Increased travel burden was associated with a decreased likelihood of receiving adjuvant chemotherapy, regardless of insurance status. Patients with nonprivate insurance who resided in low-density oncologist areas were less likely to receive adjuvant chemotherapy. If these findings are validated prospectively, interventions to decrease geographic barriers may improve the timeliness and quality of colon cancer treatment.

Purpose Epidermal growth factor receptor (EGFR) gene copy number detected by fluorescent in situ hybridization (FISH) has proven to be useful for selection of non–small-cell lung cancer (NSCLC) patients for treatment with EGFR tyrosine kinase inhibitors. Here, we evaluate EGFR FISH as a predictive marker in NSCLC patients receiving the EGFR monoclonal antibody inhibitor cetuximab plus chemotherapy. Patients and Methods Two hundred twenty-nine chemotherapy-naive patients with advanced-stage NSCLC were enrolled onto a phase II selection trial evaluating sequential or concurrent chemotherapy (paclitaxel plus carboplatin) with cetuximab. Results EGFR FISH was assessable in 76 patients with available tumor tissue and classified as positive (four or more gene copies per cell in ≥ 40% of the cells or gene amplification) in 59.2%. Response (complete response/partial response) was numerically higher in FISH-positive (45%) versus FISH-negative (26%) patients (P = .14), whereas disease control rate (complete response/partial response plus stable disease) was statistically superior (81% v 55%, respectively; P = .02). Patients with FISH-positive tumors had a median progression-free survival time of 6 months compared with 3 months for FISH-negative patients (P = .0008). Median survival time was 15 months for the FISH-positive group compared with 7 months for patients who were FISH negative. (P = .04). Furthermore, survival favored FISH-positive patients receiving concurrent therapy. Conclusion These results are the first to suggest that EGFR FISH is a predictive factor for selection of NSCLC patients for cetuximab plus chemotherapy. Prospective validation of these findings is warranted.

Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd.

BackgroundDementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.MethodsThe cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.ResultsHome-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.ConclusionThe study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.

Purpose of the study was to examine if animal-assisted activity with a dog (AAA) in homedwelling persons with dementia (PWDs) attending day-care centers would have an effect on factors related to risk of fall accidents, with balance (Berg balance scale) and quality of life (Quality of Life in Late-stage Dementia) as main outcome. The project was conducted as a prospective and cluster-randomized multicenter trial with a follow-up. 16 adapted day-care centers recruited respectively 42 (intervention group) and 38 (control group with treatment as usual) home-dwelling PWDs. The intervention consisted of 30 min sessions with AAA led by a qualified dog handler twice a week for 12 weeks in groups of 3-7 participants. The significant positive effect on balance indicates that AAA might work as a multifactorial intervention in dementia care and have useful clinical implication by affecting risk of fall.

Purpose Trimodality therapy (chemoradiation and surgery) is standard of care for Stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between density of radiation oncologist and travel distance to receipt of RT. Materials/Methods A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18–80 with Stage II/III rectal cancer diagnosed between 2007–2010. Radiation oncologists were identified through Physician Compare Dataset. Generalized Estimating Equations clustering by Hospital Service Area was utilized to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics. Results 70% of patients received RT within 180 days of diagnosis or within 90 days of surgery. Compared to travel distance <12.5 miles, patients diagnosed at reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50–249 miles: adjusted Odds Ratio [aOR] 0.75, p<.001; ≥250 miles: aOR 0.46, p=.002), all else being equal. Density level of radiation oncologists was not significantly associated with receipt of RT. Patients who were female, nonwhites, ≥50 years, and with comorbidities were less likely to receive RT (p<.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at reporting facility, and resided in Midwest had increased likelihood of receipt of RT (p<.05). Conclusions Increased travel burden was associated with a decreased likelihood of receiving RT for stage II/III rectal cancer patients when all else being equal, but radiation oncologist density was not. Further research in geographic access and establishing transportation assistance programs, or lodging services for patients with unmet need may help decrease geographic barriers and improve the quality of rectal cancer care.

Participants with severe dementia seemed to have difficulty in maintaining attention toward Paro during the group session. In the group as a whole, Paro seemed to be a mediator for increased social interactions and created engagement.

No abstract