Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S. city who were initiating palliative radiation for bone pain. Moderator regression analyses predicted variation in depressive affect that could be attributed to symptom clusters. Patients self-reported difficulty controlling each physical symptom over the past month on a Likert scale and depressive symptoms on a validated depression measure (Center for Epidemiologic Studies-Depression [CES-D]) over the past week on a four-category scale. An index of depressive affect was based on items of negative and positive affect from the CES-D. In predicting depressive affect, synergistic interactions of pain with fever, fatigue, and weight loss suggest separate pathways involving pain. A similar interaction with fever occurs when nausea was tested in place of pain. Further, the interaction between pain and fatigue is similar in form to the interaction between difficulty breathing and fatigue (when sleep is not a problem). Follow-up to the latter interaction reveals: 1) additional moderation by hypertension and palliative radiation to the hip/pelvis; and 2) a similar cluster not involving hypertension when appetite problems and weight loss were tested in place of fatigue. The significance and form of these interactions are remarkably consistent. Similar sickness mechanisms could be generating: 1) pain and nausea during fever; 2) pain and fatigue during weight loss; and 3) pain and breathing difficulty when fatigue is pronounced. Crossover effects from symptom-specific interventions appear promising.

No abstract

No abstract

Income-equivalence scales (IES) provide distinct advantages over poverty indices to adjust family income for differences in family size, including improved specification of hypothesized causal relationships involving objective measures of economic well-being. In a novel IES application, cancer patients' out-of-pocket health costs are adjusted for differences in family income and size and, along with five other subindices, contribute to an overall index of "objective family financial stress." Age-related changes are modeled simultaneously within relationships between overall objective family financial stress and subjective patient perceptions about financial strain. Among the findings, the impact of age on one area of subjective financial strain, "difficulty paying bills," is negative and curvilinear. Regardless of adjusted out-of-pocket costs, as age advances, patients appear increasingly likely to accommodate to financial stress by reporting less difficulty paying bills. This phenomenon could serve to mask and isolate older adults who are foregoing needed yet unaffordable medical care and prescriptions.The use of income-equivalence scales (IES) to adjust family income for differences in family size is described, with a novel application to derive out-of-pocket health costs that are adjusted for family income and family size. IES provide distinct advantages over the use of poverty indices. One important empirical advantage pertains to improved specification of hypothesized functional causal relationships involving objective measures of economic well-being.Causal relationships involving social structural variables and measures of objective and subjective economic well-being will be our initial focus for discussion. This will lead to a discussion and derivation of IES, which are necessary to specify this causal relationship. Then, in a unique application of IES, out-of-pocket health costs incurred by patients with recurrent cancer are adjusted for differences in family size and income and will be incorporated into an even broader index of overall objective family financial stress. Finally, curvilinear and moderated relationships based on this overall index and adult patient age will be tested in simultaneous causal relationships to three measures, in addition to a latent construct, of "subjective patient financial strain." Social Stratification as a Description of AccommodationAccording to social stratification theory and empirical findings, the social structural features reflected by demographic variables such as sex, race, and age interact over time to reflect different degrees of restrictions or barriers over access to economic resources and opportunities. This results in greater barriers within groups that are older, female, and/or a minority (Becker, 1971;Blau, 1977;Blau & Duncan, 1967;Chiswick & O'Neill, 1977;Corcoran & Duncan, 1978;Duncan, 1968;Foner, 1975;Lloyd & Niemi, 1979;Moody, 1994;Riley, Johnson, & Foner, 1972). Disadvantaged groups are more likely to experience fixed economic situations due ...