Objective
Pain and depression are two of the most prevalent and treatable cancer-related symptoms, each present in at least 20-30% of oncology patients. Both symptoms, however, are frequently either unrecognized and/or undertreated. The objective is to describe a telecare management intervention delivered by a nurse-psychiatrist team that is designed to improve recognition and treatment of pain and depression. The enrolled sample is also described.
Method
The Indiana Cancer Pain and Depression (INCPAD) study is an NCI-sponsored randomized clinical trial. A total of 405 patients with cancer-related pain and/or clinically significant depression from 16 urban or rural oncology practices throughout Indiana have been enrolled and randomized to either the intervention or a usual care control group. Intervention patients receive centralized telecare management coupled with automated home-based symptom monitoring. Outcomes will be assessed at 1, 3, 6 and 12 months by research assistants blinded to treatment arm.
Results
Of 4465 patients screened, 2185 (49%) endorsed symptoms of pain or depression. Of screen-positive patients, about one-third were ineligible (most commonly due to pain or depression not meeting severity thresholds, or pain that is not cancer-related). Of the 405 patients enrolled, 32% have depression only, 24% pain only, and 44% both depression and pain. At baseline, participants report an average of 16.8 days out of the past 4 weeks in which they were confined to bed or had to reduce their usual activities by ≥ 50% due to pain or depression. Also, 176 (44%) report being unable to work due to health reasons.
Conclusions
When completed, the INCPAD trial will test whether centralized telecare management coupled with automated home-based symptom monitoring improves outcomes in cancer patients with depression and/or pain. Findings will be important for both oncologists and mental health clinicians confronted with oncology patients' depression or pain.
While much is known about the impacts of volcanic forcing on Northern Hemisphere (NH) climates, knowledge about Southern Hemisphere (SH) responses is still in its infancy. We examine volcanic impacts on SH temperatures following eight major late 19th and 20th century eruptions (Agung, 1963; Colima, 1913; El Chichón, 1982; Pinatubo, 1991; Krakatau, 1883; Quizapu, 1932; Santa Maria, 1902; Tarawera, 1886). Coupled Model Intercomparison Project, Phase 5 (CMIP5) historical simulations are used to analyze near‐surface land temperatures. We demonstrate that four of the eight major eruptions (Krakatau, Santa Maria, Agung, and Pinatubo) significantly lowered mean SH temperatures; these tropical eruptions emitted at least 20 Tg of SO2 into the stratosphere. SH responses typically lagged NH temperature cooling responses by 1–2 months, excluding Pinatubo. Responses differ spatially and temporally with each eruption, highlighting the importance of investigating events individually. Overall, we observe relatively strong (between −0.19°C and −0.36°C) austral autumn/winter SH cooling.
Although volcanic forcing impacts on climate have gained much international attention during recent years, focus has largely been at hemispheric scale, and most particularly on the Northern Hemisphere (NH). Here we investigate the impact of major volcanic eruptions since 1883 on southern African climate, with a view to establishing potential sub‐regional differences across a variety of temporal scales. To this end, we use historical simulations from the Coupled Model Intercomparison Project, Phase 5 (CMIP5) to study near‐surface temperature responses to four major eruptions (Krakatau, 1883; Santa Maria, 1902; Agung, 1963; Pinatubo, 1991) over six sub‐regions of southern Africa. Results show significant cooling across all sub‐regions after each eruption. However, we detect considerable sub‐regional differences in the amplitude, timing and duration of responses. For instance, stronger temperature departures occur in northern rather than southern sub‐regions where diurnal and annual temperature ranges are normally greater. While significant responses occur within the first year after each eruption, there is a more delayed response in three of the sub‐regions (southwestern coast and central southern Africa) following the Santa Maria eruption. Strongest responses follow the Krakatau eruption in all sub‐regions, while the weakest response follows the Santa Maria eruption in western sub‐regions and the Agung eruption in eastern sub‐regions. Most regions experience the strongest temperature departures during austral autumn and winter (MAM and JJA), and weakest during spring (SON).
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