiences of expressing and storing colostrum antenatally: A qualitative study of mothers in regional Western Australia

This qualitative study explored the experiences and breastfeeding outcomes of a group of mothers who expressed colostrum in the antenatal period. In-depth interviews were conducted over the telephone with 12 women who had attended a unique antenatal lactation clinic appointment at 37 weeks’ gestation. Seven main response themes were identified. Most women reflected positively upon their attendance and reported that the experience of expressing colostrum allowed them to become familiar with their breasts and gave them a sense of security by having a supply of colostrum stored for possible use after birth. The main negative emotions reported were a sense of embarrassment at expressing the colostrum, particularly in front of another person, the difficulties with expressing colostrum and in one instance, the physical pain associated with the process. Antenatal expression of colostrum may improve maternal breastfeeding confidence. Further research using long-term records will determine whether this practice improves breastfeeding outcomes

Is it all about storytelling? Living and learning hereditary cancer on Twitter

Storytelling has long been used as a theoretical framework for understanding how we share information and learn about health – and illness – online. But is it all about storytelling on social media platforms? To explore how and to what extent personal stories shape health content on these platforms, the article presents an analysis of tweets discussing the BRCA gene mutation – a hereditary cancer condition. Theoretically, the study advances a new conceptual framework to explore social media practices within issue–based and long–lived social media threads. Methodologically, it develops a qualitative, platform–oriented discourse analytic approach. Findings show that non narrative content is actually more common than storytelling in Twitter conversations about BRCA, with a number of patient advocates acting as gatekeepers of scientific information. Most BRCA storytelling is mediated and shared in third person, with those at the heart of these stories becoming exemplars within the BRCA ‘subculture’