Health Day

More than one-third of elderly patients on Medicare take a companion with them for routine medical visits.

And patients who are accompanied on such visits tend to be more satisfied with the visit, according to a study published in the July 14 issue of the Archives of Internal Medicine.

“I think it’s a fabulous idea [to have companions on medical visits],” said senior study author Debra L. Roter, a professor of health behavior and society at Johns Hopkins Bloomberg School of Public Health in Baltimore. “And we have a very good notion of interventions now, ideas that can help companions and patients prepare for their visit in a more proactive and effective way. The consequences seem to be especially valuable for those elderly people that we generally think of as most vulnerable, those who are the sickest, the oldest and the least well-educated. Those are the people who seem to benefit the most by having somebody with them.”

A previous study led by Roter had also indicated that it was common for older adults to take someone with them on medical visits, usually a spouse or adult child.

“We found that companions actually do lots of very helpful things for the patient, but our study was only one, and it was relatively small,” Roter said.

She and a colleague decided to do analyze a larger population of 12,000 community-dwelling Medicare beneficiaries aged 65 and older who had participated in a 2004 survey. Roter had actually written several of the questions for that earlier survey.

Many of the findings dovetailed with the earlier, smaller study.

Here, 38.6 percent of participants said they were usually accompanied on routine medical visits. Those accompanied were usually older, less educated, and in poorer health.

Companions could be spouses (53.3 percent), adult children (31.9 percent), other relatives (6.8 percent), roommates, friends or neighbors (5.2 percent), non-relatives (2.8 percent) or nurses, nurses aids, legal or financial officers (under 1 percent).

More than 60 percent of companions helped with doctor-patient communications by writing down instructions (44.1 percent), giving information on the patients’ medical conditions or needs (41.6 percent), asking questions (41.1 percent) or explaining doctors’ instructions (29.7 percent).

Patients who were accompanied on visits were 15 percent more satisfied with their doctor’s technical skills, 19 percent more satisfied with the doctors’ information-giving, and 18 percent more satisfied with their personal skills compared with unaccompanied patients.

“This tells us that this is a national phenomenon,” Roter said. “These patient companions are commonly very active, so they don’t just stay in the waiting room. They come into the exam room with the patients, and they’re active in the communication process in a helpful way.”

Study author Jennifer L. Wolff, an assistant professor of health policy and management at Bloomberg, hopes the findings will lead to more research on better ways to use companion visits to advantage.

“This study is important in terms of thinking about the role of the visit companion, both within the encounter and also outside the encounter,” she said. “We don’t have a very good understanding of roles that family caregivers play in medical processes. It would be very exciting to relate this to safety issues, for example, adverse drug reactions or issues around adherence to medications. Theoretically, it makes sense that when an older adult has a family caregiver who is actively engaged in the health-care process, there could be some beneficial outcomes.”

Another expert agreed but offered a note of caution.

“This has pushed the science to the next level by quantifying the findings, and by doing this for more people,” said Marcia G. Ory, a professor of social and behavioral health with the Texas A&M Health Science Center School of Rural Public Health in College Station. “It’s also looking at the functions of the companions.”

“There are implications for clinicians, for companion visitors as well as for the older patient him or herself,” Ory added. “Physicians need to know how to appropriately interact with the [companion visitor]. The companion visitor needs to understand what their role is. It’s also important for the message to go to the patient that the patient is ultimately responsible for their own health care, but they don’t do it in a vacuum. They live in families.”

“In the past, we’ve ignored the third party, but we don’t want the pendulum to swing and ignore older patients,” Ory said. “It’s that delicate balance that will get us the best quality of care.”

The drug Nexavar can prolong the lives of people with liver cancer by an average of three months, new research shows.

“The results unequivocally showed that sorafenib (Nexavar) increased the survival of patients with a more than 30 percent reduction in the likelihood to die at any time point during follow-up,” said study senior author Dr. Jordi Bruix, a senior consultant in the liver unit of the Hospital Clinic of Barcelona.

“These results identify sorafenib as the first agent that is effective in improving survival in patients with this devastating disease,” said Bruix. His report is in the July 24 issue of the New England Journal of Medicine.

“Up to now, the patients diagnosed with advanced hepatocellular carcinoma had no effective treatment that could improve their survival. Now, we have an option that is based on oral treatment that is effective if liver function is still preserved,” added study author Dr. Josep Maria Llovet, director of research in liver cancer at Mount Sinai School of Medicine in New York City, and a professor at the Barcelona Clinic Liver Cancer (BCLC) Group in Barcelona.

More than 21,000 Americans are diagnosed with liver cancer each year, according to the American Cancer Society (ACS). About 18,410 people will die because of liver cancer during 2008, reports the ACS. The disease is much more common in men and is more likely to occur in people who’ve been infected with viral hepatitis B or C.

Treatment options for liver cancer are often limited. If the disease is caught early, it’s sometimes possible to remove the tumor or perform a liver transplant. Chemotherapy isn’t particularly effective in liver cancers, because one of the liver’s main functions is to detoxify drugs.

“When you administer drugs you want to affect the liver, the liver wants to detoxify them and render them ineffective. The liver is also very active in getting rid of drugs and pumping the drugs out of the liver,” explained Dr. Lewis Roberts, director of the hepatobiliary neoplasia clinic at the Mayo Clinic in Rochester, Minn.

The current study was a randomized, placebo-controlled study that included 602 people with advanced liver cancer. Despite that, however, the study volunteers still retained liver function.

Although there was no significant difference in the time to symptomatic progression of the disease, there was approximately a three-month increase in survival, on average, for the sorafenib group.

Sorafenib works by slowing down cell proliferation and reducing the formation of new blood vessels that feed the tumor mass, according to Llovet. So, while the medication doesn’t reduce the size of the tumor, it can delay the progression of the disease. In fact, Llovet said, they’ve had patients who have remained progression-free for more than three years.

Llovet also said the researchers are combining sorafenib with other treatments to see if they can make further progress against this deadly cancer. And the researchers are testing sorafenib earlier in the course of the disease to see if it might be even more effective then.

The drug was generally well-tolerated. Fatigue was the most common side effect.

Roberts said the findings are very exciting. “For the first time, we have a drug that has been clearly shown to improve survival.” But, he added, “this is clearly just a first step,” and he’d like to see more emphasis on prevention and screening for high-risk populations. He said that anyone who has been diagnosed with hepatitis B or C should be screened with an ultrasound every six months, so that if liver cancer develops, it can be treated early.

Additionally, Roberts pointed out that sorafenib is quite expensive, averaging more than $5,000 a month for treatment. The drug is currently approved in the United States for the treatment of a form of advanced kidney cancer.

The study was supported by Bayer HealthCare Pharmaceuticals-Onyx Pharmaceuticals, makers of Nexavar.