Obesity and survival among women with ovarian cancer: results from the Ovarian Cancer Association Consortium.

BACKGROUND: Observational studies have reported a modest association between obesity and risk of ovarian cancer; however, whether it is also associated with survival and whether this association varies for the different histologic subtypes are not clear. We undertook an international collaborative analysis to assess the association between body mass index (BMI), assessed shortly before diagnosis, progression-free survival (PFS), ovarian cancer-specific survival and overall survival (OS) among women with invasive ovarian cancer. METHODS: We used original data from 21 studies, which included 12 390 women with ovarian carcinoma. We combined study-specific adjusted hazard ratios (HRs) using random-effects models to estimate pooled HRs (pHR). We further explored associations by histologic subtype. RESULTS: Overall, 6715 (54%) deaths occurred during follow-up. A significant OS disadvantage was observed for women who were obese (BMI: 30-34.9, pHR: 1.10 (95% confidence intervals (CIs): 0.99-1.23); BMI: ⩾35, pHR: 1.12 (95% CI: 1.01-1.25)). Results were similar for PFS and ovarian cancer-specific survival. In analyses stratified by histologic subtype, associations were strongest for women with low-grade serous (pHR: 1.12 per 5 kg m(-2)) and endometrioid subtypes (pHR: 1.08 per 5 kg m(-2)), and more modest for the high-grade serous (pHR: 1.04 per 5 kg m(-2)) subtype, but only the association with high-grade serous cancers was significant. CONCLUSIONS: Higher BMI is associated with adverse survival among the majority of women with ovarian cancer.

Physician executives report high job satisfaction. Summary of findings from a survey of senior physician executives.

The role of the senior physician executive is well established in American hospitals and health systems. There is little research, however, on overall physician executive job satisfaction, their perceptions of their organizational role and job performance, or their views of the medical staffs with which they work. A recent survey of physician executives examined these and other areas. It found physician executives to be quite satisfied with their jobs. What follows is a summary of the findings. An article based on the survey will be featured in a future issue of The Physician Executive.

Palivizumab for respiratory syncytial virus prophylaxis in high-risk infants: a cost-effectiveness analysis.

BACKGROUND: Prophylactic therapy with palivizumab, a humanized monoclonal antibody, has been shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations in preterm infants. The cost-effectiveness of this therapy has not been evaluated from the provider's perspective using cost data. OBJECTIVES: The objectives of this study were to determine the cost per RSV infection episode avoided by using prophylactic palivizumab therapy in a high-risk infant population and to determine whether certain subgroups of infants derived greater benefit from prophylactic therapy. METHODS: A decision-analytic model simulating an RSV infection episode was developed to evaluate the cost-effectiveness of palivizumab prophylaxis from the perspective of the health care system (provider). Data to populate the model were gathered from the medical literature (identified through a MEDLINE search of studies on the incidence of RSV infection) and the IMpact-RSV clinical trial. Data included incidence of RSV infection and the associated health care resource use and costs. Costs to the provider were determined using a university-affiliated hospital cost-accounting system. Cost-effectiveness ratios were calculated over a range of RSV infection incidence rates in a control population. Sensitivity analyses were performed for the cost of palivizumab therapy, the cost of RSV-related hospitalization, and the number of emergency department, physician office, and home health care visits. For the subgroup analysis, infants were classified by gestational age (<32 and > or = 32 weeks) and stratified by severity of chronic lung disease. RESULTS: The cost per additional RSV infection episode avoided ranged from dollars 0 (cost savings) to dollars 39,591 for palivizumab prophylaxis costs of dollars 2500 and from dollars 2702 to dollars 79,706 for palivizumab prophylaxis costs of dollars 4500. The model was insensitive to changes in the number of emergency department, physician office, and home health care visits. The difference in RSV incidence between the treatment and control groups was greater among infants > or = 32 weeks' gestational age than among infants <32 weeks' gestational age. onclusions: The incremental cost-effectiveness of palivizumab compared with no prophylactic therapy was sensitive to changes in the incidence of RSV infection in control infants, the average cost of RSV hospitalization, and the cost of palivizumab. Clinicians may use this information along with additional factors to determine whether palivizumab is cost-effective in their clinical setting and geographic area.

Development and validation of a questionnaire to evaluate patient satisfaction with diabetes disease management.

OBJECTIVE: To develop a reliable and valid questionnaire to measure patient satisfaction with diabetes disease management programs. RESEARCH DESIGN AND METHODS: Questions related to structure, process, and outcomes were categorized into 14 domains defining the essential elements of diabetes disease management. Health professionals confirmed the content validity. Face validity was established by a patient focus group. The questionnaire was mailed to 711 patients with diabetes who participated in a disease management program. To reduce the number of questionnaire items, a principal components analysis was performed using a varimax rotation. The Scree test was used to select significant components. To further assess reliability and validity; Cronbach's alpha and product-moment correlations were calculated for components having > or =3 items with loadings >0.50. RESULTS: The validated 73-item mailed satisfaction survey had a 34.1% response rate. Principal components analysis yielded 13 components with eigenvalues > 1.0. The Scree test proposed a 6-component solution (39 items), which explained 59% of the total variation. Internal consistency reliabilities computed for the first 6 components (alpha = 0.79-0.95) were acceptable. CONCLUSIONS: The final questionnaire, the Diabetes Management Evaluation Tool (DMET), was designed to assess patient satisfaction with diabetes disease management programs. Although more extensive testing of the questionnaire is appropriate, preliminary reliability and validity of the DMET has been demonstrated.

The frequency of red cell transfusion for anemia in patients receiving chemotherapy. A retrospective cohort study.

The objective of this retrospective cohort study was to determine the frequency of red cell transfusion for anemia and risk factors. It was conducted at a regional cancer center and host hospital. All patients receiving chemotherapy in 1989 were studied. Complete data were available on 381; 26 were excluded. Age, diagnosis, baseline and nadir hemoglobin, transfusion history, chemotherapy regimen, and prior treatment were abstracted from the cancer center chart and hospital medical records. Transfusion for anemia was required in 18% of all patients with solid tumors; those with lung cancer had the highest rate (34%). Patients with anemia who entered chemotherapy were more likely to be transfused. Therefore, patients with leukemia, lung cancer, and/or prior anemia have higher transfusion rates and may benefit from such therapies as recombinant human erythropoietin.