Oncology Nursing Society

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Oncology Nursing Society

  1. 1. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 1 Oncology Nursing Society Annual Progress Report: 2004 Formula Grant Reporting Period July 1, 2005 – June 30, 2006 Formula Grant Overview The Oncology Nursing Society received $31,527 in formula funds for the grant award period January 1, 2005 through December 31, 2006. The funds were used to support one research project. Accomplishments for the reporting period are described below. Formula Grant Coordinator Gail A. Mallory, Ph.D., R.N., C.N.A.A. Director of Research Oncology Nursing Society 125 Enterprise Drive Pittsburgh, PA 15275-1214 (412) 859-6308 Research Project 1: Project Title and Purpose Symptom Clusters in Patients with Chronic Disease and Cancer as a Comorbidity - A symptom cluster is three or more concurrent symptoms that are related to and influence one another. As the number of cancer survivors increases, it is important to know how a past diagnosis of cancer influences the symptom clusters experienced with other chronic health problems. To date, no studies have documented symptom clusters in patients with chronic health problems who have cancer as a comorbid condition. The purpose of this exploratory, secondary analysis is to identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity. Duration of Project 1/1/2005 - 6/30/2006 (no cost extension through 12/31/2006) Project Overview This behavioral study represents a collaboration between the University of Pittsburgh School of Nursing and the Oncology Nursing Society. The specific aims of this study are to explore: 1) the symptom clusters in individuals with chronic health problems who have cancer as a comorbidity; 2) whether there are differences in symptom clusters between individuals with chronic health
  2. 2. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 2 problems who have cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity; 3) whether there are differences in the number and type of comorbidities between individuals with chronic health problems who have cancer as a comorbidity versus those who do not have cancer as a comorbidity; and 4) whether there are differences in symptom clusters, depending upon the number and type of comorbidities, in individuals with chronic health problems who have cancer as a comorbidity versus those who do not have cancer as a comorbidity. The design of this exploratory study is a secondary analysis of existing comorbidity and symptom data collected at the baseline assessment from two independent studies of subjects with chronic health problems who do and do not have cancer as a comorbid condition. Study 1 is an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis. Study 2 is an investigation of the efficacy of an intervention to decrease relapse rates following pelvic floor muscle training for urinary incontinence in the elderly. Data from two measures, used in both studies, will be analyzed. The Co-Morbidity Questionnaire is a self-report measure of comorbid conditions and symptom assessment. The Center for Research in Chronic Disorders Sociodemographic Questionnaire assesses sociodemographic and socioeconomic attributes of subjects. Merged, de- identified data from both studies will be analyzed to identify symptom clusters and to compare symptom clusters between subjects with a comorbidity of cancer and subjects without a comorbidity of cancer. Principal Investigator Catherine M. Bender, Ph.D., R.N. University of Pittsburgh School of Nursing 3500 Victoria Street, Suite 415 Pittsburgh, PA 15261 Other Participating Researchers Heidi Donovan, Ph.D., R.N., Susan Sereika, Ph.D., Margaret Rosenzweig, Ph.D., R.N., Susan Cohen, Ph.D, R.N., Janet Stewart, Ph.D., R.N., Julius Kitutu, ME.d., MS.c., Ph.D.-employed by University of Pittsburgh School of Nursing Gail A. Mallory, Ph.D., R.N. - Oncology Nursing Society Expected Research Outcomes and Benefits With the number of cancer survivors increasing every year, it is important to understand the influence of cancer as a comorbidity with other chronic health problems. In particular, being able to predict the influence of a cancer history on symptom clusters could help promote optimal symptom management for patients with chronic illnesses. Symptoms within a symptom cluster can influence one another and knowledge of this influence may direct interventions for the prevention and management of symptoms. This is an important area of research because patients with chronic health problems tend to experience multiple concurrent symptoms. Symptom clusters have a negative effect on patient outcomes such as functional status and quality of life. Management of single symptoms may have unintended implications for the management of related symptoms. It is important to identify and describe symptom clusters to insure accurate
  3. 3. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 3 and well-timed symptom identification and to develop and test interventions to prevent and manage symptom clusters in patients with chronic health problems who do and do not have cancer as a comorbidity. Summary of Research Completed Methods Used This exploratory study was a secondary analysis of existing co-morbidity and symptom data collected at the baseline assessment from two independent studies (Study 1 and Study 2) of adults with chronic disease who did and who did not have cancer as a comorbidity. Co-morbidity data was measured with the Comorbidity Scale and symptoms were measured with the Center for Research in Chronic Disorders (CRCD) Socioeconomic Questionnaire. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis. Study 2 was an investigation of the efficacy of an intervention to decrease relapse rates following pelvic floor muscle training for urinary incontinence in the elderly. Only complete cases from each study were used for the secondary analysis. Cases for which there were incomplete data were omitted. The following is a description of the samples from each study. Sample Study 1 - Adherence in Rheumatoid Arthritis: Intervention Strategies (NIH, R01-NR04554) Subjects in this study were 641 adults with rheumatoid arthritis (RA) between ages 19 and 85 years (Mean=59.5, SD=11.9). Consistent with the RA population, the sample was predominantly female (80.7%, n=517) and white (95.2%, n=610). Most were currently married (65.7%, n=421) and either retired (29.0%, n=186), part-time employed (21.4%, n=137), or disabled and unable to work (19.2%, n=123). Almost all subjects had some form of health insurance (99.5%, n=638). Of the 641 subjects in this study, 56 (8.7%) self-reported a comorbid diagnosis of cancer. Study 2 - Homebound Elderly: Maintaining Post-treatment Continence (NIH, R01-NR04304) Subjects in this study were 409 men and women age 60 years and older (Mean=76.9, SD=8.2, Range=60-98) who self-reported urinary incontinence at least twice a week for a minimum of 3 months. About 40% were homebound and the remaining 60% were not. The sample was white (95.4%, n=390), widowed (49.1%, n=201), and retired (90.5%, n=370). Almost all had health insurance (99.8%, n=409). Of the 409 subjects in this study, 99 (24.2%) self-reported a comorbid diagnosis of cancer. Statistical Analysis An honest broker was given password-protected access to retrieve data from both study measures. De-identified data were abstracted and the data files were then merged from the two studies. Only complete cases from each study were used for the secondary analysis. Cases for which there were incomplete data were omitted. A preliminary descriptive analysis of the sociodemographic data and comorbidity data (whether or not subjects have ever had a cancer diagnosis) was conducted. Data were analyzed using contingency table analysis with Chi square tests of independence and exploratory factor analysis.
  4. 4. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 4 Results of the Research Table 1 summarizes the sample characteristics for both Study 1 and Study 2. The sample of subjects with urinary incontinence is older than the RA sample when considering the means (59.5 for RA, 76.8 for UI) and the standard deviations (11.9 for RA, 8.2 for UI). The range of the UI sample (38) is smaller than that of the RA population (66). The cancer and the noncancer samples from the RA and UI studies appear to be heterogeneous when looking at characteristics such as health care coverage and highest level of education. More precisely, cases whose highest education level is Grade School are more prevalent in the UI samples. In addition, the UI population is more frequently covered by the Medicare and Medicaid programs than the RA population. Conversely, the RA population is more frequently covered by private and other types of programs than the UI population. Table 2 lists the symptoms present across subjects with and without cancer in Study 1 and Study 2. Night sweats were significantly more prevalent in subjects with cancer as a comorbidity (p=.03) than in subjects who did not have cancer as a comorbidity. Table 3 identifies the symptom clusters present in subjects with and without cancer in both studies. Four different symptoms clusters were identified in the cancer and non-cancer groups across both studies. There were commonalities in symptoms comprising these clusters. Some symptom clusters are more frequently associated with their chronic disease than with a diagnosis of cancer. Other symptoms are common to both conditions. Findings from this study will be presented at the Council for the Advancement of Nursing Science Program Committee for the 2006 National State of the Science Congress in Nursing Research in October. The reference for this presentation is: Bender, C.M., Houze, M., Dunbar-Jacob, J., Engberg, S., Mallory, G., Sereika, S.M. (2006). Symptom clusters in adults with chronic disease and cancer as a comorbidity. The 2006 National State of the Science Congress in Nursing Research. Washington D.C. October. Plans are now underway for the development of a manuscript to report the findings of this study.
  5. 5. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 5 Table 1. Characteristics of the samples for Study 1 and Study 2. RA UI Characteristic Overall Cancer Non- cancer Cancer Non- cancer Test Statistic (p- value) Number of cases n (%) 1046 56 583 98 309 Age Mean SD Range 66.3 13.6 79 61.4 10.5 47 59.4 11.9 66 77.6 7.9 34 76.6 8.3 38 Significant Gender Male Female 203(19.4) 843(80.6) 11(19.3) 46(80.7) 112(19.2) 470(80.8) 29(29.6) 69(70.4) 51(16.5) 258(83.5) 8.2(0.09) Race White Black American Indian Eskimo or Aleut Pacific Islander Asian Unknown Other Multiracial Missing 975(93.2) 40(3.8) 1(0.1) 0(0) 0(0) 3(0.3) 0(0) 2(0.2) 23(2.2) 2(0.2) 55(96.5) 2(3.5) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 535(91.9) 22(3.8) 1(0.2) 0(0) 0(0) 3(0.5) 0(0) 1(0.2) 20(3.4) 0(0) 95(96.9) 2(2.0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 1(1.0) 290(95.0) 14(4.5) 0(0) 0(0) 0(0) 0(0) 0(0) 1(0.3) 3(1.0) 1(0.3) 24.6(0.4) 1.7(0.6) 13.1(0.00) Latino Latino descent Mexican Cuban Puerto Rican Unknown Other 7(0.7) 0(0) 1(14.2) 0(0) 0(0) 6(85.7) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 6(1.1) 0(0) 1(16.7) 0(0) 0(0) 5(83.3) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 1(0.3) 0(0) 0(0) 0(0) 0(0) 1(100.0) 5.0(0.8) 3.6(0.5) Highest Education Level Did not finish Grade School Grade school High school Vocational/Technical 2-year college 4-year college Professional school Masters Doctoral Other School 23(2.2) 92(8.8) 529(50.6) 117(11.2) 53(5.1) 130(12.4) 14(1.3) 73(7.0) 14(1.3) 1(0.1) 1(1.8) 5(8.8) 26(45.6) 7(12.3) 2(3.5) 10(17.5) 1(1.8) 5(8.8) 0(0) 0(0) 11(1.9) 30(5.2) 304(52.2) 67(11.5) 33(5.7) 82(14.1) 9(1.5) 38(6.5) 7(1.2) 1(0.2) 0(0) 17(17.3) 44(44.9) 8(8.2) 4(4.1) 12(12.2) 2(2.0) 9(9.2) 2(2.0) 0(0) 11(3.6) 40(12.9) 155(50.2) 35(11.3) 14(4.5) 26(8.4) 2(0.6) 21(6.8) 5(1.6) 0(0) 8.4(0.08) 26.7(.000) 2.5(0.6) 1.0(0.9) 1.1(0.9) 7.4(0.1) 1.4(0.8) 1.0(0.9) 2.0(0.7) 0.8(0.9) Have Health Care Insurance Type of Health Care Insurance Medicare Medicaid SSI VA Workers Comp Private Other 1043(99.8) 634(60.8) 61(5.9) 25(2.4) 16(1.5) 11(1.1) 506(48.7) 344(33.0) 57(100) 28(49.1) 0(0) 2(3.5) 0(0) 0(0) 35(61.4) 13(22.8) 580(99.8) 257(44.3) 31(5.4) 20(3.5) 10(1.7) 11(1.9) 359(62.2) 130(22.5) 98(100) 87(88.8) 5(5.1) 0(0) 1(1.0) 0(0) 31(31.6) 49(50.0) 308(99.7) 262(85.1) 25(8.1) 3(1.0) 5(1.6) 0(0) 81(26.3) 152(49.4) 0.84(0.9) 177(.000) 9.8(0.04) 10.9(0.03) 2.7(0.7) 13(0.01) 119(.000) 81(.00)
  6. 6. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 6 Table 2. Symptoms present in subjects with and without cancer in Study 1 and Study 2. RA UI Symptom Overall n % Cancer n % Non-cancer n % Cancer n % Non-cancer n % Test Com. Odds Ratio Asympt. Sig. Joint pain 829 80 53 93 531 92 57 60 188 61 0.98 0.92 Fatigue 622 60 42 74 428 74 38 40 114 37 1.1 0.61 Mobility problems 576 55 28 49 320 55 57 59 171 55 1 0.98 Leaking urine 532 51 16 28 139 24 93 97 284 92 1.46 0.16 Back pain 527 51 28 50 292 50 54 55 153 50 1.12 0.54 Pain (generalized) 481 47 36 63 353 61 20 21 72 23 0.94 0.77 Sleep problems 423 41 34 60 261 45 31 33 97 31 1.36 0.1 Frequent urination 404 39 13 23 173 30 58 60 160 52 1.09 0.64 Vision 377 37 25 44 204 35 39 40 109 35 1.27 0.19 Balance problems 340 33 17 30 161 28 38 39 124 40 0.99 0.94 Leg or arm weakness 328 32 20 35 220 38 15 16 73 24 0.74 0.16 Weight gain 298 29 24 42 214 37 16 17 44 14 1.24 0.82 Hearing problems 260 25 13 23 117 20 32 33 98 32 1.11 0.61 Shortness of breath 254 24 13 23 148 26 24 25 69 22 1.03 0.9 Itching 219 21 9 16 147 25 17 18 46 15 0.87 0.54 Dizzy while standing 188 18 13 23 103 18 15 16 57 18 0.98 0.93 Constipation 176 17 14 25 86 15 20 21 56 18 1.45 0.09 Night sweats 167 16 16 28 112 19 13 13 26 8 1.69 0.03 Over eating 165 16 13 23 107 19 10 11 35 11 1.12 0.66 Skin rashes 164 15 6 11 108 19 12 13 38 12 0.76 0.31 Diarrhea 133 13 9 16 99 17 7 7 18 6 1.05 0.89 Chest palpitations 122 12 10 18 73 13 11 12 28 9 1.38 0.22 Dizzy while sitting 95 9 6 11 57 10 6 6 26 8 0.89 0.72 Loss of appetite 92 9 4 7 58 10 7 7 23 7 0.84 0.61 Nausea 86 8 9 16 71 12 3 3 3 1 1.6 0.18 Abdominal pain 82 8 10 18 48 8 2 2 22 7 1.14 0.69 Chest pain 71 7 5 9 38 7 4 4 24 8 0.83 0.6 Weight loss 65 6 4 7 48 8 5 5 8 3 1.23 0.6 Leg or arm paralysis 20 2 4 7 5 1 2 2 9 3 2.04 0.14 Fever 19 2 3 5 14 2 0 0 2 1 1.63 0.44 Vomiting 13 1 3 5 10 2 0 0 0 0 3.23 0.08 Fainting 9 1 0 0 6 1 1 1 2 1 0.76 0.81
  7. 7. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 7 Table 3. Symptom clusters present in subjects with and without cancer in Study 1 and Study 2. RA UI Factor number Overall Cancer Non-cancer Cancer Non-cancer 1 Fatigue PainGeneralized Joint Pain Mobility Pbms Leg Arm Weakness Back Pain Sleep Problems Itching Diarrhea Skin Rashes Dizzy w Sitting Itching Leg Arm Paralysis Fever Leg Arm Weakness Skin Rashes Night Sweats Mobility Prblms (-)Freqt Urination Nausea Diarrhea Night Sweats Abdominal Pain Itching Skin Rashes Sleep Problems Freqt Urination Fatigue Chest Palpitations Over Eating Weight Gain Over Eating Leg Arm Weakness Chest Pain Chest Palpitations Weight Gain Shortnss Of Breath Dizzy w Sitting Chest Pain Chest Palpitations Loss Of Appetite Abdominal Pain Diarrhea Nausea Shortnss Of Breath Dizzy w Sitting 2 Dizzy w Sitting Nausea Dizzy w Standg Chest Palpitations Vomiting Chest Pain Abdominal Pain Night Sweats Fever Abdominal Pain Chest Pain Shortnss Of Breath Dizzy w Standg Chest Palpitations Constipation Balance Problems Leaking Urine Loss Of Appetite Mobility Prblms Pain Generalized Fatigue Joint Pain Leg Arm Weakness Balance Problems Back Pain Fatigue Diarrhea Freqt Urination Leg Arm Paralysis Loss Of Appetite Sleep Problems Balance Problems Constipation Dizzy w Sitting Hearing Problems Mobility Prblms Weight Gain Joint Pain Fatigue Back Pain Pain Generalized Over Eating Leaking Urine Shortnss Of Breath 3 Leaking Urine Balance Problems Freqt Urination Hearing Problems Vision Shortnss OfBreath Constipation Diarrhea PainGeneralized Sleep Problems Nausea Fatigue Vomiting Joint Pain Leaking Urine Dizzy w Sitting Dizzy w Standg Chest Pain Fainting Hearing Problems Chest Palpitations Shortnss Of Breath Vision Balance Problems Dizzy w Standg Night Sweats Nausea Constipation Dizzy w Sitting Itching Abdominal Pain (-)Hearing Problems Skin Rashes Balance Problems Mobility Prblms Leg Arm Weakness Constipation Dizzy w Standg Vision Leg Arm Paralysis 4 Weight Loss (-)Over Eating Loss Of Appetite (-)Weight Gain Over Eating Weight Gain (-)Weight Loss (-)Loss Of Appetite (-)Hearing Problems Sleep Problems Loss Of Appetite Weight Loss (-)Over Eating (-)Weight Gain Fever Vomiting PainGeneralized Back Pain Joint Pain Mobility Prblms Weight Loss Skin Rashes Shortnss Of Breath Balance Problems Itching Night Sweats Freqt Urination Hearing Problems Fever Skin Rashes Vision Leg Arm Weakness
  8. 8. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 8 Oncology Nursing Society Annual Progress Report: 2005 Formula Grant Reporting Period January 1, 2006 – June 30, 2006 Formula Grant Overview The Oncology Nursing Society received $32,860 in formula funds for the grant award period January 1, 2006 through June 30, 2007. The funds were used to support one research project. Accomplishments for the reporting period are described below. Formula Grant Coordinator Gail A. Mallory, Ph.D., R.N., C.N.A.A. Director of Research Oncology Nursing Society 125 Enterprise Drive Pittsburgh, PA 15275-1214 (412) 859-6308 Research Project 1: Project Title and Purpose Symptom Clusters Experienced by Women Across the Ovarian Cancer Disease Trajectory - Women with ovarian cancer are known to experience a high number of co-occurring symptoms. The study of symptom clusters, defined as three or more concurrent symptoms that are related to and influence one another, has been identified as a high priority by the National Institute of Nursing Research and the Oncology Nursing Society. To date, no studies have evaluated symptom clusters experienced by women with ovarian cancer. The purpose of this exploratory, secondary analysis is to identify and compare symptom clusters experienced by women with ovarian cancer at different phases of the disease trajectory. Duration of Project 1/1/2006 - 6/30/2007 Project Overview This study is the second collaborative project between the University of Pittsburgh School of Nursing and the Oncology Nursing Society. The broad objectives of the project are to contribute to the conceptual, methodological, and clinical understanding of symptom clusters in cancer patients. The specific aims of this study are to 1) describe symptom clusters in women with ovarian cancer at six different phases in the disease trajectory (women who have no current
  9. 9. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 9 evidence of disease (NED) and have never received chemotherapy; women who have NED and had primary treatment < 5 years ago; women who have NED and had primary treatment > 5 years ago; women who currently have NED after one or more recurrences; women on treatment for recurrent cancer; and women not receiving treatment for recurrent cancer); and 2) explore whether symptom clusters are different for women at different phases of the disease trajectory, and 3) evaluate whether the predominant symptom cluster in each subset of women is a better predictor of impaired function and life satisfaction than total symptom burden. A secondary aim of the study will be to evaluate a novel approach to symptom cluster identification by using difference scores among pairs of symptoms as the basis for cluster analysis. The design of this study is an exploratory, secondary analysis of existing data from a study of the cognitive and emotional representations of women with a history of ovarian cancer. Data to be extracted from the original data set include disease and treatment status at time of survey; months since diagnosis, months since last treatment; number of previous chemotherapy regimens; symptom severity, symptom interference with life activities, life satisfaction, and demographic information (age, income, ethnicity, marital status, ethnicity). Data will be analyzed to identify symptom clusters within subsets of subjects at different phases of the disease trajectory and to compare symptom clusters between subsets of subjects. Principal Investigator Heidi S. Donovan, Ph.D., R.N. University of Pittsburgh School of Nursing 336 Victoria Building 3500 Victoria Street Pittsburgh, PA 15261 Other Participating Researchers Gail A. Mallory, Ph.D., R.N. - employed by Oncology Nursing Society Catherine M. Bender, Ph.D., R.N., Susan Sereika, Ph.D., Margaret Rosenzweig, Ph.D., R.N., Susan Cohen, Ph.D., R.N., Janet Stewart, Ph.D., R.N., Paula Sherwood, Ph.D., R.N., Rebecca Hamilton, Ph.D., R.N., Martin Houze, M.S. - employed by University of Pittsburgh School of Nursing Expected Research Outcomes and Benefits Women with ovarian cancer are known to experience high numbers of cancer and treatment related symptoms at all phases of the disease trajectory. Symptom clusters have a negative impact on physical, functional, social, and psychological outcomes. Greater understanding of the specific clusters of symptoms at different phases of disease could have tremendous clinical implications. Such understanding could promote optimal assessment and intervention to reduce symptom severity and improve quality of life outcomes. In addition, patient education about all possible cancer and treatment related symptoms is time consuming and can be overwhelming to both patients and clinicians. Findings from this study could help clinicians tailor information regarding symptom prevention and management to common clusters at every phase of the
  10. 10. ______________________________________________________________________________________ Pennsylvania Department of Health – 2005-2006 Annual C.U.R.E. Report Annual Progress Report for Oncology Nursing Society - Page 10 disease trajectory. Finally, this study will make significant conceptual and methodological contributions to the emerging field of cancer symptom cluster research. Summary of Research Completed Funds for this project were received on April 4, 2006. This project is still in the very early stages of completion. Efforts thus far have been on extracting the de-identified data, cleaning the de- identified data, and preparing and coding the data to prepare the data set for future analyses to address specific aims. Data Extraction: De-identified data was extracted from Dr. Donovan's existing data set of 713 women with a history of ovarian cancer. The following variables were extracted and comprise the data set for analyses to address specific aims of the proposal: Age, Stage at Diagnosis; Months since diagnosis, Disease Status at time of Survey; Treatment Status at time of survey; Days since last treatment; Number of previous chemotherapy regimens; symptom severity of 24 symptoms associated with ovarian cancer or cancer treatment; Symptom interference with life activities; and life satisfaction. Data Preparation: The following data preparation procedures are in progress: 1) Disease Status Coding: These 713 subjects are being classified into six different disease status categories: women who have no evidence of disease and have never received chemotherapy (NED/chemo naïve); NED less than five years after primary treatment (NED<5/primary tx); NED for more than 5 years after primary treatment (NED>5/primary tx); NED after recurrence (NED/recurrence); on treatment for recurrent cancer (recurrent/on tx;); and not receiving treatment for recurrent cancer (recurrent/not on tx). The P.I. is carrying out this coding as it requires re-accessing the original data (mailed surveys) for verification. 2) Concurrently the de-identified data set is being used to create a matrix of concordance among pairs of symptoms for each subject to be used in future analyses. Data Analyses: No analyses addressing specific aims have yet been completed and there are no results to report. Summary: We are on track to complete data analyses as projected by January 2007.

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