The Journal of Community and Supportive Oncology

On April 24, 2014, the cobas HPV Test was approved by the US Food and Drug Administration for use as a first-line primary screening tool in women aged 25 years or older to assess risk of cervical cancer based on the presence of clinically relevant high-risk human papillomavirus (HPV) DNA. It is the first and only HPV test indicated as the first-line primary screen for cervical cancer in the United States. The test simultaneously provides pooled results for high-risk (HR) genotypes (HPV-31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) and individual results for HPV-16 and HPV-18, the highest-risk genotypes.  
 

Click on the PDF icon at the top of this introduction to read the full article.

On April 24, 2014, the cobas HPV Test was approved by the US Food and Drug Administration for use as a first-line primary screening tool in women aged 25 years or older to assess risk of cervical cancer based on the presence of clinically relevant high-risk human papillomavirus (HPV) DNA. It is the first and only HPV test indicated as the first-line primary screen for cervical cancer in the United States. The test simultaneously provides pooled results for high-risk (HR) genotypes (HPV-31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) and individual results for HPV-16 and HPV-18, the highest-risk genotypes.  
 

Click on the PDF icon at the top of this introduction to read the full article.

On April 24, 2014, the cobas HPV Test was approved by the US Food and Drug Administration for use as a first-line primary screening tool in women aged 25 years or older to assess risk of cervical cancer based on the presence of clinically relevant high-risk human papillomavirus (HPV) DNA. It is the first and only HPV test indicated as the first-line primary screen for cervical cancer in the United States. The test simultaneously provides pooled results for high-risk (HR) genotypes (HPV-31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) and individual results for HPV-16 and HPV-18, the highest-risk genotypes.  
 

Click on the PDF icon at the top of this introduction to read the full article.

Background Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.

Objective To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.

Methods We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with preexisting oncologic diagnoses who received a referral to Stanford Hospital’s palliative care service.

Results Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient’s dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).

Limitations This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.

Conclusions Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

Click on the PDF icon at the top of this introduction to read the full article.

Background Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.

Objective To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.

Methods We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with preexisting oncologic diagnoses who received a referral to Stanford Hospital’s palliative care service.

Results Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient’s dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).

Limitations This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.

Conclusions Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

Click on the PDF icon at the top of this introduction to read the full article.

Background Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.

Objective To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.

Methods We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with preexisting oncologic diagnoses who received a referral to Stanford Hospital’s palliative care service.

Results Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient’s dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).

Limitations This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.

Conclusions Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

Click on the PDF icon at the top of this introduction to read the full article.

Bacground Colorectal cancer is one of the leading causes of morbidity and mortality in Canada. A report of community dwelling seniors showed that 25% received some sort of home care, and that the quantity of home care increased with age and disability. Few population-based studies have examined home care and the associated costs in elderly persons with cancer.

Objective To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.

Methods The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.

Results In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study’s time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.

Limitations Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.

Conclusion Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.

Funding This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.

Click on the PDF icon at the top of this introduction to read the full article.

Bacground Colorectal cancer is one of the leading causes of morbidity and mortality in Canada. A report of community dwelling seniors showed that 25% received some sort of home care, and that the quantity of home care increased with age and disability. Few population-based studies have examined home care and the associated costs in elderly persons with cancer.

Objective To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.

Methods The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.

Results In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study’s time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.

Limitations Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.

Conclusion Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.

Funding This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.

Click on the PDF icon at the top of this introduction to read the full article.

Bacground Colorectal cancer is one of the leading causes of morbidity and mortality in Canada. A report of community dwelling seniors showed that 25% received some sort of home care, and that the quantity of home care increased with age and disability. Few population-based studies have examined home care and the associated costs in elderly persons with cancer.

Objective To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.

Methods The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.

Results In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study’s time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.

Limitations Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.

Conclusion Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.

Funding This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.

Click on the PDF icon at the top of this introduction to read the full article.

Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

Click on the PDF icon at the top of this introduction to read the full article.

Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

Click on the PDF icon at the top of this introduction to read the full article.

Background With modern treatment, more than 95% of American men who are diagnosed with testicular cancer will be cured. Although there is growing evidence that these individuals may face heightened risk of cardiovascular disease after chemotherapy, there is a paucity of research to objectively classify health-promoting behaviors in this population and to identify the barriers to improving their health behaviors.

Objectives To identify health behavior patterns in a group of testicular cancer survivors (TCSs) and the barriers to more positive health behaviors and to examine the relationship between barriers, health behaviors, and quality of life (QOL).

Methods TCSs from the Pennsylvania State Cancer Registry who had been diagnosed during 1990-2005 completed a comprehensive survey about QOL, health behaviors, and barriers to optimal healthy behaviors. QOL, health behaviors, and the barriers were assessed for 189 respondents.

Results Smoking (25%), risky drinking (35%), elevated body-mass index (83%), poor diet (95% did not meet the guidelines for fruit and vegetable intake), and inadequate exercise (50%) were common. Barriers to achieving optimal health behaviors were categorized as either cancer-related or competing demands. Cancer-related barriers contributed to worse physical QOL, whereas competing demands related to worse mental-health–related QOL.

Limitations Our sample size was moderate and self-selected. In addition, we used self-reports rather than the more standardized observation or interview-based data collection.

Conclusion TCSs demonstrate behaviors that put them at increased risk for future cardiovascular disease and complications. Interventions aimed at reducing tobacco and risky alcohol use and improving dietary and physical activity levels are needed.

Funding/sponsorship NCI grant number 1R03CA124217; the Livestrong Foundation. Disclosures The authors have no disclosures.

Click on the PDF icon at the top of this introduction to read the full article.