Addressing Obesity To Reduce Cancer Risk And Health Disparities In Ohio

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Addressing Obesity to Reduce Cancer Risk and Health Disparities in Ohio

Author : Xiaochen Zhang (Cancer epidemiologist)
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (141 download)

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Book Synopsis Addressing Obesity to Reduce Cancer Risk and Health Disparities in Ohio by : Xiaochen Zhang (Cancer epidemiologist)

Download or read book Addressing Obesity to Reduce Cancer Risk and Health Disparities in Ohio written by Xiaochen Zhang (Cancer epidemiologist) and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Obesity is the leading preventable cause of cancer. Obesity significantly elevates risk for breast, colorectal, endometrial, liver, pancreas, and nine other cancers. Residents in rural and Appalachian areas are considered underserved populations with lower access and fewer resources to health care, but experience higher rates of obesity, obesity-related comorbidities and mortality, and higher cancer incidence and mortality, compared to residents in urban or non-Appalachian areas. Obesity and poor health behaviors are major contributors to health disparities in rural and Appalachian populations. However, the interaction of rural and Appalachian residency on obesity-related disparities is understudied. Weight loss, physical activity, and healthy diet potentially attenuate the negative effects of obesity and reduce cancer risk and premature mortality. Evidence-based weight loss programs have been implemented in clinical settings and showed various health benefits. However, these programs solely focused on health-promoting resources available in urban areas and are not generalizable to rural and Appalachian populations. Therefore, developing effective strategies to provide weight loss programs for rural and Appalachian populations is an important priority. The first aim of this dissertation examined differences in the prevalence of obesity, obesity-related health behaviors, and health outcomes by rural and Appalachian residency. Data from 2011-2019 Behavioral Risk Factor Surveillance System showed that, among Ohio residents, compared to urban non-Appalachian residents, urban Appalachian and rural Appalachian residents had a higher prevalence of obesity and obesity-related health conditions, and lower rates of healthy behaviors. The association between health behaviors and obesity-related health outcomes differed by rural and Appalachian residency. The second aim examined the role of self-efficacy and social support on behavioral changes and quantified the relationship between behavioral changes and weight loss outcomes using data from a faith-based weight loss intervention among overweight Appalachian adults. Increased social support for healthy eating from family mediated the association between intervention attendance and fruit and vegetable intake. There was a dose-response relationship between decreased caloric intake and weight loss at 12-months. The third aim determined the feasibility and acceptability of a telephone-based weight loss intervention in rural Ohio. A total of 40 overweight/obese rural Ohio residents were recruited and randomly assigned to a 15-week telephone-based weight loss group or active control group. Feasibility was established for conducting a 15-week randomized controlled weight loss study among overweight/obese rural residents. It was also feasible for rural residents to participate in a 15-week telephone-based weight loss intervention, with moderate acceptability. This dissertation demonstrates that there are potential areas for future research and implementation of interventions to improve obesity, obesity-related health behaviors and outcomes among rural and Appalachian populations. Stakeholders and community programs should consider optimizing their resources and prioritizing the needs for each population (rural, Appalachian, urban) to address specific health outcomes. To improve the efficacy of weight loss interventions, tailored strategies to improve social support are needed for Appalachian residents to improve their healthy behaviors. Finally, future studies need to implement a larger scale remotely accessible weight loss program in rural/Appalachian areas to demonstrate the therapeutic effect of lifestyle weight loss interventions to reduce obesity-related disparities.

Communities in Action

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 0309452961
Total Pages : 583 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Communities in Action by : National Academies of Sciences, Engineering, and Medicine

Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Social Inequalities and Cancer

Author : Manolis Kogevinas
Publisher : Iarc
ISBN 13 :
Total Pages : 420 pages
Book Rating : 4.4/5 (91 download)

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Book Synopsis Social Inequalities and Cancer by : Manolis Kogevinas

Download or read book Social Inequalities and Cancer written by Manolis Kogevinas and published by Iarc. This book was released on 1997 with total page 420 pages. Available in PDF, EPUB and Kindle. Book excerpt: In both industrialized and lessdeveloped societies, cancer incidence and survival are related to socioeconomic factors. This fascinating volume, the first to examine the magnitude of these socioeconomic differences in relation to cancer, provides vital information for all those interested in public health. Cancer incidence and survival are related to socioeconomic status in both industrialized and less developed countries. These differences can be explained, in part, by known risk factors, particularly tobacco smoke, occupational exposures, reproductive behaviour, diet and biological agents. T.

Healthy People 2010

Author : Government Publishing Office
Publisher : Government Printing Office
ISBN 13 : 9780160916908
Total Pages : 0 pages
Book Rating : 4.9/5 (169 download)

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Book Synopsis Healthy People 2010 by : Government Publishing Office

Download or read book Healthy People 2010 written by Government Publishing Office and published by Government Printing Office. This book was released on 2013-02-20 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Healthy People 2010 Final Review" presents a quantitative end-of-decade assessment of progress in achieving the Healthy People 2010 objectives and goals over the course of the decade. It continues the series of profiles of the nation's health objectives as an integral part of the Department of Health and Human Services' disease and health promotion initiative for the decade that began in 2000. This report presents a summary of progress toward achieving the Healthy People 2010 goals of: Increasing quality and years of healthy life, andEliminating health disparities. This publication provides the final tracking data used to present a quantitative assessment of progress for the 969 objectives in the 28 Healthy People 2010 Focus Areas. A summary of progress for the Healthy People 2010 Leading Health indicators is also presented.NOTE: NO FURTHER DISCOUNT FOR THIS PRODUCT. Significantly reduced price. Overstock List Price"

Pain Management and the Opioid Epidemic

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 0309459575
Total Pages : 483 pages
Book Rating : 4.3/5 (94 download)

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Book Synopsis Pain Management and the Opioid Epidemic by : National Academies of Sciences, Engineering, and Medicine

Download or read book Pain Management and the Opioid Epidemic written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-09-28 with total page 483 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Physical Activity and Cancer

Author : Kerry S. Courneya
Publisher : Springer Science & Business Media
ISBN 13 : 3642042317
Total Pages : 389 pages
Book Rating : 4.6/5 (42 download)

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Book Synopsis Physical Activity and Cancer by : Kerry S. Courneya

Download or read book Physical Activity and Cancer written by Kerry S. Courneya and published by Springer Science & Business Media. This book was released on 2010-11-26 with total page 389 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book explores in depth the relation between physical activity and cancer control, including primary prevention, coping with treatments, recovery after treatments, long-term survivorship, secondary prevention, and survival. The first part of the book presents the most recent research on the impact of physical activity in preventing a range of cancers. In the second part, the association between physical activity and cancer survivorship is addressed. The effects of physical activity on supportive care endpoints (e.g., quality of life, fatigue, physical functioning) and disease endpoints (e.g., biomarkers, recurrence, survival) are carefully analyzed. In addition, the determinants of physical activity in cancer survivors are discussed, and behavior change strategies for increasing physical activity in cancer survivors are appraised. The final part of the book is devoted to special topics, including the relation of physical activity to pediatric cancer survivorship and to palliative cancer care.

Dietary Guidelines for Americans 2015-2020

Author : HHS, Office of Disease Prevention and Health Promotion (U.S.)
Publisher : Government Printing Office
ISBN 13 : 0160934656
Total Pages : 195 pages
Book Rating : 4.1/5 (69 download)

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Book Synopsis Dietary Guidelines for Americans 2015-2020 by : HHS, Office of Disease Prevention and Health Promotion (U.S.)

Download or read book Dietary Guidelines for Americans 2015-2020 written by HHS, Office of Disease Prevention and Health Promotion (U.S.) and published by Government Printing Office. This book was released on 2015-12-31 with total page 195 pages. Available in PDF, EPUB and Kindle. Book excerpt: Learn more about how health nutrition experts can help you make the correct food choices for a healthy lifestyle The eighth edition of the Dietary Guidelines is designed for professionals to help all individuals, ages 2 years-old and above, and their families to consume a healthy, nutritionally adequate diet. The 2015-2020 edition provides five overarching Guidelines that encourage: healthy eating patterns recognize that individuals will need to make shifts in their food and beverage choices to achieve a healthy pattern acknowledge that all segments of our society have a role to play in supporting healthy choices provides a healthy framework in which individuals can enjoy foods that meet their personal, cultural and traditional preferences within their food budget This guidance can help you choose a healthy diet and focus on preventing the diet-related chronic diseases that continue to impact American populations. It is also intended to help you to improve and maintain overall health for disease prevention. **NOTE: This printed edition contains a minor typographical error within the Appendix. The Errata Sheet describing the errors can be found by clicking here. This same errata sheet can be used for the digital formats of this product available for free. Health professionals, including physicians, nutritionists, dietary counselors, nurses, hospitality meal planners, health policymakers, and beneficiaries of the USDA National School Lunch and School Breakfast program and their administrators may find these guidelines most useful. American consumers can also use this information to help make helathy food choices for themselves and their families.

Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences

Author : Michele Ver Ploeg
Publisher : DIANE Publishing
ISBN 13 : 1437921345
Total Pages : 160 pages
Book Rating : 4.4/5 (379 download)

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Book Synopsis Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences by : Michele Ver Ploeg

Download or read book Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences written by Michele Ver Ploeg and published by DIANE Publishing. This book was released on 2010-02 with total page 160 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Food, Conservation, and Energy Act of 2008 directed the U.S. Dept. of Agr. to conduct a 1-year study to assess the extent of areas with limited access to affordable and nutritious food, identify characteristics and causes of such areas, consider how limited access affects local populations, and outline recommend. to address the problem. This report presents the findings of the study, which include results from two conferences of national and internat. authorities on food deserts and a set of research studies. It also includes reviews of existing literature, a national-level assessment of access to large grocery stores and supermarkets, analysis of the economic and public health effects of limited access, and a discussion of existing policy interventions. Illus.

The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity

Author :
Publisher : Office of the Surgeon General
ISBN 13 :
Total Pages : 80 pages
Book Rating : 4.:/5 ( download)

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Book Synopsis The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity by :

Download or read book The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity written by and published by Office of the Surgeon General. This book was released on 2001 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt: Promotes the recognition, treatment, and prevention of conditions of overweight and obesity in the United States.

Greater Than the Sum

Author :
Publisher :
ISBN 13 :
Total Pages : 328 pages
Book Rating : 4.0/5 (891 download)

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Book Synopsis Greater Than the Sum by :

Download or read book Greater Than the Sum written by and published by . This book was released on 2007 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Preventing Childhood Obesity

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309133408
Total Pages : 435 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Preventing Childhood Obesity by : Institute of Medicine

Download or read book Preventing Childhood Obesity written by Institute of Medicine and published by National Academies Press. This book was released on 2005-01-31 with total page 435 pages. Available in PDF, EPUB and Kindle. Book excerpt: Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, we begin the 21st-century with a shocking developmentâ€"an epidemic of obesity in children and youth. The increased number of obese children throughout the U.S. during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st-century. Preventing Childhood Obesity provides a broad-based examination of the nature, extent, and consequences of obesity in U.S. children and youth, including the social, environmental, medical, and dietary factors responsible for its increased prevalence. The book also offers a prevention-oriented action plan that identifies the most promising array of short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of numerous stakeholders in various sectors of society to reduce its future occurrence. Preventing Childhood Obesity explores the underlying causes of this serious health problem and the actions needed to initiate, support, and sustain the societal and lifestyle changes that can reverse the trend among our children and youth.

Fulfilling the Potential of Cancer Prevention and Early Detection

Author : National Research Council
Publisher : National Academies Press
ISBN 13 : 0309170133
Total Pages : 564 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Fulfilling the Potential of Cancer Prevention and Early Detection by : National Research Council

Download or read book Fulfilling the Potential of Cancer Prevention and Early Detection written by National Research Council and published by National Academies Press. This book was released on 2003-05-07 with total page 564 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cancer ranks second only to heart disease as a leading cause of death in the United States, making it a tremendous burden in years of life lost, patient suffering, and economic costs. Fulfilling the Potential for Cancer Prevention and Early Detection reviews the proof that we can dramatically reduce cancer rates. The National Cancer Policy Board, part of the Institute of Medicine, outlines a national strategy to realize the promise of cancer prevention and early detection, including specific and wide-ranging recommendations. Offering a wealth of information and directly addressing major controversies, the book includes: A detailed look at how significantly cancer could be reduced through lifestyle changes, evaluating approaches used to alter eating, smoking, and exercise habits. An analysis of the intuitive notion that screening for cancer leads to improved health outcomes, including a discussion of screening methods, potential risks, and current recommendations. An examination of cancer prevention and control opportunities in primary health care delivery settings, including a review of interventions aimed at improving provider performance. Reviews of professional education and training programs, research trends and opportunities, and federal programs that support cancer prevention and early detection. This in-depth volume will be of interest to policy analysts, cancer and public health specialists, health care administrators and providers, researchers, insurers, medical journalists, and patient advocates.

Health, United States, 2016, with Chartbook on Long-Term Trends in Health

Author : National Center for Health Statistics
Publisher : Government Printing Office
ISBN 13 : 9780160939778
Total Pages : 494 pages
Book Rating : 4.9/5 (397 download)

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Book Synopsis Health, United States, 2016, with Chartbook on Long-Term Trends in Health by : National Center for Health Statistics

Download or read book Health, United States, 2016, with Chartbook on Long-Term Trends in Health written by National Center for Health Statistics and published by Government Printing Office. This book was released on 2017-08-16 with total page 494 pages. Available in PDF, EPUB and Kindle. Book excerpt: This annual overview report of national trends in health statistics contains a Chartbook that assesses the nation's health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization and access, health risk factors, prevention, health insurance, and personal health-care expenditures. Chapters devoted to population characteristics, prevention, health risk factors, health care resources, personal health care expenditures, health insurance, and trend tables may provide the health/medical statistician, data analyst, biostatistician with additional information to complete experimental studies or provide necessary research for pharmaceutical companies to gain data for modeling and sampling. Undergraduate students engaged in applied mathematics or statistical compilations to graduate students completing biostatistics degree programs to include statistical inference principles, probability, sampling methods and data analysis as well as specialized medical statistics courses relating to epidemiology and other health topics may be interested in this volume. Related products: Your Guide to Choosing a Nursing Home or Other Long-Term Services & Supports available here: https://bookstore.gpo.gov/products/your-guide-choosing-nursing-home-or-other-long-term-services-supports Health Insurance Coverage in the United States, 2014 available here: https://bookstore.gpo.gov/products/health-insurance-coverage-united-states-2014 "Some System of the Nature Here Proposed": Joseph Lovell's Remarks on the Sick Report, Northern Department, U.S. Army, 1817, and the Rise of the Modern US Army Medical Department can be found here: https://bookstore.gpo.gov/products/some-system-nature-here-proposed-joseph-lovells-remarks-sick-report-northern-department-us Guide to Clinical Preventive Services 2014: Recommendations of the U.S. Preventive Services Task Force (ePub) -Free digital eBook download available at the US Government Online Bookstore here: https://bookstore.gpo.gov/products/guide-clinical-preventive-services-2014-recommendations-us-preventive-services-task-force --Also available for FREE digital eBook download from Apple iBookstore, BarnesandNoble.com (Nook Bookstore), Google Play eBookstore, and Overdrive -Please use ISBN: 9780160926426 to search these commercial platforms.

A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309212197
Total Pages : 200 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases by : Institute of Medicine

Download or read book A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases written by Institute of Medicine and published by National Academies Press. This book was released on 2011-08-26 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt: Chronic diseases are common and costly, yet they are also among the most preventable health problems. Comprehensive and accurate disease surveillance systems are needed to implement successful efforts which will reduce the burden of chronic diseases on the U.S. population. A number of sources of surveillance data-including population surveys, cohort studies, disease registries, administrative health data, and vital statistics-contribute critical information about chronic disease. But no central surveillance system provides the information needed to analyze how chronic disease impacts the U.S. population, to identify public health priorities, or to track the progress of preventive efforts. A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases outlines a conceptual framework for building a national chronic disease surveillance system focused primarily on cardiovascular and chronic lung diseases. This system should be capable of providing data on disparities in incidence and prevalence of the diseases by race, ethnicity, socioeconomic status, and geographic region, along with data on disease risk factors, clinical care delivery, and functional health outcomes. This coordinated surveillance system is needed to integrate and expand existing information across the multiple levels of decision making in order to generate actionable, timely knowledge for a range of stakeholders at the local, state or regional, and national levels. The recommendations presented in A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases focus on data collection, resource allocation, monitoring activities, and implementation. The report also recommends that systems evolve along with new knowledge about emerging risk factors, advancing technologies, and new understanding of the basis for disease. This report will inform decision-making among federal health agencies, especially the Department of Health and Human Services; public health and clinical practitioners; non-governmental organizations; and policy makers, among others.

Quality Through Collaboration

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309094399
Total Pages : 289 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Quality Through Collaboration by : Institute of Medicine

Download or read book Quality Through Collaboration written by Institute of Medicine and published by National Academies Press. This book was released on 2005-04-24 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.

Healthy People 2000

Author : United States. Public Health Service
Publisher : Jones & Bartlett Learning
ISBN 13 : 9780867201796
Total Pages : 808 pages
Book Rating : 4.2/5 (17 download)

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Book Synopsis Healthy People 2000 by : United States. Public Health Service

Download or read book Healthy People 2000 written by United States. Public Health Service and published by Jones & Bartlett Learning. This book was released on 1992 with total page 808 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Breast Cancer Metastasis and Drug Resistance

Author : Aamir Ahmad
Publisher : Springer Nature
ISBN 13 : 3030203018
Total Pages : 427 pages
Book Rating : 4.0/5 (32 download)

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Book Synopsis Breast Cancer Metastasis and Drug Resistance by : Aamir Ahmad

Download or read book Breast Cancer Metastasis and Drug Resistance written by Aamir Ahmad and published by Springer Nature. This book was released on 2019-08-27 with total page 427 pages. Available in PDF, EPUB and Kindle. Book excerpt: Resistance to therapies, both targeted and systemic, and metastases to distant organs are the underlying causes of breast cancer-associated mortality. The second edition of Breast Cancer Metastasis and Drug Resistance brings together some of the leading experts to comprehensively understand breast cancer: the factors that make it lethal, and current research and clinical progress. This volume covers the following core topics: basic understanding of breast cancer (statistics, epidemiology, racial disparity and heterogeneity), metastasis and drug resistance (bone metastasis, trastuzumab resistance, tamoxifen resistance and novel therapeutic targets, including non-coding RNAs, inflammatory cytokines, cancer stem cells, ubiquitin ligases, tumor microenvironment and signaling pathways such as TRAIL, JAK-STAT and mTOR) and recent developments in the field (epigenetic regulation, microRNAs-mediated regulation, novel therapies and the clinically relevant 3D models). Experts also discuss the advances in laboratory research along with their translational and clinical implications with an overarching goal to improve the diagnosis and prognosis, particularly that of breast cancer patients with advanced disease.