Search

Objective. Little is known about how cancer physicians communicate with limited English proficient (LEP) patients. We studied physician-reported use and availability of interpreters. Data Sources. A 2004 survey was fielded among physicians identified by a population-based sample of breast cancer patients. Three hundred and forty-eight physicians completed mailed surveys (response rate: 77 percent) regarding the structure and organization of care. Study Design and Settings. We used logistic regression to analyze use and availability of interpreters. Principal Findings. Most physicians reported treating LEP patients. Among physicians using interpreters within the last 12 months, 42 percent reported using trained medical interpreters, 21 percent telephone interpreter services, and 75 percent reported using untrained interpreters to communicate with LEP patients. Only one-third of physicians reported good availability of trained medical interpreters or telephone interpreter services when needed. Compared with HMO physicians, physicians in solo practice and single-specialty medical groups were less likely to report using trained medical interpreters or telephone interpreter services, and they were less likely to report good availability of these services. Conclusions. There were important practice setting differences predicting use and availability of trained medical interpreters and telephone interpretation services. These findings may have troubling implications for effective physician–patient communication critically needed during cancer treatment. [ABSTRACT FROM AUTHOR]

: BackgroundUnderstanding the quality of life and health utility for cancer survivors is important; however, little data are available—particularly for long-term (>5 year) survivors. Using “health utility” scores as a proxy for quality of life may be advantageous because it is a single value. Utility scores range from 1.0 (perfect health) to 0 (death), and have been shown to be a good numerical summary of overall quality of life. Using a validated instrument for health utility (HALex), we calculated and report the scores of four different surgical cancers at multiple periods of follow-up, ranging from <1 year to >5 years after diagnosis.: MethodsPatients diagnosed with either breast, colon, melanoma, or lung cancer were studied using the 1998 National Health Information Survey. Responses to several validated questions were collected and health utility scores were calculated. Different time periods were measured; acute (<1 year), short term (1–5 years), and long term (>5 years). Once a single health utility score was calculated, multivariate analyses were performed to identify important predictors of better versus worse health utility scores.: ResultsThe total sample size was 692 (breast 377, colon 169, melanoma 92, lung 54). Mean ages at diagnosis for the cancer groups were 56, 61, 52, and 60 years, respectively. The mean health utility scores in the acute period after diagnosis were: breast 0.62, colon 0.67, melanoma 0.73, and lung 0.42. In this acute period, the mean utility score for lung cancer survivors was statistically lower versus the others in the acute period (P < 0.001). Although variable trends were noted in the short-term period, all cancers demonstrated an increase in mean scores in the long-term period; the percent increases were: breast 15% (P = 0.01), colon 12%, melanoma 7%, and lung 47%. Multivariate regression analyses identified important associations of health utility scores. Significant predictors of lower health utility included the presence of pain and the presence of co-existent diseases, most commonly joint problems, cardiovascular disease, and diabetes.: ConclusionsFor four surgical cancers in three time periods after diagnosis, health utility scores were lowest immediately after treatment and improved over time. Long-term (>5 year) survivors had the highest scores. Additionally, our analyses show that a part of health utility in this cohort is determined by the presence of pain and co-existent diseases, which are often items that can be improved by quality clinical care. [Copyright &y& Elsevier]

: IntroductionPrevious studies have suggested that young breast cancer patients have poorer survival as compared with their older counterparts. Most of this research reflects single institution experiences that may not be representative of the population. This study was designed to determine whether young breast cancer patients have poorer survival as compared with an older cohort using a national population-based cancer registry and, more specifically, to determine whether differences in survival are caused by more advanced tumor stage, more aggressive disease, or patient-specific characteristics.: Materials and methodsUsing the Surveillance, Epidemiology, and End Results cancer database (1992–1998), data for all patients with a diagnosis of invasive breast cancer were extracted. Two age categories were analyzed: young group (≤35 years old, n = 4,616) and older group (50–55 years old, n = 20,319). Patient demographics, 5-year survival rates, tumor characteristics (stage, grade, and receptor status), surgical treatment, and use of radiation were compared between the groups.: ResultsOverall, young patients had worse 5-year survival when compared with the older group (74.3% vs. 85.1%). Stage for stage, the young patients also had poorer survival (except for stage IV). They present with more advanced stage disease and have more aggressive tumor characteristics, that is, higher grade tumors and more estrogen- and progesterone receptor-negative tumors. Even after controlling for patient characteristics, tumor factors, and receipt of treatment, a multivariate regression showed that young age was an independent risk factor for death (HR = 1.095).: ConclusionsYoung breast cancer patients have poorer outcomes, which are in part attributed to later stage disease, more aggressive tumors, and less favorable receptor status. There still appears to be other important factors, not included in our study, that are contributing to the worse outcomes for these young patients, such as socioeconomic status. Physicians need to have heightened awareness when evaluating this population, and increasingly efficacious adjuvant therapies need to be developed. [Copyright &y& Elsevier]

In 2001 approximately 40,000 deaths from breast cancer will occur in the United States. Although some estimates suggest possible state-to-state variations in breast cancer mortality rates the reasons for such differences remain unknown. Our objective was to confirm whether breast cancer mortality rates are significantly different by state and to identify predictors for such variation. Administrative data from the National Center for Health Statistics (NCHS) report were used to determine statewide death rates. Analyses were similarly performed with the Surveillance, Epidemiology, and End Results (SEER) cancer database to determine predictors of high versus low mortality rates. State-level variation in breast cancer mortality rates was demonstrated in the NCHS database. A subsequent analysis of high versus low mortality states in the SEER cancer registry demonstrates that stage at presentation was a significant predictor of mortality, as "high" mortality states had more patients presenting with later-stage disease. We conclude that variations in the breast cancer mortality rates exist between states. A nearly 50 per cent increase is observed between the states with the highest and lowest mortality rates. Adjusted analyses demonstrate that stage at presentation is a more important predictor of mortality variation than treatment differences. As such breast cancer mortality rates may be best improved by targeting screening and access-to-care issues rather than treatment. [ABSTRACT FROM AUTHOR]