Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to... more Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.
In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified;... more In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified; each trajectory according to socio demographic and family characteristics was described. Participants came from two national population surveys (n = 7,253; n = 901) and were aged 1-6 years at baseline. Children were surveyed biennially over eight waves up to 14-20 years of age. BMI trajectories by sex and survey cohort were identified by group-based trajectory modeling. After crossvalidating trajectories between survey cohorts, the characteristics of trajectory membership were assessed by multinomial regression. Four BMI trajectories were found: low, decreasing, medium, and high. The decreasing trajectory was characterized by an overweight or obese childhood followed by a normal-weight adolescence. The low, medium, and high trajectories were characterized by growth curves culminating, by age 20, to BMI 22.6, 29.3, and 34.9 kg/m(2) , respectively, for males and 20.6, 24.5, and 32.0 kg/m(2) , respectively, for females. Factors associated with the high trajectory included ethnicity and paternal education (female only), large for gestational age, rural area residence, and maternal smoking. The identification and validation of four major trajectories reflect the heterogeneity in patterns of BMI development from 1 to 20 years.
Journal of pain and symptom management, Jan 29, 2015
Clinical trials utilize clinician-graded adverse events (AEs) and patient-reported outcomes (PROs... more Clinical trials utilize clinician-graded adverse events (AEs) and patient-reported outcomes (PROs) to describe symptoms. To examine the agreement between PROs and AEs in the clinical trial setting. Patient-level data were pooled from seven North Central Cancer Treatment Group, two Southwest Oncology Group and three Radiation Therapy Oncology Group lung studies that included both PROs and AE data. Ten-point changes (on a 0-100 scale) in PRO scores were considered clinically significant differences (CSDs). PRO score changes were compared to AE grade (Gr) categories (2+ yes vs. no and 3+ yes vs. no) using Wilcoxon rank- sum or two-sample t-tests between Gr categories. Incidence rates and concordance of CSD in PRO scores and AE grade categories were compiled. Spearman correlations were computed between PRO scores and AE severity. PROs completed by patients (N=1013) were the Uniscale, Lung Cancer Symptom Scale (LCSS), Functional Assessment of Cancer Therapy-Lung (FACT-L), Symptom Distres...
To evaluate the effectiveness of exercise interventions on overall health-related quality of life... more To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among adults scheduled to, or actively undergoing, cancer treatment. 11 electronic databases were searched through November 2011. In addition, the authors searched PubMed's related article feature, trial registries, and reference lists of included trials and related reviews. 56 trials with 4,826 participants met the inclusion criteria. At 12 weeks, people exposed to exercise interventions had greater improvement in overall HRQOL, physical functioning, role functioning, social functioning, and fatigue. Improvement in HRQOL was associated with moderate-to-vigorous intensity exercise interventions. Exercise can be a useful tool for managing HRQOL and HRQOL domains for people scheduled to, or actively undergoing, cancer treatment. More methodologically rigorous trials are needed to examine the attributes of exercise programs most effective for improving HRQOL. Evidence from this review supports the incorporation of exercise programs of moderate-to-vigorous intensity for the management of HRQOL among people scheduled to, or actively undergoing, cancer treatment into clinical guidelines through the Oncology Nursing Society's Putting Evidence Into Practice resources.
To evaluate the effectiveness of exercise interventions on overall health-related quality of life... more To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among cancer survivors who have completed primary treatment. 11 electronic databases were searched from inception (dates varied) to October 2011. The authors also identified eligible trials through a search of additional sources. 40 trials with 3,694 participants met the inclusion criteria. At 12 weeks, cancer survivors exposed to exercise interventions had greater positive improvement in overall HRQOL (standardized mean difference [SMD] 0.48; 95% confidence interval [CI] [0.16, 0.81]), emotional well-being (SMD 0.33; 95% CI [0.05, 0.61]), and social functioning (SMD 0.45; 95% CI [0.02, 0.87]); and had a significant reduction in anxiety (SMD -0.26; 95% CI [-0.44, -0.07]) and fatigue (SMD -0.82; 95% CI [-1.5, -0.14]). Exercise programs have a beneficial effect on HRQOL and most of its domains and can be integrated into the management plans for cancer survivors who...
This study assessed quality of life in long-term cervical cancer survivors eligible for health ca... more This study assessed quality of life in long-term cervical cancer survivors eligible for health care in the military health system. TRICARE beneficiaries who were diagnosed as having cervical cancer in 1980 to 2000 completed self-administered questionnaires including standardized measures of quality of life, distress, and sexuality. Forty-one women (72% of those who received questionnaire packets) provided questionnaire data. More than 2,500 questionnaires were undeliverable, with no forwarding address. Data indicated that quality of life, cervical cancer-related stress, and intimacy concerns were comparable to population normative values. Survivors received more cancer screenings than the general population. Nearly one-half of respondents reported no effect of cancer on their sexual relationships, whereas approximately one-half said that cancer had a negative impact. Although cervical cancer survivors overall reported a high quality of life, many experienced significant decrements in sexual functioning. The Automated Central Tumor Registry presents challenges and potential for conducting this kind of research.
Assessments of adolescents' smoking intentions indicate t... more Assessments of adolescents' smoking intentions indicate that many are susceptible to smoking initiation because they do not have resolute intentions to abstain from trying smoking in the future. Although researchers have developed personality and affect-related risk factor profiles to understand risk for the initiation of substance use and abuse (e.g., alcohol), few have examined the extent to which these risk factors are related to the tobacco use intentions of adolescents who have yet to try tobacco smoking. The objective of this study was to examine the relationships between personality and affect-related risk factors measured by the Substance Use Risk Profile Scale (SURPS) and smoking intentions in a sample of adolescents who have not experimented with tobacco smoking. Data is based on responses from 1352 participants in the British Columbia Adolescent Substance Use Survey (56% female, 76% in Grade 8) who had never tried smoking tobacco. Of these 1352 participants, 29% (n=338) were classified as not having resolute intentions to not try smoking. Generalized estimating equations were used to examine the relationship between each SURPS dimension (Anxiety Sensitivity, Hopelessness, Impulsivity and Sensation Seeking) and the intention to try cigarettes in the future. Hopelessness (AOR 1.06, 95% CI [1.03, 1.10], p<.001), Impulsivity (AOR 1.07 [1.03, 1.11], p<.001) and Sensation Seeking (AOR 1.05 95% CI [1.02, 1.09], p<.01) had independent statistically significant associations with having an intention to try smoking. These findings may be used to inform a prevention-oriented framework to reduce susceptibility to tobacco smoking.
Quality of life (QOL) is increasingly assessed in cancer patients. In this article, the authors e... more Quality of life (QOL) is increasingly assessed in cancer patients. In this article, the authors examined the psychometric performance of a commonly used QOL questionnaire, the Quality of Life Questionnaire--Cancer 30 (QLQ-C30; N. K. Aaronson et al., 1993), in multiethnic cancer patients. Content validation studies in patients and clinicians identified possible new items. Multiple-group confirmatory factor analysis supported equivalent structure across ethnic groups (Caucasians and Asian/Pacific Islanders [APIs]). A higher order QOL factor appeared to directly affect functioning scales and symptom count. Exploratory factor analysis examined effects of new items. Ten factors were extracted, 6 consistent with the original instrument and 4 reflecting potentially new aspects of QOL: Positive Social Support, Coping, Existential Well-Being, and Sexuality/Intimacy. The QLQ-C30 appears appropriate for use in API cancer patients. Further work needs to ensure that it includes all important domains.
There is growing recognition that patient-reported outcome (PRO) measures--encompassing, for exam... more There is growing recognition that patient-reported outcome (PRO) measures--encompassing, for example, health-related quality of life--can complement traditional biomedical outcome measures (eg, survival, disease-free survival) in conveying important information for cancer care decision making. This paper provides an integrated review and interpretation of how PROs have been defined, measured, and used in a range of recent cancer research and policy initiatives. We focus, in turn, on the role of PRO measurement in the evaluation and approval of cancer therapies, the assessment of cancer care in the community, patient-provider decision making in clinical oncology practice, and population surveillance of cancer patients and survivors. The paper concludes with a discussion of future challenges and opportunities in PRO measure development and application, given the advancing state of the science in cancer outcomes measurement and the evolving needs of cancer decision makers at all levels.
Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to... more Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.
In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified;... more In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified; each trajectory according to socio demographic and family characteristics was described. Participants came from two national population surveys (n = 7,253; n = 901) and were aged 1-6 years at baseline. Children were surveyed biennially over eight waves up to 14-20 years of age. BMI trajectories by sex and survey cohort were identified by group-based trajectory modeling. After crossvalidating trajectories between survey cohorts, the characteristics of trajectory membership were assessed by multinomial regression. Four BMI trajectories were found: low, decreasing, medium, and high. The decreasing trajectory was characterized by an overweight or obese childhood followed by a normal-weight adolescence. The low, medium, and high trajectories were characterized by growth curves culminating, by age 20, to BMI 22.6, 29.3, and 34.9 kg/m(2) , respectively, for males and 20.6, 24.5, and 32.0 kg/m(2) , respectively, for females. Factors associated with the high trajectory included ethnicity and paternal education (female only), large for gestational age, rural area residence, and maternal smoking. The identification and validation of four major trajectories reflect the heterogeneity in patterns of BMI development from 1 to 20 years.
Journal of pain and symptom management, Jan 29, 2015
Clinical trials utilize clinician-graded adverse events (AEs) and patient-reported outcomes (PROs... more Clinical trials utilize clinician-graded adverse events (AEs) and patient-reported outcomes (PROs) to describe symptoms. To examine the agreement between PROs and AEs in the clinical trial setting. Patient-level data were pooled from seven North Central Cancer Treatment Group, two Southwest Oncology Group and three Radiation Therapy Oncology Group lung studies that included both PROs and AE data. Ten-point changes (on a 0-100 scale) in PRO scores were considered clinically significant differences (CSDs). PRO score changes were compared to AE grade (Gr) categories (2+ yes vs. no and 3+ yes vs. no) using Wilcoxon rank- sum or two-sample t-tests between Gr categories. Incidence rates and concordance of CSD in PRO scores and AE grade categories were compiled. Spearman correlations were computed between PRO scores and AE severity. PROs completed by patients (N=1013) were the Uniscale, Lung Cancer Symptom Scale (LCSS), Functional Assessment of Cancer Therapy-Lung (FACT-L), Symptom Distres...
To evaluate the effectiveness of exercise interventions on overall health-related quality of life... more To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among adults scheduled to, or actively undergoing, cancer treatment. 11 electronic databases were searched through November 2011. In addition, the authors searched PubMed's related article feature, trial registries, and reference lists of included trials and related reviews. 56 trials with 4,826 participants met the inclusion criteria. At 12 weeks, people exposed to exercise interventions had greater improvement in overall HRQOL, physical functioning, role functioning, social functioning, and fatigue. Improvement in HRQOL was associated with moderate-to-vigorous intensity exercise interventions. Exercise can be a useful tool for managing HRQOL and HRQOL domains for people scheduled to, or actively undergoing, cancer treatment. More methodologically rigorous trials are needed to examine the attributes of exercise programs most effective for improving HRQOL. Evidence from this review supports the incorporation of exercise programs of moderate-to-vigorous intensity for the management of HRQOL among people scheduled to, or actively undergoing, cancer treatment into clinical guidelines through the Oncology Nursing Society's Putting Evidence Into Practice resources.
To evaluate the effectiveness of exercise interventions on overall health-related quality of life... more To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among cancer survivors who have completed primary treatment. 11 electronic databases were searched from inception (dates varied) to October 2011. The authors also identified eligible trials through a search of additional sources. 40 trials with 3,694 participants met the inclusion criteria. At 12 weeks, cancer survivors exposed to exercise interventions had greater positive improvement in overall HRQOL (standardized mean difference [SMD] 0.48; 95% confidence interval [CI] [0.16, 0.81]), emotional well-being (SMD 0.33; 95% CI [0.05, 0.61]), and social functioning (SMD 0.45; 95% CI [0.02, 0.87]); and had a significant reduction in anxiety (SMD -0.26; 95% CI [-0.44, -0.07]) and fatigue (SMD -0.82; 95% CI [-1.5, -0.14]). Exercise programs have a beneficial effect on HRQOL and most of its domains and can be integrated into the management plans for cancer survivors who...
This study assessed quality of life in long-term cervical cancer survivors eligible for health ca... more This study assessed quality of life in long-term cervical cancer survivors eligible for health care in the military health system. TRICARE beneficiaries who were diagnosed as having cervical cancer in 1980 to 2000 completed self-administered questionnaires including standardized measures of quality of life, distress, and sexuality. Forty-one women (72% of those who received questionnaire packets) provided questionnaire data. More than 2,500 questionnaires were undeliverable, with no forwarding address. Data indicated that quality of life, cervical cancer-related stress, and intimacy concerns were comparable to population normative values. Survivors received more cancer screenings than the general population. Nearly one-half of respondents reported no effect of cancer on their sexual relationships, whereas approximately one-half said that cancer had a negative impact. Although cervical cancer survivors overall reported a high quality of life, many experienced significant decrements in sexual functioning. The Automated Central Tumor Registry presents challenges and potential for conducting this kind of research.
Assessments of adolescents' smoking intentions indicate t... more Assessments of adolescents' smoking intentions indicate that many are susceptible to smoking initiation because they do not have resolute intentions to abstain from trying smoking in the future. Although researchers have developed personality and affect-related risk factor profiles to understand risk for the initiation of substance use and abuse (e.g., alcohol), few have examined the extent to which these risk factors are related to the tobacco use intentions of adolescents who have yet to try tobacco smoking. The objective of this study was to examine the relationships between personality and affect-related risk factors measured by the Substance Use Risk Profile Scale (SURPS) and smoking intentions in a sample of adolescents who have not experimented with tobacco smoking. Data is based on responses from 1352 participants in the British Columbia Adolescent Substance Use Survey (56% female, 76% in Grade 8) who had never tried smoking tobacco. Of these 1352 participants, 29% (n=338) were classified as not having resolute intentions to not try smoking. Generalized estimating equations were used to examine the relationship between each SURPS dimension (Anxiety Sensitivity, Hopelessness, Impulsivity and Sensation Seeking) and the intention to try cigarettes in the future. Hopelessness (AOR 1.06, 95% CI [1.03, 1.10], p<.001), Impulsivity (AOR 1.07 [1.03, 1.11], p<.001) and Sensation Seeking (AOR 1.05 95% CI [1.02, 1.09], p<.01) had independent statistically significant associations with having an intention to try smoking. These findings may be used to inform a prevention-oriented framework to reduce susceptibility to tobacco smoking.
Quality of life (QOL) is increasingly assessed in cancer patients. In this article, the authors e... more Quality of life (QOL) is increasingly assessed in cancer patients. In this article, the authors examined the psychometric performance of a commonly used QOL questionnaire, the Quality of Life Questionnaire--Cancer 30 (QLQ-C30; N. K. Aaronson et al., 1993), in multiethnic cancer patients. Content validation studies in patients and clinicians identified possible new items. Multiple-group confirmatory factor analysis supported equivalent structure across ethnic groups (Caucasians and Asian/Pacific Islanders [APIs]). A higher order QOL factor appeared to directly affect functioning scales and symptom count. Exploratory factor analysis examined effects of new items. Ten factors were extracted, 6 consistent with the original instrument and 4 reflecting potentially new aspects of QOL: Positive Social Support, Coping, Existential Well-Being, and Sexuality/Intimacy. The QLQ-C30 appears appropriate for use in API cancer patients. Further work needs to ensure that it includes all important domains.
There is growing recognition that patient-reported outcome (PRO) measures--encompassing, for exam... more There is growing recognition that patient-reported outcome (PRO) measures--encompassing, for example, health-related quality of life--can complement traditional biomedical outcome measures (eg, survival, disease-free survival) in conveying important information for cancer care decision making. This paper provides an integrated review and interpretation of how PROs have been defined, measured, and used in a range of recent cancer research and policy initiatives. We focus, in turn, on the role of PRO measurement in the evaluation and approval of cancer therapies, the assessment of cancer care in the community, patient-provider decision making in clinical oncology practice, and population surveillance of cancer patients and survivors. The paper concludes with a discussion of future challenges and opportunities in PRO measure development and application, given the advancing state of the science in cancer outcomes measurement and the evolving needs of cancer decision makers at all levels.
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Papers by Carolyn Gotay