Lecuyer, Lucien; Chevret, Sylvie; Thiery, Guillaume; Darmon, Michael; Schlemmer, Benoît; Azoulay, Elie
Cancer patients requiring mechanical ventilation are widely viewed as poor candidates for intensive care unit (ICU) admission. We designed a prospective study evaluating a new admission policy titled The ICU Trial. Prospective study. Intensive care unit. One hundred eighty-eight patients requiring mechanical ventilation and having at least one other organ failure. Over a 3-yr period, all patients with hematologic malignancies or solid tumors proposed for ICU admission underwent a triage procedure. Bedridden patients and patients in whom palliative care was the only cancer treatment option were not admitted to the ICU. Patients at earliest phase of the malignancy (diagnosis ventilation, vasopressors, or dialysis after 3 days in the ICU died. Survival was 40% in mechanically ventilated cancer patients who survived to day 5 and 21.8% overall. If these results are confirmed in future interventional studies, we recommend ICU admission with full-code management followed by reappraisal on day 6 in all nonbedridden cancer patients for whom lifespan-extending cancer treatment is available.
Borras, Josep M; Lievens, Yolande; Barton, Michael
BACKGROUND: The objective of this HERO study was to assess the number of new cancer patients that will require at least one course of radiotherapy by 2025. METHODS: European cancer incidence data by tumor site and country for 2012 and 2025 was extracted from the GLOBOCAN database. The projection ...
Sachdev, Sean; Refaat, Tamer; Bacchus, Ian D; Sathiaseelan, Vythialinga; Mittal, Bharat B
A significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding. One hundred patients with advanced stage HNSCC were retrospectively analyzed after intensity-modulated radiation therapy (IMRT) to a median dose of 70 Gy (range: 60-75 Gy) with concurrent chemotherapy in nearly all cases (97%). Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube. Detailed DVH parameters were collected for several structures. Univariate and multivariate analyses using logistic regression were used to determine clinical and dosimetric factors associated with needing enteral feeding. Dichotomous outcomes were tested using Fisher’s exact test and continuous variables between groups using the Wilcoxon rank-sum test. Thirty-three percent of patients required placement of an enteral feeding tube. The median time to tube placement was 25 days from start of treatment, after a median dose of 38 Gy. On univariate analysis, age (p = 0.0008), the DFH (Docetaxel/5-FU/Hydroxyurea) chemotherapy regimen (p = .042) and b.i.d treatment (P = 0.040) (used in limited cases on protocol) predicted need for enteral feeding. On multivariate analysis, age remained the single statistically significant factor (p = 0.003) regardless of other clinical features (e.g. BMI) and all radiation planning parameters. For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p = 0.0019). Older age was found to be the most significant risk factor for needing enteral feeding in
Akiba, Tadashi; Nakada, Takeo; Inagaki, Takuya
Thoracoscopic pulmonary segmentectomy of the lung is sometime adopted for the lung cancer, but a problem with segmentectomy is variable anatomy. Recently, we are exploring the impact of three-dimensional models using rapid-prototyping technique. It is useful for decision making, surgical planning, and intraoperative orientation for surgical treatment in patient with lung cancer who underwent pulmonary segmentectomy. These newly created models allow us to clearly identify the surgical margin and the intersegmental plane, vessels, and bronchi related to the cancer in the posterior segment. To the best of our knowledge, there are few reports describing a pulmonary model so far.
Kitami, Akihiko; Kamio, Yoshito; Gen, Ryozo
The purpose of this study was to assess the risk factors for severe infections developing as a complication of transbronchial biopsy in lung cancer patients. From April 2001 to March 2007, 1091 patients underwent bronchoscopy at our institution. We reviewed the records of 5 of these patients diagnosed with lung cancer and who developed lung abscess or cavitary infection after transbronchial biopsy necessitating surgical resection. The 5 patients (4 men, 1 woman; mean age at diagnosis, 62.4 years; range, 42-78 years) were all smokers and were immunocompetent. One patient suffered from diabetes mellitus. Of the 5 patients, chest CT revealed a cavitary lesion in 2 patients, central low attenuation in 2 patients, and a small nodule in 1 patient. The longest tumor diameter ranged from 20-60 mm (mean, 42 mm). Sputum cultures taken prior to bronchoscopy showed no significant bacterial growth in 4 of the patients, with 1 patient showing Streptococcus pneumoniae. Three cases showed elevated serum C-reactive protein. Histologically, the diagnosis was squamous cell carcinoma in 3 patients and adenocarcinoma in 2 patients. The risk factors for the development of a lung abscess after transbronchial biopsy include large mass lesions with central necrosis or cavitary lesions. (author)
Full Text Available Background/Aims: Traditionally, patients with acute diverticulitis undergo follow-up endoscopy to exclude colorectal cancer (CRC. However, its usefulness has been debated in this era of high-resolution computed tomography (CT diagnosis. We assessed the frequency and outcome of endoscopic follow-up for patients with CT-proven acute diverticulitis, according to the confidence in the CT diagnosis.Methods: Records of patients with CT-proven acute diverticulitis between October 2007 and March 2014 at Sandwell & West Birmingham Hospitals NHS Trust were retrieved. The National Cancer Registry confirmed the cases of CRC. Endoscopy quality indicators were compared between these patients and other patients undergoing the same endoscopic examination over the same period.Results: We identified 235 patients with CT-proven acute diverticulitis, of which, 187 were managed conservatively. The CT report was confident of the diagnosis of acute diverticulitis in 75% cases. Five of the 235 patients were subsequently diagnosed with CRC (2.1%. Three cases of CRC were detected in the 187 patients managed conservatively (1.6%. Forty-eight percent of the conservatively managed patients underwent follow-up endoscopy; one case of CRC was identified. Endoscopies were often incomplete and caused more discomfort for patients with diverticulitis compared with controls.Conclusions: CRC was diagnosed in patients with CT-proven diverticulitis at a higher rate than in screened asymptomatic populations, necessitating follow-up. CT reports contained statements regarding diagnostic uncertainty in 25% cases, associated with an increased risk of CRC. Follow-up endoscopy in patients with CT-proven diverticulitis is associated with increased discomfort and high rates of incompletion. The use of other follow-up modalities should be considered.
Borras, Josep M; Lievens, Yolande; Barton, Michael; Corral, Julieta; Ferlay, Jacques; Bray, Freddie; Grau, Cai
The objective of this HERO study was to assess the number of new cancer patients that will require at least one course of radiotherapy by 2025. European cancer incidence data by tumor site and country for 2012 and 2025 was extracted from the GLOBOCAN database. The projection of the number of new cases took into account demographic factors (age and size of the population). Population based stages at diagnosis were taken from four European countries. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model. Among the different tumor sites, the highest expected relative increase by 2025 in treatment courses was prostate cancer (24%) while lymphoma (13%), head and neck (12%) and breast cancer (10%) were below the average. Based on the projected cancer distributions in 2025, a 16% expected increase in the number of radiotherapy treatment courses was estimated. This increase varied across European countries from less than 5% to more than 30%. With the already existing disparity in radiotherapy resources in mind, the data provided here should act as a leverage point to raise awareness among European health policy makers of the need for investment in radiotherapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Cole, R M; Robinson, F; Harvey, L; Trethowan, K; Murdoch, V
Chemically induced nausea and vomiting is a common symptom of advanced cancer effected through stimulation of dopamine (D2) or serotonin (5-HT3) receptors located in the chemoreceptor trigger zone (CTZ). These may be blocked by therapeutic doses of haloperidol and ondansetron, respectively. This case, reporting on a single patient acting as her own control, establishes that combined blockade of these receptors is sometimes required to relieve intractable nausea and vomiting. It also demonstrates the value of clinical review, audit of care, and quality assurance in the palliative care setting.
Okamoto, Takuya; Ando, Michiyo; Morita, Tatsuya; Hirai, Kei; Kawamura, Ryo; Mitsunori, Miyashita; Sato, Kazuki; Shima, Yasuo
The aim of this study was to explore the most suitable religious care for Japanese terminally ill patients with cancer based on the opinions of bereaved family members. A multicenter questionnaire survey on palliative care service was sent to 592 bereaved family members of patients with cancer who were admitted to palliative care units in Japan, and 430 responded by mail. In the section of the questionnaire about religious care, 382 responses were used for quantitative analysis, and 71 responses about religious care for qualitative analysis. In the current study, the 71 responses were grouped into families with and without a religion and were analyzed qualitatively. Families with a religion (N = 28) chose answers such as ''Instrumental care'' such as music or a religious event, ''Freedom of choice of kinds for religious care,'' ''Staff involvement of religious care,'' ''Meeting with a pastoral care workers,'' and ''Burden of offering a different kind of personal religion.'' In contrast, families without a religion (N = 44) chose answers such as ''Instrumental care,'' ''Freedom of choice whether patients receive religious care or not,'' ''Spiritual care,'' ''Not being able to accept religious care,'' and ''Burden of thinking about a religion and nuisance.'' These findings suggest that Japanese bereaved families with a religion generally regard religious care positively and prefer care through their own religion, whereas some families without a religion require religious care but some do not prefer it.
Gomez, Izabella; Szekanecz, Éva; Szekanecz, Zoltán; Bender, Tamás
Physiotherapy of cancer patients is one of the most controversial issues in our country. Malignant diseases are firstly mentioned as a contraindication of physiotherapy. Until now, physiotherapy was not suggested (or only in limited accessibility) for those patients who had malignant disease in medical history. International medical practice was less restrictive in managing this topic. The development of imaging techniques put this question in a new light. On the basis of evidence, the majority of articles have reported beneficial effects of physiotherapy in cancer patients, and only few articles mentioned it as harmful. Of course, each patient requires an individual assessment, however, if we exclude the possibility of tumor recurrence and metastasis, most of physiotherapy procedures can be used safely. One of the aims of this review is to support the physicians' decisions when to prescribe treatments, in such a way, that more patients could receive physiotherapy. Orv. Hetil., 2016, 157(31), 1224-1231.
Iredale, R.; Rapport, F.; Sivell, S.; Jones, W.; Edwards, A.; Gray, J.; Elwyn, G.
RATIONALE: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the
Chikhladze, Nana; Tebidze, Nino; Chabukiani, Tamar; Chabukiani, Nana; Chkhartishvili, Nikoloz; Jincharadze, Memed; Kordzaia, Dimitri
In developing a model of palliative care, the attitudes, needs, and requirements of its beneficiaries recognizing the limited remaining life expectancy need to be met. We aimed to map and compare these issues at the end of life in the groups of patients with advanced cancer and elderly individuals. The prospective study based on the analysis of semistructured interviews was conducted. Fifty individuals aged older than 85 and 50 incurable patients with advanced cancer were studied. Transcripts of interviews were analyzed qualitatively (the interviews were divided into logically completed themes, and the compliance of each with one of the levels of Abraham Maslow pyramid was determined) and quantitatively (data comparisons of 2 groups were tested in bivariate analysis using Pearson χ 2 or Fisher exact test. Two-sided significance tests were used; P value of Maslow pyramid. Their comparison showed small differences in the narratives of the patients with advanced cancer and elderly individuals aged 85 and older-concerning the past, present, and future terms of lives. In studied themes explicitly prevail the stories that are consistent with satisfaction of the upper levels of the hierarchy of needs and demands of Maslow: social relation (belonging), love, esteem, and transcendence. The attitudes, needs, and requirements at the end of life of the people are basically similar, regardless of what determined the sense of limitation of the remaining life-incurable disease or advanced age.
Full Text Available It is not enough to consider treatment and care depression in the oncology that is the most common psychiatric illness in cancer patient affects of cancer treatment and the patient`s quality of life negatively, which is determined through researches in the field. With development of psycho-oncology it has been demonstrated to establish an important link between the cancer patient`s treatment as well as psycho-social support for the patient and psychiatric treatment and care for the if it is needed. With this connection between them it has been proposed to use of bio-psycho-social-model in cancer patient to improve their care. To achieve this goal, it is expected from medical personnel to realize patients psychosocial need und if he/she has a psychiatric disorders or syndromes. For the medical personnel that work in oncology services, it is inevitable to organize in order to raise the awareness of depression in the cancer patients. In the present study, it is focused on raising the awareness of depression in cancer patient for the medical personnel. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 186-198
Full Text Available ABSTRACTBACKGROUNDNowadays cancer patients tend to be more involved in the medical decision process. Active participation improves health outcomes and patient satisfaction. To participate effectively patients require a huge amount of information, but time limits make it impossible to satisfy all information needs at clinics. We tried to find out which kind of media cancer patients use when searching for information and how often. Lastly, we try to find out how popular the Internet is in this regard.METODSIn this research we invited cancer patients, who had regular clinic examinations at the Oncology Institute between 21st and 25th May in 2012. We carried out a prospective research by anonymous questionnaires. We were investigating which media were used and how often. We analysed results with descriptive statistics, ANOVA, the χ²-Test and the t-test.RESULTS478 of 919 questionnaires distributed among cancer patients were returned. Mean age was 59.9 years. 61 % of responders were female, and the most common level of education was high school (33 %. Most common cancer type was breast cancer (33 %, followed by gastrointestinal and lung cancer. Patients search for information most often on television (81.4% responders, followed by specialized brochures (78%, internet (70.8% and newspapers (67.6%. Patients who do not use media for information searching are older than average (62.5 years vs. 59.9 years; p<0,000.CONCLUSIONSAccording to our results patients search for information most often on television, followed by brochures, internet and newspapers. Older patients less often search for information. This data might help doctors in everyday clinical practice.
Leitao, Mario M; Malhotra, Vivek; Briscoe, Gabriel; Suidan, Rudy; Dholakiya, Priyal; Santos, Kevin; Jewell, Elizabeth L; Brown, Carol L; Sonoda, Yukio; Abu-Rustum, Nadeem R; Barakat, Richard R; Gardner, Ginger J
Laparoscopy (LSC) offers superior patient outcomes compared to laparotomy. Small retrospective/prospective series have suggested robotics offers further reduction in postoperative pain and pain medication use compared to standard LSC. Our objective was to compare postoperative pain in patients undergoing robotically assisted (RBT) versus standard LSC for newly diagnosed endometrial cancer. All preoperative endometrial cancer cases scheduled for RBT and LSC from May 1, 2007 to June 9, 2010 were identified. For this analysis, we only included cases not requiring conversion to laparotomy. All patients were offered intravenous (IV) patient-controlled analgesia (PCA) postoperatively. Intraoperative equivalent fentanyl doses (IEFDs) and pain scores in the postanesthesia care unit (PACU) were assessed. IV PCA was used in 206 RBTs (86 %) and 208 LSCs (88 %). Median IEFD was 425 μg for LSCs and 500 μg for RBTs (P = 0.03). Median pain scores on PACU arrival were similar in both groups. Median highest pain score was 5 for LSCs and 4 for RBTs (P = 0.007). Linear regression demonstrated that the IEFD was not correlated with the highest pain score (R = 0.09; P = 0.07). Fentanyl was used postoperatively in 196 of 206 RBTs (95 %) and 187 of 208 LSCs (90 %). The total fentanyl doses were 242.5 (range 0-2705) μg and 380 (range 0-2625) μg, respectively (P multiple regression analysis further demonstrated RBT was independently associated with a lower total fentanyl dose compared to LSC (P = 0.02). RBT is independently associated with significantly lower postoperative pain and pain medication requirements compared to LSC. The amount of intraoperative fentanyl analgesia does not appear to correlate with postoperative pain.Endometrial cancer is the most common gynecologic malignancy in the United States, with an estimated 47,130 new cases in 2012.1 An estimated 287,100 women were diagnosed with endometrial cancer worldwide in 2008.2 Surgery is the primary treatment of choice for the
Civilotti, Cristina; Castelli, Lorys; Binaschi, Luca; Cussino, Martina; Tesio, Valentina; Di Fini, Giulia; Veglia, Fabio; Torta, Riccardo
Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients. The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation. Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology. Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance. Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic spectrum within the context of cancer, emphasizing the close relationship between the origin of dissociative constituents which, according to the scientific literature, compose the traumatic experience. Our results have implications for understanding dissociative symptomatology in a cancer
Chong Guan, Ng; Mohamed, Salina; Kian Tiah, Lai; Kar Mun, Teoh; Sulaiman, Ahmad Hatim; Zainal, Nor Zuraida
Objective Psychotherapy is a common non-pharmacological approach to help cancer patients in their psychological distress. The benefit of psychotherapies was documented, but the types of psychotherapies proposed are varied. Given that the previous literature review was a decade ago and no quantitative analysis was done on this topic, we again critically and systematically reviewed all published trials on psychotherapy in cancer patients. Method We identified 17 clinical trials on six types of psychotherapy for cancer patients by searching PubMed and EMBASE. Result There were four trials involved adjunct psychological therapy which were included in quantitative analysis. Each trial demonstrated that psychotherapy improved the quality of life and coping in cancer patients. There was also a reduction in distress, anxiety, and depression after a psychological intervention. However, the number and quality of clinical trials for each type of psychotherapy were poor. The meta-analysis of the four trials involved adjunct psychological therapy showed no significant change in depression, with only significant short-term improvement in anxiety but not up to a year-the standardized mean differences were -0.37 (95% confidence interval (CI) = -0.57, -0.16) at 2 months, -0.21 (95% CI = -0.42, -0.01) at 4 months, and 0.03 (95 % CI = -0.19, 0.24) at 12 months. Conclusion The evidence on the efficacy of psychotherapy in cancer patients is unsatisfactory. There is a need for more rigorous and well-designed clinical trials on this topic.
Ross, Lone; Petersen, Morten Aagaard; Johnsen, Anna Thit
The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication.......The aims of this study were to assess how communication with health care staff is perceived by Danish cancer patients and to characterise those patients who report problems in communication....
Abbasowa, Leda; Madsen, Poul Henning
INTRODUCTION: Lung cancer remains a leading cause of cancer-related death. The incidence increases with age and the occurrence in young patients is relatively low. The clinicopathological features of lung cancer in younger patients have not been fully explored previously. METHODS: To assess the age...... differences in the clinical characteristics of lung cancer, we conducted a retrospective analysis comparing young patients ≤ 65 years of age with an elderly group > 65 years of age. Among 1,232 patients evaluated due to suspicion of lung cancer in our fast-track setting from January-December 2013, 312 newly...... diagnosed lung cancer patients were included. RESULTS: Patients ≤ 65 years had a significantly higher representation of females (p = 0.0021), more frequent familial cancer aggregation (p = 0.028) and a lower incidence of squamous cell carcinoma (p = 0.0133). When excluding pure carcinoid tumours...
... Protect: Know the Signs and Symptoms of Infection Neutropenia and Risk for Infection Health Care Providers Educational Materials Cancer and Flu How to Prevent Flu from Spreading Flu Symptoms Information for Families and Caregivers Flu Treatment for Cancer Patients and ...
Christensen, Jesper Frank; Jones, L W; Andersen, J L
dysfunction in cancer patients lies in the correlation to vital clinical end points such as cancer-specific and all-cause mortality, therapy complications and quality of life (QoL). Such associations strongly emphasize the need for effective therapeutic countermeasures to be developed and implemented...... implications of muscle dysfunction in cancer patients. The efficacy of exercise training to prevent and/or mitigate cancer-related muscle dysfunction is also discussed. DESIGN: We identified 194 studies examining muscular outcomes in cancer patients by searching PubMed and EMBASE databases. RESULTS: Muscle...... dysfunction is evident across all stages of the cancer trajectory. The causes of cancer-related muscle dysfunction are complex, but may involve a wide range of tumor-, therapy- and/or lifestyle-related factors, depending on the clinical setting of the individual patient. The main importance of muscle...
The author's personal experience as a kidney cancer patient, researcher and founder of a kidney cancer support group forms the basis for consideration of the challenges involved in researching patients' experiences. The researcher needs to understand the variability of those experiences in both clinical and psychological-emotional terms, and in relation to the personal, familial and social contexts of the patient. It is also essential to define the purpose of the research and to show how an understanding of personal experiences of cancer can be used to enhance the quality of care for cancer patients. The research encounter with a patient is also in some respects a therapeutic encounter requiring a considerable degree of sensitivity on the part of the researcher. The person-centred approach of Carl Rogers is of value in supporting such an encounter.
Heidari, Haydeh; Mardani-Hamooleh, Marjan
Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients' perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients' informational needs in Iran.
Kronowitz, Steven J; Lam, Candace; Terefe, Welela; Hunt, Kelly K; Kuerer, Henry M; Valero, Vicente; Lance, Samuel; Robb, Geoffrey L; Feng, Lei; Buchholz, Thomas A
The authors examined the safety of a protocol for planned skin-preserving delayed breast reconstruction after postmastectomy radiotherapy with placement of a tissue expander for patients with locally advanced breast cancer (stages IIB and III). The authors compared 47 patients treated according to the protocol between December 2003 and May 2008 with 47 disease-stage-matched control patients who underwent standard delayed reconstruction after postmastectomy radiotherapy (no skin preservation or tissue expander) during the same period. Protocol-group complication rates were 21 percent for skin-preserving mastectomy and placement of the expander (stage 1), 5 percent for postmastectomy radiotherapy, 25 percent for expander reinflation after radiotherapy, and 24 percent for skin-preserving delayed reconstruction. The complication rate for standard delayed reconstruction was 38 percent. Tissue-expander loss rates were 32 percent overall, 9 percent for stage 1, 5 percent for postmastectomy radiotherapy, and 22 percent for reinflation. Wound-healing complications after reconstruction occurred in 3 percent of protocol-group and 10 percent of control-group patients. The median follow-up time for patients still alive at last follow-up was 40 months (range, 8.5 to 85.3 months). Three-year recurrence-free survival rates were 92 percent (95 percent CI, 83 to 100 percent) and 86 percent (95 percent CI, 76 to 98 percent) for the protocol and control groups, respectively (p = 0.87). In patients with locally advanced breast cancer, skin-preserving mastectomy with a deflated tissue expander on the chest wall during postmastectomy radiotherapy does not increase locoregional recurrence risk and is associated with lower complication rates of definitive reconstruction.
Arthur, Susan T; Van Doren, Bryce A; Roy, Debosree; Noone, Joshua M; Zacherle, Emily; Blanchette, Christopher M
Cancer cachexia is a debilitating condition and results in poor prognosis. The purpose of this study was to assess hospitalization incidence, patient characteristics, and medical cost and burden of cancer cachexia in the US. This study used a cross-sectional analysis of the Nationwide Inpatient Sample (NIS) for 2009. Five cancers reported to have the highest cachexia incidence were assessed. The hospitalization incidence related to cachexia was estimated by cancer type, cost and length of stay were compared, and descriptive statistics were reported for each cancer type, as well as differences being compared between patients with and without cachexia. Risk of inpatient death was higher for patients with cachexia in lung cancer (OR = 1.32; CI = 1.20-1.46) and in all cancers combined (OR = 1.76; CI = 1.67-1.85). The presence of cachexia increased length of stay in lung (IRR = 1.05; CI = 1.03-1.08), Kaposi's sarcoma (IRR = 1.47; CI = 1.14-1.89) and all cancers combined (IRR = 1.09; CI = 1.08-1.10). Additionally, cachectic patients in the composite category had a longer hospitalization stay compared to non-cachectic patients (3-9 days for those with cachexia and 2-7 days for those without cachexia). The cost of inpatient stay was significantly higher in cachexic than non-cachexic lung cancer patients ($13,560 vs $13 190; p Cachexia increases hospitalization costs and length of stay in several cancer types. Identifying the medical burden associated with cancer cachexia will assist in developing an international consensus for recognition and coding by the medical community and ultimately an effective treatment plans for cancer cachexia.
Full Text Available Objectives. The incidence of cancer among the indigenous Sami people of Northern Finland is lower than among the Finnish general population. The survival of Sami cancer patients is not known, and therefore it is the object of this study. Study design. The cohort consisted of 2,091 Sami and 4,161 non-Sami who lived on 31 December 1978 in the two Sami municipalities of Inari and Utsjoki, which are located in Northern Finland and are 300–500 km away from the nearest central hospital. The survival experience of Sami and non-Sami cancer patients diagnosed in this cohort during 1979–2009 was compared with that of the Finnish patients outside the cohort. Methods. The Sami and non-Sami cancer patients were matched to other Finnish cancer patients for gender, age and year of diagnosis and for the site of cancer. An additional matching was done for the stage at diagnosis. Cancer-specific survival analyses were made using the Kaplan–Meier method and Cox regression modelling. Results. There were 204 Sami and 391 non-Sami cancer cases in the cohort, 20,181 matched controls without matching with stage, and 7,874 stage-matched controls. In the cancer-specific analysis without stage variable, the hazard ratio for Sami was 1.05 (95% confidence interval 0.85–1.30 and for non-Sami 1.02 (0.86–1.20, indicating no difference between the survival of those groups and other patients in Finland. Likewise, when the same was done by also matching the stage, there was no difference in cancer survival. Conclusion. Long distances to medical care or Sami ethnicity have no influence on the cancer patient survival in Northern Finland.
Peleg-Nesher, Sharon; Yachini, Brurya; Inbar, Moshe
Sexuality is a basic need for every human being as long as he or she is alive, irrespective of age or health status. Approximately 23,500 individuals are diagnosed with cancer each year in Israel and join the 120,000 cancer patients currently living in Israel. The results of cancer treatments are traditionally assessed and based on the outcome regarding mortality versus survival. An equally important aspect to be addressed in this assessment must relate to quality of life. One of the more painful insults to the quality of life of cancer patients relates to the deleterious effects on sexuality. This article aims to present physicians with the spectrum of sexuality-related issues which are encountered by cancer patients and their partners, starting from the moment of diagnosis, throughout the various stages of treatment and to provide basic knowledge. Many individuals contracting cancer have difficulty dealing with the issue of sexuality. They are typically embarrassed and feel uneasy when asking health care providers about such a non-life threatening issue. Partners similarly feel both shame and guilt. In many cases sexuality, intimacy and emotional attachment are important aspects and may be essential for survival. Addressing these issues during treatment can provide patients with a sense of security, avoiding embarrassment and further exacerbation of such problems. Unfortunately, little has been done to develop an optimal interventional program, although standard sexual treatments have often been applied. Prospective clinical research and outcomes are missing. The physician can use the well-known PLISSIT model (1978): to provide sexuality involvement on different levels. The very new BETTER model (2004) can help emphasize that cancer treatment and the disease have an influence on intimacy and sexuality.
Sharma, Sunil Dutt; Kumar, Gaurav; Guner, Karen; Kaddour, Hesham
We present a retrospective case series of patients with hyperthyroidism and thyroid cancer. Our goal was to look at their clinical characteristics and outcomes to determine which patients would require further investigation. We reviewed the case notes of all patients with a histopathologic diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism who had been treated at a thyroid cancer center from January 2006 through October 2013. During that time, 66 patients had been diagnosed with thyroid cancer. Of these, 8 patients (12%)-all women, aged 29 to 87 years (mean: 55.6; median: 50.5)-had biochemical evidence of hyperthyroidism. Among these 8 patients, 4 had an autonomously functioning toxic nodule (AFTN), 3 were diagnosed with Graves disease, and 1 had a toxic multinodular goiter. Five patients had suspicious features on preoperative ultrasonography. All 8 patients were diagnosed with the papillary type of thyroid carcinoma. The mean size of the tumor in the 4 patients with AFTN was significantly larger than it was in those with Graves disease (42.3 ± 23.8 mm vs. 3.8 ± 1.6; p = 0.04). The 3 patients with Graves disease all had incidentally found papillary microcarcinoma. Between these two groups, the patients with AFTN had a poorer prognosis; 2 of them had extracapsular invasion and lymph node metastasis, and another died of her disease. We found that the incidence of hyperthyroidism in thyroid cancer patients was relatively high (12%). In contrast to what has previously been reported in the literature, patients with AFTN seem to have more aggressive disease and poorer outcomes than do patients with Graves disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.
Coleman, R; Body, J J; Aapro, M
There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major...... morbidity including fractures, severe pain, nerve compression and hypercalcaemia. Through optimum multidisciplinary management of patients with bone metastases, including the use of bone-targeted treatments such as potent bisphosphonates or denosumab, it has been possible to transform the course of advanced...... cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling...
Arends, Jann; Bachmann, Patrick; Baracos, Vickie; Barthelemy, Nicole; Bertz, Hartmut; Bozzetti, Federico; Fearon, Ken; Hütterer, Elisabeth; Isenring, Elizabeth; Kaasa, Stein; Krznaric, Zeljko; Laird, Barry; Larsson, Maria; Laviano, Alessandro; Mühlebach, Stefan; Muscaritoli, Maurizio; Oldervoll, Line; Ravasco, Paula; Solheim, Tora; Strasser, Florian; de van der Schueren, Marian; Preiser, Jean-Charles
institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd.. All rights reserved.
Kaldrymidis, Dimitrios; Papadakis, Georgios; Tsakonas, Georgios; Kaldrymidis, Philippos; Flaskas, Theofanis; Seretis, Andreas; Pantazi, Eleni; Kostoglou-Athanassiou, Ifigenia; Peppa, Melpomeni; Roussou, Paraskevi; Diamanti-Kandarakis, Evanthia
Several studies have suggested that patients with acromegaly have an increased risk of thyroid, colorectal, breast and prostate cancers. In this study we determined the prevalence of malignant neoplasms in patients with acromegaly. Cancer risk was evaluated in a cohort of 110 patients (M/F 48/62, age 58.63±13.8 years, range 30-86) with acromegaly. Mean age at diagnosis of acromegaly was 46.37±13.11 years. Mean period of time since diagnosis of acromegaly was 12.26+9.6 years. From 110 patients, cancer was diagnosed in 26 (23.6%) patients. Thyroid cancer was the most common cancer and was diagnosed in 13 patients (11.8%); other cancers encountered were gastric cancer (N=2), endometrial cancer (N-2), and breast cancer, colon cancer, prostate cancer (N-2), myelodysplastic syndrome, renal cell carcinoma, lung cancer and pancreatic carcinoma, one case each. Age, gender, age at the time of diagnosis of acromegaly, tumor size of pituitary adenoma and duration of disease were not associated with cancer development. This study suggests that patients with acromegaly have an increased risk of thyroid cancer and therefore they should undergo regular screening with hormonal and ultrasound evaluation of the thyroid and FNAB when required.
Bruera, E; Belzile, M; Watanabe, S; Fainsinger, R L
In this retrospective study we reviewed the volume and modality of hydration of consecutive series of terminal cancer patients in two different settings. In a palliative care unit 203/290 admitted patients received subcutaneous hydration for 12 +/- 8 days at a daily volume of 1015 +/- 135 ml/day. At the cancer center, 30 consecutive similar patients received intravenous hydration for 11.5 +/- 5 days (P > 0.2) but at a daily volume of 2080 +/- 720 ml/day (P palliative care unit patients required discontinuation of hydration because of complications. Hypodermoclysis was administered mainly as a continuous infusion, an overnight infusion, or in one to three 1-h boluses in 62 (31%), 98 (48%) and 43 (21%) patients, respectively. Our findings suggest that, in some settings, patients may be receiving excessive volumes of hydration by less comfortable routes such as the intravenous route. Increased education and research in this area are badly needed.
Romito, Francesca; Goldzweig, Gil; Cormio, Claudia; Hagedoorn, Mariët; Andersen, Barbara L.
According to the recent worldwide estimation by the GLOBOCAN project, in total, 12.7 million new cancer cases and 7.6 million cancer deaths occurred in 2008. The worldwide number of cancer survivors within 5 years of diagnosis has been estimated at be almost 28.8 million. Informal caregivers, such as family members and close friends, provide essential support to cancer patients. The authors of this report provide an overview of issues in the study of informal caregivers for cancer patients and long-term survivors in the United States and Europe, characterizing the caregivers commonly studied; the resources currently available to them; and their unmet needs, their psychosocial outcomes, and the psychosocial interventions tailored to their special circumstances. A broad overview of the state of research and knowledge, both in Europe and the United States, and observations on the directions for future research are provided. PMID:23695928
Full Text Available As a result of advances in treatment, almost 80% of children and adolescents who receive a diagnosis of cancer become long-term survivors. The increased survival rate of children and adolescents with cancer has resulted in a major interest in the long-term effects of cancer treatment on the possibility for future fertility. Currently established methods for the preservation of fertility are available only for pubertal males and females. Pubertal male cancer patients should be encouraged to freeze numerous sperm samples even when sperm count and motility are poor. In these cases, intracytoplasmic sperm injection is a powerful technique compared with intrauterine insemination since thawed sperm samples with poor parameters can produce relatively high fertilization rates resulting in normal pregnancies and deliveries. Married pubertal women should be proposed ovulation induction, follicular aspiration, and fertilization with husband sperm. Single women could benefit from vitrification of oocytes. This requires a delay of about 3 weeks in the commencement of chemotherapy to enable follicular growth. Fertility preservation for prepubertal patients is more of a problem. Young girls could be offered cryopreservation of gametes in the gonadal tissue. Cryopreservation of testicular tissue was suggested for fertility preservation for young boys, but this method is totally experimental and not currently offered. Discussing future fertility is part of the consultation of young female and male patients facing potentially gonadotoxic cancer therapy. It is the role of reproductive specialists to create various options in their laboratory to preserve fertility potential of cancer patients.
Alifrangis, C; Koizia, L; Rozario, A; Rodney, S; Harrington, M; Somerville, C; Peplow, T; Waxman, J
To assess the needs of cancer patients for information about their condition and to understand the psychological impact of their illness. The discussion of prognosis and treatment options in the palliative setting is an important and difficult part of oncology practice. To evaluate this, we examined the experiences of cancer patients of the physical and psychological impact of their disease on their life, and their opinions on the communication of end-of-life decisions and treatment options. A patient questionnaire was designed that encompassed communication regarding treatment and prognosis, quality-of-life attitudes subsequent to cancer diagnosis, end-of-life care and cancer drug funding. One hundred and twenty-five patients with a diagnosis of cancer were asked to participate and 96 questionnaires were completed and available for analysis. The questionnaire consisted of 63 questions and was completed in both an inpatient and outpatient setting. This survey brought to light a number of controversial issues in cancer service provision, highlighting the emotional and psychological changes brought about by a cancer diagnosis. Major concerns of our patients include fear of death and pain, changes in interpersonal relationships and financial constraints. Only 66% of the patients wanted to be given a prognosis by their clinicians and just 70% of the patients recalled being given a detailed prognosis. 11% of the patients were not prepared to undergo palliative treatment. In all, 7% were not prepared to accept treatment for 1 year and 2% for 5 years of life in exchange for the potential side effects of cytotoxic chemotherapy. 12% of the patients would not want to be in possession of the information that they were in the terminal phase of the illness with a short time to live and 16% would not want this discussed with their next of kin. This study informs medical professionals about the importance of tailoring information to the needs of the individual patient, and we
Full Text Available Cancer is accompanied by important psychological distress experienced by both patient and family. From the moment of the diagnosis on, the patient has to develop a great number of mechanisms and tasks of adjustment to the illness and its circumstances. The high prevalence of anxiety and depressive disorders during the course of cancer increases in the end stage disea‐ se. Therefore, a global plan of intervention integrating somatic and psychological/ psychiatric care throughout all the phases of the illness is crucial in the treatment of these patients. Health professionals working on this field can also experience emotional reactions to their patients’ suffering. They should be aware of the emotional aspects involved and develop training to help them intervene adequately with the patient and the family. The articulation between oncologists, palliative care professionals, and mental health care teams can be of great help in providing good quality of care to cancer patients.
Selma Turan Kavradim
Full Text Available Cancer, which is one of the major health problems leading to despair, uncertainty, pain and suffering, is perceived as a serious and chronic disease. Cancer negatively affects individuals' quality of life due to the physical, psychological, and socio-economic problems. Today, despite inspiring advances in diagnosis and treatment of cancer and increase in survival rates of patients, appearance of physical and psycho-social disorders during cancer course disrupts the adaptation mechanisms of patients and undermines expectations for the future. Most of the time in clinical practice, clinicians focus on physical assessments and treatment planning of cancer patients primarily, ignoring social, psychological, economic and cultural factors related with the disease. This approach definitely influences patients' hope levels and their effective dealing with the disease. The aim of this article is to guide medical staff and increase awareness about the concept of hope in patients with cancer. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(2.000: 154-164
Malaguarnera, Giulia; Giordano, Maria; Cappellani, Alessandro; Berretta, Massimiliano; Malaguarnera, Michele; Perrotta, Rosario Emanuele
Cancer in older people is a common problem worldwide. Among various types of cancer, skin cancers represent an important percentage. The principal risk factors are sun exposure, family history of skin cancer, fair skin color, but also the age plays an important role in the genesis of skin cancers. In older people there are a more prolonged exposure to carcinogenesis and a decreased functionality of reparation mechanisms of the cells so they acquire a selective advantage of growing and proliferating. At the same time age causes alteration in immune system by increasing NK-cells absolute number and decreasing both the endogenous and the lymphokine-induced lytic activities. The anti-tumor immune response is also mediated by the cytotoxic T- lymphocytes and in the elderly a strong reduction of T-cell function has been demonstrated. In elderly patients the diagnosis and the treatment of skin cancers can be different from younger counterpart. For example in older patients with melanoma is important to evaluate Breslow depth while higher mitotic rate has major value in younger patients. Moreover, the treatment should consider the performance status of patients and their compliance.
Pinquart, Martin; Silbereisen, Rainer K
This study analyzed the contact preferences of newly diagnosed cancer patients and healthy control group participants. In line with the theory of socioemotional selectivity, patients were more likely than control participants to prefer contact with familiar social partners, but this difference was stronger in younger and middle-aged patients than in older patients. Across a 6-month interval, patients' contact preferences changed according to the perceived success of therapy. For example, if therapy was perceived to be successful, patients showed an increasing interest in contacts with unfamiliar social partners. Results indicate that contact preferences are adapted to the perception of limited versus extended future lifetime. Copyright (c) 2006 APA, all rights reserved.
Mehlsen, Mimi Yung; Jensen, Anders Bonde; Zachariae, Bobby
Cancer can have a serious impact on patient well-being and quality of life. The international literature reports a higher prevalence of psychosocial problems among cancer patients; primarily problems associated with difficulties in the family, duties in the household, work and leisure, sexuality and finances. The prevalence of these problems among Danish cancer patients is still unknown. A questionnaire assessing psychosocial problems and needs was mailed out to all patients who had been at the Department of Oncology, Aarhus Hospital in week 35, 2004. A total of 71%, i.e. 515 patients (34% men and 66% women) in active treatment and control returned the questionnaire. High levels of emotional distress were reported by 39% of the patients. High levels of distress were primarily related to problems with worries about their spouses, household duties, financial problems and experiences of insufficient collaboration between health care and social services. Between 19% and 25% of the patients required further help to handle emotional problems, legal and financial problems and practical problems in the home. A considerable proportion of oncology patients experience significant levels of distress. This group of distressed patients also report unmet needs for psychosocial support.
Valizadeh, Leila; Zamanzadeh, Vahid; Rahmani, Azad; Howard, Fuchsia; Nikanfar, Ali-Reza; Ferguson, Caleb
This study explored Iranian patients' experiences of cancer disclosure, paying particular attention to the ways of disclosure. Twenty cancer patients were invited to participate in this qualitative inquiry by research staff in the clinical setting. In-depth, semistructured interview data were analyzed through content analysis. The rigor of the study was established by principles of credibility, transferability, dependability, and confirmability. Four themes emerged: the atmosphere of non-disclosure, eventual disclosure, distress in knowing, and the desire for information. Non-disclosure was the norm for participants, and all individuals involved made efforts to maintain an atmosphere of non-disclosure. While a select few were informed of their diagnosis by a physician or another patient, the majority eventually became aware of their diagnosis indirectly by different ways. All participants experienced distress after disclosure. The participants wanted basic information about their prognosis and treatments from their treating physicians, but did not receive this information, and encountered difficulty accessing information elsewhere. These challenges highlight the need for changes in current medical practice in Iran, as well as patient and healthcare provider education. © 2012 Blackwell Publishing Asia Pty Ltd.
Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade, E-mail: email@example.com [Curso de Pós-Graduação em Ciências Cardiovasculares da Universidade Federal Fluminense, Niterói, RJ (Brazil)
There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality.
Souza, Vinicius Barbosa de; Silva, Eduardo Nani; Ribeiro, Mario Luiz; Martins, Wolney de Andrade
There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013. There was a high coprevalence of hypertension and cancer, since both diseases share the same risk factors, such as sedentary lifestyle, obesity, smoking, unhealthy diet and alcohol abuse. The use of chemotherapy and adjuvant drugs effective in the treatment of cancer increased the survival rate of these patients and, consequently, increased the incidence of hypertension. We described the association between the use of angiogenesis inhibitors (bevacizumab, sorafenib and sunitinib), corticosteroids, erythropoietin and non-steroidal anti-inflammatory drugs with the development of hypertension. We also described the relationship between hypertension and carotid baroreceptor injury secondary to cervical radiotherapy. Morbidity and mortality increased in patients with cancer and hypertension without proper antihypertensive treatment. We concluded that there is need for early diagnosis, effective monitoring and treatment strategies for hypertension in cancer patients in order to reduce cardiovascular morbidity and mortality
What do patients prefer in cancer care and does gender matter? Introduction: To provide patient-centred care for cancer patients it is important to have insight into the patients' specific preferences for health care. To gain such insight we have developed a questionnaire based on cancer patients’
Full Text Available Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the forefront the potential for fertility preservation in patients being treated for cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total body irradiation, radiation to the gonads, and certain high dose chemotherapy regimens can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the adolescent and young adult population at the time of diagnosis. There are established means of preserving fertility before cancer treatment; specifically, sperm cryopreservation for men and in vitro fertilization and embryo cryopreservation for women. Several innovative techniques are being actively investigated, including oocyte and ovarian follicle cryopreservation, ovarian tissue transplantation, and in vitro follicle maturation, which may expand the number of fertility preservation choices for young cancer patients. Fertility preservation may also require some modification of cancer therapy; thus, patients' wishes regarding future fertility and available fertility preservation alternatives should be discussed before initiation of therapy.
Full Text Available Aim. To determine the influence of socio-demographic variables on attendance rate at screening examinations in cancer patients. Material and methods. The research group comprised of 100 cancer patients. The method applied in the research was a diagnostic survey. The research instrument was the authors‘ own questionnaire specially compiled to measure cancer patients‘ interest in screening examinations. The research material was analysed with the statistical packet STATISTICA 12 and Microsoft Office Excel software. Significance level was assumed at p<0.05 to determine statistically significant differences and dependencies. A Chi2 test was used in the research. Results. The surveyed patients mostly did not participate in screening examinations aimed at diagnosing cancer (66%. Their Age (p=0.05, gender (p=0.003 and place of residence (p=0.04 determined their participation rate in screening tests. The patients‘ marital status (p=0.47, education (p=0.85 and economic status (p=0.13 did not affect their willingness to attend screening examinations. Conclusions. The process of cancer incidence and death rate limitation requires greater participation of the population in prevention programmes.
The majority of cancer patients becomes malnourished during the course of their disease. Malnutrition deteriorates the efficiency of all kinds of oncologic interventions. As a consequence of it, treatment-related toxicity increases, hospital stay is lengthened, chances of cure and survival as well as the quality of life of the patients worsen. Nutritional status therefore influences all aspects of outcome of oncology care. In spite of this the use of nutritional therapy varies across health care providers but its application is far from being sufficient during active oncology interventions as well as rehabilitation and supportive care. It threatens not only the outcome and quality of life of cancer patients but also the success of oncologic treatments which often demand high input of human and financial resources. Meanwhile application of nutritional therapy is legally regulated in Hungary and a very recent update of the European guideline on cancer patient nutrition published in 2017 is available. Moreover, cost effectiveness of nutritional therapy has been proven in a number of studies. In this review we present the basics of nutritional therapy including nutritional screening and evaluation, nutritional plan, the role of nutrition support teams, oral, enteral and parenteral nutrition, the use of different drugs and special nutrients and the follow-up of the patients.
During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.
Ndahimana, Didace; Kim, Eun-Kyung
During the management of critical illness, optimal nutritional support is an important key for achieving positive clinical outcomes. Compared to healthy people, critically ill patients have higher energy expenditure, thereby their energy requirements and risk of malnutrition being increased. Assessing individual nutritional requirement is essential for a successful nutritional support, including the adequate energy supply. Methods to assess energy requirements include indirect calorimetry (IC) which is considered as a reference method, and the predictive equations which are commonly used due to the difficulty of using IC in certain conditions. In this study, a literature review was conducted on the energy metabolic changes in critically ill patients, and the implications for the estimation of energy requirements in this population. In addition, the issue of optimal caloric goal during nutrition support is discussed, as well as the accuracy of selected resting energy expenditure predictive equations, commonly used in critically ill patients.
Ito, Hirotoshi; Takahata, Akiko; Goto, Mariko; Masunami, Terutoshi; Yuen, Sachiko; Yamada, Kei; Nishimura, Tsunehiko
The purpose of this study was to evaluate the usefulness of magnetic resonance (MR) imaging in detecting prostate cancer in cases requiring repeat biopsy. Twenty patients with negative first prostate biopsy were evaluated by T2-weighted images (T 2 W), diffusion weighted image (DWI), and contrast-enhanced dynamic MRI at 1.5T prior to repeat biopsy. Eleven of the 20 also underwent MR imaging before initial biopsy. Cancer criteria were defined as an area of low signal intensity on T 2 W, high signal intensity on DWI, and early enhancement on dynamic MR imaging. We compared MR imaging findings with biopsy results. Prostate cancer was detected by repeat biopsy in nine of 20 patients. MR imaging demonstrated the cancer lesion in seven of the 9 patients whose biopsies were positive for cancer. MR imaging of 5 patients whose biopsies showed cancer also demonstrated cancer lesion previous to initial biopsy. Most cancers were detected in the anterior, apex, and far lateral areas. False-negative cases were low-grade cancers and had a few positive biopsy cores. In patients with repeat prostate biopsy, prior MR imaging may be valuable for detecting and localizing prostate cancer. (author)
Fuly, Patrícia dos Santos Claro; Pires, Livia Márcia Vidal; Souza, Claudia Quinto Santos de; Oliveira, Beatriz Guitton Renaud Baptista de; Padilha, Katia Grillo
Abstract OBJECTIVE To verify the nursing workload required by cancer patients undergoing palliative care and possible associations between the demographic and clinical characteristics of the patients and the nursing workload. METHOD This is a quantitative, cross-sectional, prospective study developed in the Connective Bone Tissue (TOC) clinics of Unit II of the Brazilian National Cancer Institute José Alencar Gomes da Silva with patients undergoing palliative care. RESULTS Analysis of 197 ...
Campbell, G Adam; Hu, Daniel; Okusa, Mark D
Acute kidney injury (AKI) is a frequent and significant complication of cancer and cancer therapy. Cancer patients frequently encounter risk factors for AKI including older age, CKD, prerenal conditions, sepsis, exposure to nephrotoxins, and obstructive physiology. AKI can also be secondary to paraneoplastic conditions, including glomerulonephritis and microangiopathic processes. This complication can have significant consequences, including effects on patients' ability to continue to receive therapy for their malignancy. This review will serve to summarize potential etiologies of AKI that present in patients with cancer as well as to highlight specific patient populations, such as the critically ill cancer patient. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications
Sibolt, Patrik; Ottosson, Wiviann; Sjöström, David
to investigate the need for adaptation due to anatomical changes, for both standard (ST) and DE plans in free-breathing (FB) and DIBH. Material and methods. The effect of tumor shrinkage (TS), pleural effusion (PE) and atelectasis was investigated for patients and for a CIRS thorax phantom. Sixteen patients were...... volume. Results. Phantom simulations resulted in maximum deviations in mean dose to the GTV-T ( GTV-T ) of -1% for 3 cm PE and centrally located tumor, and + 3% for TS from 5 cm to 1 cm diameter for an anterior tumor location. For the majority of the patients, simulated PE resulted in a decreasing...
Chan, Daniel L
The presence or development of malnutrition during critical illness has been unequivocally associated with increased morbidity and mortality in people. Recognition that malnutrition may similarly affect veterinary patients emphasizes the need to properly address the nutritional requirements of hospitalized dogs and cats. Because of a lack in veterinary studies evaluating the nutritional requirements of critically ill small animals, current recommendations for nutritional support of veterinary patients are based largely on sound clinical judgment and the best information available, including data from experimental animal models and human studies. This, however, should not discourage the veterinary practitioner from implementing nutritional support in critically ill patients. Similar to many supportive measures of critically ill patients, nutritional interventions can have a significant impact on patient morbidity and may even improve survival. The first step of nutritional support is to identify patients most likely to benefit from nutritional intervention. Careful assessment of the patient and appraisal of its nutritional needs provide the basis for a nutritional plan, which includes choosing the optimal route of nutritional support, determining the number of calories to provide, and determining the composition of the diet. Ultimately, the success of the nutritional management of critically ill dogs and cats will depend on close monitoring and frequent reassessment.
Nelson, M; Palmer, J L; Fu, J; Williams, J L; Yadav, R; Guo, Y
This study identifies the incidence of hyponatraemia in cancer patients on an inpatient rehabilitation unit and examines the association between admission hyponatraemia and rehabilitation length of stay (LOS), functional outcome, and survival. After institutional review committee's approval, we retrospectively reviewed medical records of 295 consecutive patients who were admitted to this inpatient cancer rehabilitation unit between 27 January 2009 through 31 July 2010 in a tertiary cancer centre. The incidence of hyponatraemia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na rehabilitation stay was not significantly different between three different patient groups. We concluded that large portion of patients who require acute inpatient rehabilitation presented with hyponatraemia, which is associated with prolonged rehabilitation LOS. Whether aggressive management of hyponatraemia will shorten rehabilitation stay needs further study. © 2013 John Wiley & Sons Ltd.
Boehmer, Dirk; Maingon, Philippe; Poortmans, Philip; Baron, Marie-Helene; Miralbell, Raymond; Remouchamps, Vincent; Scrase, Christopher; Bossi, Alberto; Bolla, Michel
Background and purposes: The appropriate application of 3-D conformal radiotherapy, intensity modulated radiotherapy or image guided radiotherapy for patients undergoing radiotherapy for prostate cancer requires a standardisation of target delineation as well as clinical quality assurance procedures. Patients and methods: Pathological and imaging studies provide valuable information on tumour extension. In addition, clinical investigations on patient positioning and immobilisation as well as treatment verification data offer an abundance of information. Results: Target volume definitions for different risk groups of prostate cancer patients based on pathological and imaging studies are provided. Available imaging modalities, patient positioning and treatment preparation studies as well as verification procedures are collected from literature studies. These studies are summarised and recommendations are given where appropriate. Conclusions: On behalf of the European Organisation for Research and Treatment of Cancer (EORTC) Radiation Oncology Group this article presents a common set of recommendations for external beam radiotherapy of patients with prostate cancer
Shimizu, Yuri; Niibe, Yuzuru; Terahara, Atsuro; Shimada, Hideaki; Yajima, Satoshi; Kikuchi, Yoshinori
To retrospectively assess the efficacy of radiotherapy in esophageal cancer patients with dysphagia due to the primary lesion at our institute, by evaluating change of Mellow-Pinkas-dysphagia score and subjective symptom. We confarmed radiotherapy for esophageal cancer help improve dysphagia. Change of Mel-low-Pinkas-dysphagia score throughout radiotherapy did not match with change of subjective dysphagia, which have relevancy to patients' quality of life. New evaluation criterion is required. (author)
Tsang, Julian S
BACKGROUND: Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS: Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded. RESULTS: Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year. CONCLUSION: Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.
Full Text Available Cancer is a physical disorder with concurrent mental and social components. During cancer, the feelings of fear, hopelessness, guilt, helplessness, abandonment perceived as a crisis leading to destruction in the suffering person. Breast cancer is the most common type of cancer among women. Prevalence of psychiatric disorders among cancer patients is approximately 50% and most of disorders are related with the occurrence of cancer and cancer treatment. Majority of patients present with major depression, adjustment disorder, anxiety disorders, sleep disorders, suicidial ideation, and delirium. Treatment of psychiatric disorders and cancer therapy should be conducted along with special consideration of drug interactions. This article reviews the adaptation process experienced by individuals during diagnosis and treatment of breast cancer, it psychological effects, resulting psychiatric comorbidites and their treatments. [Archives Medical Review Journal 2012; 21(3.000: 189-219
Joana Pedro Lopes; Paula Manuela de Castro Cardoso Pereira; Ana Filipa dos Reis Baltazar Vicente; Alexandra Bernardo; María Fernanda de Mesquita
The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery...
Fouad, Mona N.; Lee, Jeannette Y.; Catalano, Paul J.; Vogt, Thomas M.; Zafar, Syed Yousuf; West, Dee W.; Simon, Christian; Klabunde, Carrie N.; Kahn, Katherine L.; Weeks, Jane C.; Kiefe, Catarina I.
Both practice environment and patient clinical and demographic characteristics are associated with cancer clinical trial enrollment; simultaneous intervention may be required when trying to increase enrollment rates.
The benefits of exercise are well documented in a number of cancers. A panel of experts in cancer, fitness, obesity, and exercise training convened by the American College of Sports Medicine is spreading what they believe to be one of the most important messages for cancer patients and survivors: Avoid inactivity.
Dizdar, Omer; Hayran, Mutlu; Guven, Deniz Can; Yılmaz, Tolga Birtan; Taheri, Sahand; Akman, Abdullah C; Bilgin, Emre; Hüseyin, Beril; Berker, Ezel
Previous studies have noted a possible association between periodontal diseases and the risk of various cancers. We assessed cancer risk in a cohort of patients with moderate to severe periodontitis. Patients diagnosed with moderate to severe periodontitis by a periodontist between 2001 and 2010 were identified from the hospital registry. Patients younger than 35 years of age or with a prior cancer diagnosis were excluded. The age- and gender-standardized incidence rates (SIR) were calculated by dividing the number of observed cases by the number of expected cases from Turkish National Cancer Registry 2013 data. A total of 280 patients were included (median age 49.6, 54% female). Median follow-up was 12 years. Twenty-five new cancer cases were observed. Patients with periodontitis had 77% increased risk of cancer (SIR 1.77, 95% CI 1.17-2.58, p = .004). Women with periodontitis had significantly higher risk of breast cancer (SIR 2.40, 95% CI 0.88-5.33) and men with periodontitis had significantly higher risk of prostate cancer (SIR 3.75, 95% CI 0.95-10.21) and hematological cancers (SIR 6.97, 95% CI 1.77-18.98). Although showing a causal association necessitates further investigation, our results support the idea that periodontitis might be associated with increased cancer risk, particularly with hematological, breast and prostate cancers.
Sprah, L.; Sostaric, M.
Background. The aim of this review is to present common psychosocial problems in cancer patients and their possible coping strategies. Cancer patients are occupied with many psychosocial problems, which are only partially related to their health state and medical treatments. They are faced with a high social pressure, based on prejudices and stereotypes of this illness. The review presents the process of confrontation with the cancer diagnosis and of managing the psychological consequences of cancer. The effects of specific coping styles, psychosocial interventions and a social support on initiation, progression and recurrence of cancer are also described. Conclusions. Although some recent meta-analysis could not provide scientific evidence for the association between coping strategies and the cancer initiation, the progression or the recurrence (neither have studies rejected the thesis of association), the therapeutic window for the psychosocial intervention is still wide and shows an important effect on the quality of lives of many cancer patients. (author)
Sigel, Keith; Dubrow, Robert; Silverberg, Michael; Crothers, Kristina; Braithwaite, Scott; Justice, Amy
Non-AIDS-defining cancers are a rising health concern among HIV-infected patients. Cancer screening is now an important component of health maintenance in HIV clinical practice. The decision to screen an HIV-infected patient for cancer should include an assessment of individualized risk for the particular cancer, life expectancy, and the harms and benefits associated with the screening test and its potential outcome. HIV-infected patients are at enhanced risk of several cancers compared to the general population; anal cancer, hepatocellular carcinoma, Hodgkin's lymphoma, and lung cancer all have good evidence demonstrating an enhanced risk in HIV-infected persons. A number of cancer screening interventions have shown benefit for specific cancers in the general population, but data on the application of these tests to HIV-infected persons are limited. Here we review the epidemiology and background literature relating to cancer screening interventions in HIV-infected persons. We then use these data to inform a conceptual model for evaluating HIV-infected patients for cancer screening.
As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his\\/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses\\' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.
Thaler, Johannes; Ay, Cihan; Weinstabl, Harald; Dunkler, Daniela; Simanek, Ralph; Vormittag, Rainer; Freyssinet, Jean-Marie; Zielinski, Christoph; Pabinger, Ingrid
Abstract Accumulating evidence indicates that microparticles (MPs) are important mediators of the interaction between cancer and the hemostatic system. We conducted a large prospective cohort study to determine whether the number of circulating procoagulant MPs is elevated in cancer patients and whether the elevated MP levels are predictive of occurrence of venous thrombembolism (VTE). We analyzed plasma samples of 728 cancer patients from the ongoing prospective observational Vien...
When a patient is diagnosed with cancer, feelings such as fear, anxiety, and hopelessness can negatively affect a person's frame of mind. Hope can help a patient decrease anxiety and increase quality of life. Nurses should assess hope, provide interventions, be empathetic, listen, and treat patients with dignity to help improve hope and quality of life. This article features how hope can have a positive impact and provides specific information about how nurses can promote and foster hope in patients with cancer.
Patients with cancer often experience changes in taste and smell perception during chemotherapy. The aim of this dissertation was to investigate taste and smell changes and short- and long-term effects of chemotherapy in a homogeneous population of testicular cancer patients treated with
complications, African patients with breast cancer may well be predisposed to thrombotic complications during illness. ... having breast cancer were studied. The patients were diagnosed by one of the authors from histological biopsy from the lump removed from the breast. None of ... statistics (Student's t-test for paired data.
Zaorsky, N G; Churilla, T M; Egleston, B L; Fisher, S G; Ridge, J A; Horwitz, E M; Meyer, J E
The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (i) calendar year, (ii) patient age, and (iii) time after diagnosis. US death certificate data in Surveillance, Epidemiology, and End Results Stat 8.2.1 were used to categorize cancer patient death as being due to index-cancer, nonindex-cancer, and noncancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared with all persons. The greatest relative decrease in index-cancer death (generally from > 60% to deaths were stable (typically >40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; >40% of deaths from heart disease. The highest SMRs were from nonbacterial infections, particularly among 1,000 for lymphomas, P death from index- and nonindex-cancers varies widely among primary sites. Risk of noncancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Kus, Lukas H; Shah, Manish; Eski, Spiro; Walfish, Paul G; Freeman, Jeremy L
To compare the outcomes of patients having thyroid cancer among Filipinos vs non-Filipinos. Retrospective medical record review. High-volume tertiary referral center in Toronto, Ontario, Canada. A total of 499 patients with thyroid cancer (36 Filipino and 463 non-Filipino) treated at Mount Sinai Hospital from January 1, 1984, to August 31, 2003, with a minimum 5-year follow-up period and a minimum 1.0-cm tumor size. Patients were identified from a thyroid cancer database. Data on patient, tumor, and treatment factors were collected along with outcomes. The presence of thyroid cancer recurrence, the rate of death from disease, and the time to recurrence. The 2 groups were similar for sex, age, history of head and neck radiation exposure, family history of thyroid cancer, follow-up time, tumor size, tumor pathologic findings, presence of tumor multifocality, stage of primary disease, type of thyroid surgery, use of postoperative radioactive iodine therapy, and use of external beam radiation therapy. Filipino patients experienced a thyroid cancer recurrence rate of 25% compared with 9.5% for non-Filipino patients (odds ratio, 3.20; 95% confidence interval, 1.23-7.49; P = .004). On multivariate analysis, the increased risk of thyroid cancer recurrence persisted for Filipino patients (odds ratio, 6.99; 95% confidence interval, 2.31-21.07; P Filipino patients and non-Filipino patients regarding the rate of death from disease (5.6% vs 1.9%) and the time to recurrence (52.6 vs 53.1 months). Filipino patients have a significantly higher risk of thyroid cancer recurrence compared with non-Filipino patients. However, no significant difference was noted in the time to recurrence or the rate of death from disease. These findings justify a more aggressive initial management and follow-up regimen for Filipino patients with thyroid cancer.
Kjørstad, Odd Jarle; Haugen, Dagny Faksvåg
The criteria for refraining from cardiopulmonary resuscitation in palliative care cancer patients are based on patients' right to refuse treatment and the duty of the treating personnel not to exacerbate their suffering and not to administer futile treatment. When is cardiopulmonary resuscitation futile in these patients? Systematic literature searches were conducted in PubMed for the period 1989-2010 on the results of in-hospital cardiopulmonary resuscitation in advanced cancer patients and on factors that affected the results of CPR when special mention was made of cancer. The searches yielded 333 hits and 18 included articles: four meta-analyses, eight retrospective clinical studies, and six review articles. Cancer patients had a poorer post-CPR survival than non-cancer patients. Survival declined with increasing extent of the cancer disease. Widespread and therapy-resistant cancer disease coupled with a performance status lower than WHO 2 or a PAM score (Pre-Arrest Morbidity Index) of above 8 was regarded as inconsistent with survival after cardiopulmonary resuscitation. Cardiopulmonary resuscitation is futile for in-hospital cancer patients with widespread incurable disease and poor performance status.
Meropol, Neal J; Egleston, Brian L; Buzaglo, Joanne S; Benson, Al B; Cegala, Donald J; Diefenbach, Michael A; Fleisher, Linda; Miller, Suzanne M; Sulmasy, Daniel P; Weinfurt, Kevin P
Optimal patient decision making requires integration of patient values, goals, and preferences with information received from the physician. In the case of a life-threatening illness such as cancer, the weights placed on quality of life (QOL) and length of life (LOL) represent critical values. The objective of the current study was to describe cancer patient values regarding QOL and LOL and explore associations with communication preferences. Patients with advanced cancer completed a computer-based survey before the initial consultation with a medical oncologist. Assessments included sociodemographics, physical and mental health state, values regarding quality and length of life, communication preferences, and cancer-related distress. Among 459 patients with advanced cancer, 55% placed equal valued on QOL and LOL, 27% preferred QOL, and 18% preferred LOL. Patients with a QOL preference had lower levels of cancer-related distress (P LOL over QOL desired a more supportive and less pessimistic communication style from their oncologists. These data indicate that a values preference for LOL versus QOL may be simply measured, and is associated with wishes regarding the nature of oncologist communication. Awareness of these values during the clinical encounter could improve decision making by influencing the style and content of the communication between oncologists and their patients.
Mercurit, Angelina; Kallady, Susannah
Literature indicates that cancer patients experience high levels of unmet needs, particularly in relation to health information, psychological requirements and physical and daily living needs. It suggests that the needs of patients living in rural areas are likely to be higher than those of urban patients due to geographical factors and health service accessibility issues. This paper will explore the needs of cancer patients with particular focus on the impact of location (rural vs. urban), present the basis of these needs and identify strategies that address the needs expressed, by reviewing current literature. Copyright (2005) Australian Institute of Radiography
Full Text Available Prostate cancer is the second most common cancer worldwide for males, and the fifth most common cancer overall. Using of autogenic training could reduce the influence of ADT and raise quality of prostate cancer patients. The aim of this study was to determine the effects of autogenic training in patients with prostate cancer. Patients were divided to experimental and control group. Experimental group participated in fourteen weeks long autogenic training program. Control group performed usual daily activities. Every subject of research performed input and output diagnostics which monitored psychical states of patients by psychological standardized tests - Differential questionnaire of depression (DDF and Questionnaire of anxiety (STAI X1. Our data showed autogenic training program significant improved depressions symptoms and anxiety in experimental research group (p ≤ 0.05, however there was no main change of depression symptoms and anxiety values for control group (p = n.s..
Full Text Available Thyroid cancer is the second most common cancer diagnosed during pregnancy after breast cancer. The goal of management is to control malignancy and prevent maternal and fetal complications as a result of maternal hypothyroidism. The role of female sex hormones as an etiologic factor was investigated, with no clear association. Pregnancy can cause an increase in size of a previously existed thyroid nodule through the structural similarity between TSH and BHCG, and the normally expressed estrogen receptors on thyroid gland cells. Effect of pregnancy on development and prognosis of differentiated thyroid malignancies (papillary and follicular has also been studied. The prognosis of thyroid cancer is not worse in patients diagnosed during pregnancy or those who got pregnant after curative treatment. Termination of pregnancy is not indicated at all, surgery can be delayed till after delivery except in rapidly growing aggressive tumors. While radioactive iodine ablation is absolutely contra-indicated, the new systemic therapies are not well studied during pregnancy. However, almost all these new agents are classified as FDA category C or D and are better to be avoided. The effect of pregnancy on other types of thyroid cancer (medullary and anaplastic thyroid tumors is not well studied because of very low incidence with pregnancy. The endocrinological management of thyroid cancer during pregnancy is of utmost importance. The hypothyroidism after total thyroidectomy can cause fetal hypothyroidism. Therefore, the management of thyroid cancer related to pregnancy needs a multidisciplinary team.
Full Text Available Successful implementation of treatment in cancer care partially depends on how patients' perspectives are taken into account, as preferences of health care professionals and patients may differ. Objectives of this exploratory research were (I to identify patient preferences and values (PPVs in cancer care as indicated by patient organizations (POs, (II to determine how these PPVs are captured in cancer care guidelines and (III to review how guidelines take into account these PPVs. Based on a survey developed and completed by 19 POs, a literature review was conducted to analyse how patient perspectives are incorporated in oncology treatment guidelines. Based on survey results traditional health technology assessment value propositions of oncology care, such as extended life, treatment-free remission and pain reduction, were also highly rated by POs. However, the heterogeneity of cancer PPVs were clearly reflected in the survey results. PPVs in cancer care guidelines were mostly limited to those micro-level aspects that are strictly related to health care provision, such as side-effects and comorbidities. Patient experience, emotional support and convenience of care were relatively neglected fields in the reviewed guidelines. Patient engagement was rarely presented in the guideline development phase. POs believe that patients should be encouraged to take an active role in their own care due to the heterogeneity of cancer patients and PPVs. Even if patient-centricity is a leading paradigm in cancer policy, based on our research it is not yet standard practice to include patients or POs at all appropriate levels of decision-making processes that are related to their health and well-being. Patient engagement should be an integral part of cancer care decision-making. This complexity must be reflected throughout policy making, avoiding a population level “one-size-fits-all” solution.
Full Text Available Madeline Li,1,2 Ekaterina Kouzmina,3 Megan McCusker,1 Danielle Rodin,4 Paul C Boutros,3,5,6 Christopher J Paige,6–8 Gary Rodin1,2 1Princess Margaret Cancer Centre, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; 2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; 3Informatics & Biocomputing Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada; 4Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; 5Department of Pharmacology & Toxicology, Toronto, Ontario, Canada; 6Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; 7Department of Immunology, University of Toronto, Toronto, Ontario, Canada; 8Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada Objective: A better understanding of the biobehavioral mechanisms underlying depression in cancer is required to translate biomarker findings into clinical interventions. We tested for associations between cytokines and the somatic and psychological symptoms of depression in cancer patients and their healthy caregivers.Patients and methods: The GRID Hamilton Rating Scale for Depression (Ham-D was administered to 61 cancer patients of mixed type and stage, 26 primary caregivers and 38 healthy controls. Concurrently, blood was drawn for multiplexed plasma assays of 15 cytokines. Multiple linear regression, adjusted for biobehavioral variables, identified cytokine associations with the psychological (Ham-Dep and somatic (Ham-Som subfactors of the Ham-D.Results: The Ham-Dep scores of cancer patients were similar to their caregivers, but their Ham-Som scores were significantly higher (twofold, p=0.016. Ham-Som was positively associated with IL-1ra (coefficient: 1.27, p≤0.001 in cancer patients, and negatively associated with IL-2 (coefficient: -0.68, p=0.018 in caregivers. Ham-Dep was negatively associated with IL-4 (coefficient: -0.67, p
Quintero, Enrique; Alarcón-Fernández, Onofre; Jover, Rodrigo
The strategies used in population-based colorectal screening strategies culminate in colonoscopy and consequently the success of these programs largely depends on the quality of this diagnostic test. The main factors to consider when evaluating quality are scientific-technical quality, safety, patient satisfaction, and accessibility. Quality indicators allow variability among hospitals, endoscopy units and endoscopists to be determined and can identify those not achieving recommended standards. In Spain, the working group for colonoscopy quality of the Spanish Society of Gastroenterology and the Spanish Society of Gastrointestinal Endoscopy have recently drawn up a Clinical Practice Guideline that contains the available evidence on the quality of screening colonoscopy, as well as the basic requirements that must be met by endoscopy units and endoscopists carrying out this procedure. The implementation of training programs and screening colonoscopy quality controls are strongly recommended to guarantee the success of population-based colorectal cancer screening. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.
Braun, Kathryn L.; Kagawa-Singer, Marjorie; Holden, Alan E. C.; Burhansstipanov, Linda; Tran, Jacqueline H.; Seals, Brenda F.; Corbie-Smith, Giselle; Tsark, JoAnn U.; Harjo, Lisa; Foo, Mary Anne; Ramirez, Amelie G.
Cancer patient navigation (PN) programs have been shown to increase access to and utilization of cancer care for poor and underserved individuals. Despite mounting evidence of its value, cancer patient navigation is not universally understood or provided. We describe five PN programs and the range of tasks their navigators provide across the cancer care continuum (education and outreach, screening, diagnosis and staging, treatment, survivorship, and end-of-life). Tasks are organized by their potential to make cancer services understandable, available, accessible, affordable, appropriate, and accountable. Although navigators perform similar tasks across the five programs, their specific approaches reflect differences in community culture, context, program setting, and funding. Task lists can inform the development of programs, job descriptions, training, and evaluation. They also may be useful in the move to certify navigators and establish mechanisms for reimbursement for navigation services. PMID:22423178
Handberg, C; Lomborg, K; Nielsen, C V; Oliffe, J L; Midtgaard, J
The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: 'Fear of losing control' and 'Striving for normality'. While 'Fear of losing control' signified what the men believed rehabilitation would invoke: 'Reduced manliness', 'Sympathy and dependency' and 'Confrontation with death', 'Striving for normality' was based on what the men believed rehabilitation would hinder: 'Autonomy and purpose', 'Solidarity and fellowship' and 'Forget and move on'. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation. © 2015 John Wiley & Sons Ltd.
Matos, Erika; Skrbinc, Breda; Zakotnik, Branko
Testicular cancer affects men mostly in their reproductive age with a cure rate over 90% and fertility is one of the main concerns of survivors. To further elucidate the question of fertility after treatment for testicular cancer, we performed a survey in patients treated in our institution. We sent a questionnaire to patients treated for testicular cancer at our institute from 1976 to 2002 (n = 490) of whom 297 (60.6%) responded. We considered the patients to have conserved fertility if they had children after treatment without assisted reproductive technologies. Before treatment 119/297 (40.1%) of patients and after treatment 150/297 (50.5%) of patients tried to have children (p = 0.019). Of 119 patients who tried to have children before treatment for testicular cancer 98 (82.4%) succeeded and 74/150 (49.3%) were successful after treatment (p years. The post-treatment fatherhood in patients treated with surgery only (orchidectomy +/- retroperitoneal lymphnode dissection-RPLND) was 59%, in those with additional radiotherapy 68%, and chemotherapy 50% (p = 0.233). Fertility rate in patients where a non nerve sparing RPLND was performed was only 37%, 62% in patients with nerve sapring RPLND, and 77% in patients where RPLND was not performed (p Fertility rate after treatment for testicular cancer is reduced. From our data, the most important treatment modality that influences fertility is non nerve sparing RPLND that should be avoided whenever possible in order improve the quality of life our patients.
Wang, Jing; Liao, Qian-jin [The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013 (China); Zhang, Yi [Department of Obstetrics and Gynaecology, Xiangya Hospital, Central South University, Changsha 410078 (China); Zhou, Hui; Luo, Chen-hui; Tang, Jie; Wang, Ying; Tang, Yan; Zhao, Min; Zhao, Xue-heng [The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013 (China); Zhang, Qiong-yu [Department of Basic Medical Science, Yongzhou Vocational Technical College, Yong Zhou 425100 (China); Xiao, Ling, E-mail: email@example.com [Department of Histology and Embryology, School of Basic Medical Sciences, Central South University, Changsha 410013 (China); Institute of Clinical Pharmacology, Central South University, Changsha 410018 (China)
Highlights: • Silence of TRPM7 in ovarian cancer cells inhibits cell proliferation, migration and invasion. • Silence of TRPM7 decreases phosphorylation levels of Akt, Src and p38 in ovarian cancer cells. • Silence of TRPM7 increases expression of filamentous actin and number of focal adhesions in ovarian cancer cells. - Abstract: Our previous study demonstrated that the melastatin-related transient receptor potential channel 7 (TRPM7) was highly expressed in ovarian carcinomas and its overexpression was significantly associated with poor prognosis in ovarian cancer patients. However, the function of TRPM7 in ovarian cancer is mostly unknown. In this study, we examined the roles of TRPM7 in ovarian cancer cell proliferation, migration and invasion. We found that short hairpin RNA interference-mediated silence of TRPM7 significantly inhibited cell proliferation, colony formation, migration and invasion in multiple ovarian cancer cell lines. Mechanistic investigation revealed that silence of TRPM7 decreased phosphorylation levels of Akt, Src and p38 and increased filamentous actin and focal adhesion number in ovarian cancer cells. Thus, our results suggest that TRPM7 is required for proliferation, migration and invasion of ovarian cancer cells through regulating multiple signaling transduction pathways and the formation of focal adhesions.
Izmajłowicz, Barbara; Kornafel, Jan; Błaszczyk, Jerzy
and prophylactic tests. Synchronic neoplasms require detailed diagnostics and planning of treatment by a team of specialists. The occurrence of primary multiple cervical neoplasms does not worsen the prognosis as compared to patients suffering exclusively from cervical cancer.
Full Text Available Background: A supportive needs assessment is an essential component of any care program. There is no research evidence regarding the supportive care needs of cancer patients in Iran or other Middle Eastern countries. Aims: The aim of this study was to determine the supportive care needs of Iranian cancer patients. Materials and Methods: This descriptive study was conducted in a referral medical center in the northwest of Iran. A total of 274 cancer patients completed the Supportive Care Needs Survey (SCNS-59. Descriptive statistics were used for data analysis. Results: In 18 items of the SCNS, more than 50% of the participants reported that their needs were unmet. Most frequently, unmet needs were related to the health system, information, physical, and daily living domains, and most met needs were related to sexuality, patient care, and support domains. Conclusions: Iranian cancer patients experience many unmet needs and there is an urgent need for establishing additional supportive care services in Iran.
Buchali, A.; Dinges, S.; Koswig, S.; Rosenthal, P.; Salk, S.; Harder, C.; Schlenger, L.; Budach, V.
Investigation of options of virtual simulation in patients with localized prostate cancer. Twenty-four patients suffering from prostate cancer were virtual simulated. The clinical target volume was contoured and the planning target volume was defined after CT scan. The isocenter of the planning target volume was determined and marked at patient's skin. The precision of patients marking was controlled with conventional simulation after physical radiation treatment planning. Mean differences of the patient's mark revealed between the 2 simulations in all room axes around 1 mm. The organs at risk were visualized in the digital reconstructed radiographs. The precise patient's mark of the isocentre by virtual simulation allows to skip the conventional simulation. The visualisation of organs at risk leeds to an unnecessarity of an application of contrast medium and to a further relieve of the patient. The personal requirement is not higher in virtual simulation than in conventional CT based radiation treatment planning. (orig./MG) [de
Reiners, C.; Farahati, J.
Thyroid cancer is a rare malignancy with wide inter ethnic and geographic variations. In Germany thyroid carcinoma is the 13. most frequent malignancy (2.7 new cases yearly per 100,000 inhabitants). The overall temporal incidence is increasing slightly in recent years. The most common types of cancer are papillary (60-80%) and follicular cancers (10-20%). The relevant prognostic indicators are tumor stage and distant metastases. The mean survival rates in papillary thyroid cancer usually exceed 90%, whereas in follicular thyroid cancer they amount to approximately 80%. The standard treatment procedure in differentiated papillary and follicular thyroid cancer consists of total thyroidectomy followed by adjuvant ablative therapy with radioiodine. Only in papillary thyroid cancer stage pT 1 N 0 M 0 lobectomy alone is considered to be appropriate. In patients with locally invasive differentiated thyroid cancers stage pT 4 adjuvant percutaneous radiation therapy is a treatment option. Radioiodine therapy has to be performed under the stimulative influence of TSH. Usually TSH suppressive medication with Levothyroxine has to be withdrawn approximately 4 weeks prior to radioiodine therapy. In the future, exogenous stimulation by recombinant TSH may be used instead of thyroid hormone withdrawal. It has been proved by different studies that ablative radioiodine therapy reduces the frequency of recurrences and tumor spread in patients with thyroid cancer significantly. In patients with distant metastases, up to 50% of complete responses may be achieved with radioiodine treatment
Full Text Available Cognitive behavioral therapy is one of the structured but flexible psychosocial interventions that could be applied to patients with cancer. In many studies the positive effects of cognitive behavioral therapy in reducing psychological morbidity and improving the quality of life of cancer patients have been shown. In this article, the contents and techniques of adapted cognitive behavioral therapy for patients with cancer and its effectiveness in commonly seen psychiatric disorders have been reviewed. The aim of this article is to contribute positively to physicians and nurses in Turkey for early detection of psychological distress and referral to the therapist that would clearly increase the quality of life of cancer patients. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(3.000: 257-270
Gillessen, S; Omlin, A; Attard, G
The first St Gallen Advanced Prostate Cancer Consensus Conference (APCCC) Expert Panel identified and reviewed the available evidence for the ten most important areas of controversy in advanced prostate cancer (APC) management. The successful registration of several drugs for castration......-resistant prostate cancer and the recent studies of chemo-hormonal therapy in men with castration-naïve prostate cancer have led to considerable uncertainty as to the best treatment choices, sequence of treatment options and appropriate patient selection. Management recommendations based on expert opinion...
A Rahmani; R Mohammadian; C Ferguson; L Golizadeh; M Zirak; H Chavoshi
Objectives: To investigate the level and determinants of posttraumatic growth in Iranian cancer patients. Materials and Methods: This descriptive-correlational design study was conducted within a university-affiliated oncology hospital in Iran. A convenience sample of 450 patients with a definitive diagnosis of cancer of any type completed a demographic questionnaire and a posttraumatic growth inventory. Some disease-related information was obtained from patients′ medical records. Results: Th...
Basaglia, Giancarlo; Moras, Laura; Bearz, Alessandra; Scalone, Simona; Paoli, Paolo De
A coagulase-negative staphylococcal strain was isolated from peripheral blood and central venous catheter blood of a febrile patient with cancer. This isolate, initially classified by a commercial test as Staphylococcus kloosii, was definitively assigned to Staphylococcus cohnii by physiological and molecular tests. The strain lacked virulence factors, such as biofilm production and haemagglutination, and was sensitive to the antibiotics tested. The data suggest that rare micro-organisms with low pathogenic potential can cause severe illness in cancer patients; reference identification is required, however, to describe correctly the epidemiological characteristics and virulence factors of these clinical isolates.
Shim, Yoon Sang; Choi, Soo Yong; Won, Hyuk; Kim, Kee Hwa
The total number of malignant neoplasms included on this study 7,787 cases(10.4%) among 74,928 cases for 2 years. On sex, females with 57.6% were much more than males with 42.4%. The highest proportion of cancer 50-59 age group. The most frequent primary site among males was found to be stomach with 36.2%, followed by liver(12.3%), lung(12.2%), esophagus(15.5%) and larynx(4.9%). In females, the first order was uterine cervix with 47.3%, followed most common type of morphology of malignant neoplasms was adenocarcinoma(39.0%) in males an squamous cell carcinoma(56.2%) in females. Among the cancer patients initially diagnosed in this hospital, the proportion of malignant neoplasms by the extent of disease was 4.6% for patient with carcinoma-in-situ, 76.3% for patients with localized involvement, 11.6% for patients with regional involvement and 7.5% for patients with distant involvement. Among,the cancer patients initially treatment in this hospital, the proportion of malignant neoplasms by the method of treatment was 19.0% for surgery, 27.7 for radiotherapy and 24.2% for chemotherapy. Among the cancer patients confirmed by medical records, 11.2% was traced more than 5 years. (Author)
Shahvazi, Simin; Onvani, Shokouh; Heydari, Marziyeh; Mehrzad, Valiollah; Nadjarzadeh, Azadeh; Fallahzadeh, Hosseyn
Malnutrition is a common problem among cancer patients, usually occurs due to poor appetite, low food intake, and changes in body metabolism. The aim of this study is to determine the prevalence of malnutrition in patients receiving chemotherapy on an outpatient basis. This cross-sectional study conducted on 300 cancer patients referred to hospital. The prevalence of malnutrition among patients was assessed using the abridged scored patient-generated subjective global assessment (abPG-SGA) standard questionnaire. Moreover, patient's weight and 24 h dietary recall were measured. Descriptive statistics were used to present characteristics of patients and dietary recalls. For revealing the correlation, Spearman correlation was used. The average abPG-SGA score was 7.6 (standard deviation [SD] = 5.4) and 60.7% of patients were malnourished and required nutritional intervention. Patients mean age and mean duration of illness were 54.2 (SD = 14.7(years, 25 months, respectively. The most common complaint of patients included fatigue (51.3%), anorexia (43.3%), and dry mouth (41%). Reduction in food intake in past month was reported by 41.7% of patients. According to the high prevalence of cancers and increasing growth of them in recent years with regard to outpatient treatment development for cancer patients, using the abPG-SGA standard questionnaire by nutritionist or nurses can be effective to detect malnourished patients and reduce complications caused by disease.
Leng, Jennifer; Lee, Trevor; Li, Yanjun; Stern, Charles; Chen, Mei Hsuan; Winkel, Gary; Gany, Francesca
To enable better psychosocial, informational, and practical support of Chinese patients with cancer, this study was conducted to identify the specific support needs of Chinese immigrant cancer patients. The Cancer Portal Project at Memorial Sloan-Kettering Cancer Center's Center for Immigrant Health and Cancer Disparities is a patient navigation program that assists underserved and minority cancer patients in obtaining social and economic assistance at ten New York City cancer clinics. This need assessment was conducted as part of the Portal Project. Sixty-four questions were added to the existing Portal Intake Form about the needs and preferences for Chinese-language support and survivorship services. Descriptive analysis was performed, as well as an exploratory principal component's factor analysis to determine if there were any patterns in the services and programs in which patients were interested. Ninety-six patients were approached for participation; 59 agreed to participate. Eighty-eight percent of participants were born in China. Ninety-seven percent preferred to speak Mandarin, Cantonese, or Fujianese in the healthcare setting. When asked about general interest in support programs, 53 % of the participants were "very interested," 27 % were "maybe interested," and 17 % were "not interested." Programs in which more participants were "very interested" included those that would provide information about obtaining financial assistance (79 %) and social assistance (74 %), information on treatment options (67 %), help in coping with the burden of illness on the family (65 %), and information about general healthcare (63 %). The factor analysis resulted in the identification of five factors: social/financial/treatment and care issues, nutrition and exercise/networking/general health care, coping with fear and stress, herbs and dietary supplements, and acupuncture and acupressure. In this study, 80 % of the participants expressed interest in programs tailored for
Seo, Kyung Won; Yoon, Ki Young
Weight loss and malnutrition are common in cancer patients. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and required for the multidisciplinary approach. Subjective global assessment (SGA) is made by the patients nutritional symptoms and weight loss. The objective assessment, a significant weight loss (>10%) for 6 months is considered an indicator of nutritional deficiency. The mean body index, body fat mass and body protein mass are decreased as cancer stage increases. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count are decreased in advanced cancer stage. Daily energy intake, cabohyderate and Vit B1 intake is decreased according to cancer stage. The patients are divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss%, 6 month weight loss%, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake protein and energy malnutrition. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase in stomach cancer associated morbidity and mortality. The authors concluded that nutritional assessment should be done in cancer patients preoperatively, and with adequate nutritional support, the morbidity and mortality would be decreased.
Ernstmann, N; Neumann, M; Ommen, O; Galushko, M; Wirtz, M; Voltz, R; Hallek, M; Pfaff, H
Cancer patients often experience distress. However, the majority of newly diagnosed patients gradually adapt to the crisis. When symptoms of distress and anxiety persist over months, patients require psychosocial support. The aim of the present study was to determine the proportion of cancer patients who indicate the need for psychosocial support and to identify sociodemographic, psychological and illness-related factors predicting the need for psychosocial support in a German sample. The cross-sectional retrospective study was administered to 710 cancer patients who had been inpatients at the University Hospital of Cologne. The response rate was 49.5%. Patients suffering from bronchial, oesophageal, colorectal, breast, prostate and skin cancer participated in the study. The severity of depressive symptoms was assessed using the German version of the Major Depression Inventory. The level of anxiety was assessed with the state subscale of the German version of the State-Trait Anxiety Inventory. To measure the functional aspects of health-related quality of life, the scales "physical functioning", "role functioning", "emotional functioning", "cognitive functioning" and "role functioning" of the European Organisation for Research and Treatment of Cancer QLQ-C30 Questionnaire (EORTC QLQ-C30) were used. Of the cancer patients, 18.9% indicate an unmet need for psychosocial support and 9.5% are actually using psychosocial services. In a multiple logistic regression, significant indicators of the need for psychosocial support are gender [p = 0.014; standardised effect coefficient (sc) = 1.615] and emotional functioning (p Emotional functioning is a central predictor of the requirement for psychosocial support. Women are emotionally more affected than men and need more psychosocial support. The prognostic validity of the severity of depression and anxiety is limited.
Ohtake, Eiji; Tobari, Chitose; Matsui, Kengo; Iio, Masahiro.
The results and problems of radiotherapy were analyzed in 57 lung cancer patients more than 65 years of age (average age: 74.8 years). Of these, 45 (79%) were irradiated with a total dose exceeding 40 Gy. In these patients, the median survival was 13 months for Stages I and II, 6.5 months for Stage III, and 5 months for Stage IV. The results of combined radiotherapy and chemotherapy were better than those of radiotherapy alone. Also, slightly better results were obtained in patients treated with split-course than continuous-course irradiation. In aged lung cancer patients the prognosis was highly influenced by their respiratory function. Double cancers were present in 9 (16%) of the 57 patients. (author)
Egeberg, A; Thyssen, Jacob Pontoppidan; Gislason, G. H.
Background: Psoriasis is a chronic inflammatory skin disease that is commonly treated with ultraviolet phototherapy and systemic immunosuppressant drugs, which may confer a risk of skin cancer. Previous studies on the risk of skin cancer in patients with psoriasis have shown conflicting results....... Objectives: We investigated the risk of new-onset melanoma and non-melanoma skin cancer (NMSC), respectively, in a large cohort of patients with psoriasis and psoriatic arthritis. Methods: Data on all Danish individuals aged ≥18 years between 1 January 1997 and 31 December 2012 were linked at individual...... of skin cancer is only modestly increased in patients with psoriasis, clinicians should remain vigilant. © 2016 European Academy of Dermatology and Venereology...
Smith, Angela B; Chisolm, Stephanie; Deal, Allison; Spangler, Alejandra; Quale, Diane Z; Bangs, Rick; Jones, J Michael; Gore, John L
Patient-centered research requires the meaningful involvement of patients and caregivers throughout the research process. The objective of this study was to create a process for sustainable engagement for research prioritization within oncology. From December 2014 to 2016, a network of engaged patients for research prioritization was created in partnership with the Bladder Cancer Advocacy Network (BCAN): the BCAN Patient Survey Network (PSN). The PSN leveraged an online bladder cancer community with additional recruitment through print advertisements and social media campaigns. Prioritized research questions were developed through a modified Delphi process and were iterated through multidisciplinary working groups and a repeat survey. In year 1 of the PSN, 354 patients and caregivers responded to the research prioritization survey; the number of responses increased to 1034 in year 2. The majority of respondents had non-muscle-invasive bladder cancer (NMIBC), and the mean time since diagnosis was 5 years. Stakeholder-identified questions for noninvasive, invasive, and metastatic disease were prioritized by the PSN. Free-text questions were sorted with thematic mapping. Several questions submitted by respondents were among the prioritized research questions. A final prioritized list of research questions was disseminated to various funding agencies, and a highly ranked NMIBC research question was included as a priority area in the 2017 Patient-Centered Outcomes Research Institute announcement of pragmatic trial funding. Patient engagement is needed to identify high-priority research questions in oncology. The BCAN PSN provides a successful example of an engagement infrastructure for annual research prioritization in bladder cancer. The creation of an engagement network sets the groundwork for additional phases of engagement, including design, conduct, and dissemination. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.
Full Text Available Intoduction: Melanosis coli is a benign lesion affecting the mucosa of the large intestine. There is a relationship between the presence of melanosis and anthraquinone laxative use. Melanosis coli is also observed in patients with colon cancer, but there is doubt whether these two conditions are related. Aim : To analyze the correlation between melanosis and colon cancer. Material and methods: We analyzed retrospectively 436 patients undergoing colon cancer surgery. There were 246 women and 190 men. Patients were divided into three age groups: under 50 years, between 51 and 65 years, and over 66 years. We analyzed sections of the cancer and intestinal mucosa from the tumor’s proximal (2–5 cm and distal (8–10 cm zone. Results : Melanosis coli was present in 52 patients, which represents 11.9% of patients with colon cancer. More often it was present in women. The most common location of melanosis and colon cancer was the terminal part of the large intestine. In patients below 50 years of age in both sexes melanosis coli did not occur. In men, melanosis was more common in the age group over 66 years. Intensity of pigmentation was higher in the tumor’s distal zone. Conclusions : The incidence of melanosis coli increases with age, similar to that of colon cancer. Melanosis was not present inside tumors, in almost half of the cases it was not present in the proximal zone, and the degree of pigmentation increased in distal zone. The cause-effect relationship between melanosis coli and colon cancer remains uncertain.
Momm, F.; Lutterbach, J. [Dept. of Radiation Therapy, Univ. Clinic Freiburg (Germany); Pflieger, D. [Dept. of Dermatology, Univ. Clinic Freiburg (Germany)
Background: Erythroderma is an inflammation of the skin, which can be triggered by various diseases as psoriasis, allergies, side effects of medication, infections or malignant tumors. Caused by these various etiologic possibilities patients require extensive diagnostic effort. Patient: We report a case of a 71-year-old man presenting with an erythroderma of unknown etiology. Therapy with corticosteroids was not successful. A complete remission was reached by therapy with cyclosporine A, 350 mg/day. Finally, an increased prostate specific antigene (PSA) value was found and a prostate cancer was diagnosed in the patient. Results: After definitive radiotherapy of the carcinoma (total dose 74 Gy, 5 x 2 Gy/week), the cyclosporine A was displaced without recurrence of erythroderma. Conclusion: In this case, we consider the erythroderma to have been a paraneoplastic effect of the prostate carcinoma. In male patients with erythroderma an early PSA test should be performed. (orig.) [German] Hintergrund: Die Erythrodermie ist eine entzuendliche Reaktion der Haut, die durch verschiedene Grunderkrankungen wie Psoriasis, Allergien, Infektionen, Nebenwirkungen von Medikamenten oder paraneoplastisch in Erscheinung treten kann. Wegen dieser vielfachen aetiologischen Moeglichkeiten erfordern Erythrodermiepatienten eine aufwaendige Diagnostik. Patient: Wir berichten ueber einen 71-jaehrigen Patienten mit einer Erythrodermie zunaechst unbekannter Aetiologie. Durch die Gabe von Cyclosporin A in einer Dosis von 350 mg/Tag konnte eine Remission erreicht werden. Schliesslich wurde bei dem Patienten ein erhoehter Wert des prostataspezifischen Antigens (PSA) im Blut gefunden und daraufhin ein Prostatakarzinom diagnostiziert. Ergebnisse: Nach primaerer perkutaner Strahlentherapie des Prostatakarzinoms (Gesamtdosis 74 Gy, 5 x 2 Gy/Woche) konnte das Cyclosporin A abgesetzt werden, ohne dass ein weiterer Schub der Erythrodermie auftrat. Schlussfolgerung: Wir halten die Erythrodermie bei
Full Text Available Most cancer patients often neglect the possibility of secondary cancer. Colorectal cancer (CRC is the third leading cause of cancer death in Taiwan. It is important to be aware of the clinical characteristics of double cancer in CRC patients for early diagnosis and treatment. We retrospectively analyzed 1,031 CRC patients who underwent surgical treatment at the Department of Surgery of Kaohsiung Medical University Hospital between January 1998 and December 2004. Among these patients, CRC was accompanied by cancer of other organs in 17 patients (1.65%, either synchronously or metachronously. Therefore, we describe our experience regarding the location of CRC, the clinical symptoms and signs of these patients, the TNM stage, histology, phase, association with other malignancies, interval between cancers and clinical outcomes. Of the 17 patients in whom CRC was accompanied by primary cancer of other organs, there were four synchronous and 13 metachronous multiple cancer patients. Our patient group comprised six men and 11 women with ages ranging from 47 to 88 years (median age, 66 years. The most common location of CRC was the sigmoid colon. Six gastric cancers (35.2% and six breast cancers (35.2% were associated with primary CRC. The remaining six second primary cancers were one lung cancer, one thyroid cancer, one cervical cancer, one ovarian cancer, one skin cancer, and one urinary bladder cancer. Of the 13 metachronous multiple cancer patients, eight patients developed subsequent CRC after primary cancers of other organs, whereas two patients developed a subsequent second primary cancer after CRC. The intervals between the development of metachronous multiple cancers ranged from 2 to 19 years. In this retrospective analysis, breast and gastric cancer patients were at increased risk of developing subsequent secondary CRC. Careful attention should always be paid to the possibility of secondary CRC in treating these cancer patients. Cancer
Omoti, C.E.; Osime, E.
To assess the rheological changes in haematological and non-haematological cancer patients pre and post chemotherapy. It is a prospective study of 50 patients comprising 16(32%) haematological and 34(68%) non-haematological cancers of various types from March to December 2005 at University of Benin Teaching Hospital, Nigeria. Rheologic parameters estimated by the various specific diagnostic methods were determined in cancer patient's pre and post chemotherapy. The rheological tests estimated were relative plasma viscosity (RPV) measured by means of a capillary viscometer, whole blood viscosity (WBV), erythrocyte sedimentation rate (ESR) and plasma fibrinogen concentration (PFC) estimated by the Ingram's Clot weight method. The RPV in pre chemotherapy (p=0.006) and WBV in post chemotherapy (p=0.0231) patients measured revealed a significant difference when compared to controls. The fibrinogen concentration (P<0.0001) and ESR values (P<0.0001) were significantly increased in cancer patients when compared to controls. We conclude that total reduction of hyperviscosity and hyperfibrinogenaemia may contribute to effective treatment strategies in cancer patients. (author)
Rahmani, A; Mohammadian, R; Ferguson, C; Golizadeh, L; Zirak, M; Chavoshi, H
To investigate the level and determinants of posttraumatic growth in Iranian cancer patients. This descriptive-correlational design study was conducted within a university-affiliated oncology hospital in Iran. A convenience sample of 450 patients with a definitive diagnosis of cancer of any type completed a demographic questionnaire and a posttraumatic growth inventory. Some disease-related information was obtained from patients' medical records. The mean of posttraumatic growth reported by participants was 76.1. There was a statistically significant association between experience of posttraumatic growth and age (r = - 0.21, P=0.001), education at university level (F = 8.9, P=0.001) and history of treatment by radiotherapy (t = 2.1, P=0.03). The findings of this study suggest that Iranian cancer patients experience a moderate to high level of posttraumatic growth and confirm the hypothesis that the level of posttraumatic growth in non-Western cancer patients is more than that of Western cancer patients. Although, assessing the reasons for this difference needs more investigations.
Karampitsakos, Theodoros; Tzilas, Vasilios; Tringidou, Rodoula; Steiropoulos, Paschalis; Aidinis, Vasilis; Papiris, Spyros A; Bouros, Demosthenes; Tzouvelekis, Argyris
Idiopathic pulmonary fibrosis (IPF) is a chronic fibrotic lung disease of unknown etiology. With a gradually increasing worldwide prevalence and a mortality rate exceeding that of many cancers, IPF diagnosis and management are critically important and require a comprehensive multidisciplinary approach. This approach also involves assessment of comorbid conditions, such as lung cancer, that exerts a dramatic impact on disease survival. Emerging evidence suggests that progressive lung scarring in the context of IPF represents a risk factor for lung carcinogenesis. Both disease entities present with major similarities in terms of pathogenetic pathways, as well as potential causative factors, such as smoking and viral infections. Besides disease pathogenesis, anti-cancer agents, including nintedanib, have been successfully applied in the treatment of patients with IPF while an oncologic approach with a cocktail of several pleiotropic anti-fibrotic agents is currently in the therapeutic pipeline of IPF. Nevertheless, epidemiologic association between IPF and lung cancer does not prove causality. Currently there is significant lack of knowledge supporting a direct association between lung fibrosis and cancer reflecting to disappointing therapeutic algorithms. An optimal therapeutic strategy for patients with both IPF and lung cancer represents an amenable need. This review article synthesizes the current state of knowledge regarding pathogenetic commonalities between IPF and lung cancer and focuses on clinical and therapeutic data that involve both disease entities. Copyright © 2017. Published by Elsevier Ltd.
Khoshnevis, N; Ahmadizar, F; Alizadeh, M; Akbari, M E
Weight loss and malnutrition are common among cancer patients, these two factors greatly affecting survival and quality of life during treatment. Since cancer is becoming increasingly common in the world and in order to provide better treatment measures, it is important to identify and prevent side effects. The present study has been conducted in 2010 on a sample of cancer patients in the oncology center of Shahid Beheshti University of Medical Sciences to determine the prevalence rates of malnutrition and the factors affecting it. The PG-SGA standard questionnaire was administered to 416 cancer patients to evaluate their nutrition status and determine the frequency of each malnutrition stage. Correlations and ANOVA tests were used to analyze the relationship between factors and weight loss and how they might affect the development of malnutrition. The prevalence of malnutrition among the patients was 53.1% out of which 29.1% had moderate and 24% had severe malnutrition. The most common factors inducing nutritional symptoms were depression and anorexia. Some 35 % of the patients had over 5% weight loss in the last mouth. The average PG-SGA score was 10.1 with 49 being the highest. 46.1 percent of the patients scored over 9 (requiring critical nutrient intervention). Malnutrition has a high correlation with weight loss, activity limitations, nutritional symptoms, and cancer stage, but low correlation with treatment and pathologic type. Malnutrition has a high prevalence in Iranian cancer patients and has a close relationship with mortality, morbidity and treatment-related problems and also quality of life. Therefore, periodical assessment by PG-SGA to detect malnutrition in patients should be made so that appropriate nutritional interventions can be provided.
Jensen, Line Flytkjær; Hvidberg, Line; Pedersen, Anette Fischer
Størstedelen af kolorektal cancere opdages gennem patienters symptomatiske henvendelse i almen praksis. Man ved dog ikke meget om, hvordan patienter selv oplever deres symptomer. Formålet med studiet var, at undersøge om symptom attributioner er associeret med hvilket symptom man oplevede før...
Victoria M Villaflor; Marco E Allaix; Bruce Minsky; Fernando A Herbella; Marco G Patti
Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced.There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease.Often,esophageal cancer is not diagnosed until patients present with dysphagia,odynophagia,anemia or weight loss.When symptoms occur,the stage is often stage Ⅲ or greater.Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection.The treatment of patients who have locally advanced esophageal cancer is more complex and controversial.Despite multiple trials,treatment recommendations are still unclear due to conflicting data.Sadly,much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically.Additionally,studies have been underpowered or stopped early due to poor accrual.In the United States,concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient.Patients who have metastatic disease are treated palliatively.The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer,and to review the literature which guides our treatment recommendations.
CONCLUSION: This study shows that patients who are less depressed have higher levels of resilience and that psychological resilience may independently contribute to lower levels of depression among breast cancer patients. The level of psychological resilience may be a protective factor for depression and psychological distress.
ten Kroode, H F
Approximately two thirds of all Dutch cancer patients have severe emotional problems; shortly after their change from the treatment regime into the regime of medical controls. Half of them even need professional support. It is, therefore, important that a professional listens with empathy to the patient's version of the illness story. Story telling helps to overcome the existential crisis of being a cancer patient; it is an essential step in the revalidation process. Themes and open questions which structure the communication are suggested in this article.
Damaskos, Penny; Amaya, Beau; Gordon, RuthAnn; Walters, Chasity Burrows
To present the ways in which race, ethnicity, class, gender, and sexual orientation interact in the context of cancer risk, access to care, and treatment by health care providers. Cancer risk factors, access to care, and treatment for lesbian, gay, bisexual, and transgender (LGBT) patients are discussed within the context of intersectionality and cultural humility. Peer reviewed articles, cancer organizations, and clinical practice. LGBT patients have multiple identities that intersect to create unique experiences. These experiences shape their interactions with the health care system with the potential for positive or negative consequences. More data is needed to describe the outcomes of those experiences and inform clinical practice. Oncology nurses have an obligation to acknowledge patients' multiple identities and use the practice of cultural humility to provide individualized, patient-centered care. Copyright © 2017 Elsevier Inc. All rights reserved.
McLaughlin, Laura; Mahon, Suzanne M
Taste dysfunction is a significant but underestimated issue for patients with cancer. Impaired taste results in changes in diet and appetite, early satiety, and impaired social interactions. Nurses can play a key role in educating patients and families on the pathophysiology of taste dysfunction by suggesting interventions to treat the consequences of taste dysfunction, when available, and offering psychosocial support as patients cope with this often devastating consequence of treatment. Taste recognition helps humans identify the nutritional quality of food and signals the digestive tract to begin secreting enzymes. Spoiled or tainted foods typically are recognized by their bad taste. Along with the other sensory systems, taste is crucial for helping patients treated for cancer feel normal. This article will review the anatomy and physiology of taste; define the different types of taste dysfunction, including the underlying pathophysiologic basis related to cancer treatment; and discuss potential nursing interventions to manage the consequences of taste dysfunction.
Kang, Soo Man; Lee, Choul Soo
The purpose of this study is to understand preliminary education. Level of understanding and the degrees of educational requirement for cancer patients on radiotherapy and to present the preliminary data to development of effective and practical patients treatment programs. Based on the above mentioned results of this study. Relationship between degrees of knowledge and demand for educational requirement for patients who are undertaking radiotherapy could be varied with different factors such as educational background, ages, regions of treatment, experience of symptoms. In general, patients do not have enough information, on the other hand, have very high demand for educational requirement. Customized education patients by patients would not be possible in reality. However, if we could provide standard for patients and establish systematic sessions during treatment based on this study, more and better patients satisfaction and results of treatments could be achieved.
Choi, Soo Yong; Kim, Kee Hwa; Mok, Kang Sung [Korea Cancer Center Hospital of Korea Atomic Energy Research Institute, Seoul (Korea, Republic of)
The total number of malignant neoplasms included in this study 53,566 cases(14.1%) among 379,582 patients from 1984 to 1993. On sex, females with 51.3% were much more than males with 48.7%. The highest proportion of cancer patients by age was 35.0% in males and 28.4% in females, respectively for 50-59 age group. The most frequent primary site among males was found to be stomach with 33.2%, followed by liver(15.1%), lung(14.9%), esophagus(5.3%) and larynx(3.3%). In females, the first order was uterine cervix with 37.8%, followed by stomach(16.5%), breast(14.8%), thyroid gland(4.3%) and lung (3.8%). The proportion of malignant neoplasms diagnosed by histology made up 67.0%, whereas 20.2% was diagnosed by clinical investigation(X-ray, CT, MRI etc). Among the cancer patients initially diagnosed in this hospital, the proportion of malignant neoplasms by the extent of disease was 3.7% for patient with carcinoma-in-situ, 58.7% for patients with localized involvement, 18.4% for patients with regional involvement and 11.1% for patients with distant involvement. Among the cancer patients initially treatment in this hospital, the proportion of malignant neoplasms by the method of treatment was 27.5% for surgery, 22.5% for radiotherapy and 30.1% for chemotherapy. The proportion of cancer patients traced to death was only to 3.6%, 1,944 cases. Among them, 72.5% survived for less than 1 year. 17 figs, 7 tabs, 28 refs. (Author).
Choi, Soo Yong; Kim, Kee Hwa; Kang Sung Mok
The total number of malignant neoplasms included in this study 53,566 cases(14.1%) among 379,582 patients from 1984 to 1993. On sex, females with 51.3% were much more than males with 48.7%. The highest proportion of cancer patients by age was 35.0% in males and 28.4% in females, respectively for 50-59 age group. The most frequent primary site among males was found to be stomach with 33.2%, followed by liver(15.1%), lung(14.9%), esophagus(5.3%) and larynx(3.3%). In females, the first order was uterine cervix with 37.8%, followed by stomach(16.5%), breast(14.8%), thyroid gland(4.3%) and lung (3.8%). The proportion of malignant neoplasms diagnosed by histology made up 67.0%, whereas 20.2% was diagnosed by clinical investigation(X-ray, CT, MRI etc). Among the cancer patients initially diagnosed in this hospital, the proportion of malignant neoplasms by the extent of disease was 3.7% for patient with carcinoma-in-situ, 58.7% for patients with localized involvement, 18.4% for patients with regional involvement and 11.1% for patients with distant involvement. Among the cancer patients initially treatment in this hospital, the proportion of malignant neoplasms by the method of treatment was 27.5% for surgery, 22.5% for radiotherapy and 30.1% for chemotherapy. The proportion of cancer patients traced to death was only to 3.6%, 1,944 cases. Among them, 72.5% survived for less than 1 year. 17 figs, 7 tabs, 28 refs. (Author)
Kjær, Andreas; Loft, Annika; Law, Ian
Combined PET/MRI systems are now commercially available and are expected to change the medical imaging field by providing combined anato-metabolic image information. We believe this will be of particular relevance in imaging of cancer patients. At the Department of Clinical Physiology, Nuclear...... described include brain tumors, pediatric oncology as well as lung, abdominal and pelvic cancer. In general the cases show that PET/MRI performs well in all these types of cancer when compared to PET/CT. However, future large-scale clinical studies are needed to establish when to use PET/MRI. We envision...... that PET/MRI in oncology will prove to become a valuable addition to PET/CT in diagnosing, tailoring and monitoring cancer therapy in selected patient populations....
This paper reviews the results of a breast cancer screening program sponsored by organizations at workplace or community locations. A comprehensive mobile breast cancer screening program, including education, breast physical examination, and mammography, was provided to 89 local organizations at $50.00 per examination over an 18-month period. The examination was patient initiated, following the ACS screening guidelines. Estimates of eligible women were provided by each organization. A total of 5,030 women at 89 organizations were screened for breast cancer. Approximately 25,727 women were eligible
Shim, Yun Sang; Choi, Soo Yong; Kim, Ki Wha; Kang, Sung Mok
The total number of malignant neoplasms included in this study 15,737 cases(11.8%) among 133,251 cases for 3 years. On sex, females with 52.9% were much more than males with 47.1%. The highest proportion of cancer patients by age was 33.7% in males and 28.5% in females, respectivelty for 50-59 age group. The most frequent primary site among males was found to be stomach with 35.5%, followed by liver(14.7%), lung(13.0%), esophagus(5.4%) and colon (3.2%). In females, the first order was uterine cervix with 40.6%, followed by stomach(17.2%), breast(14.4), rectum(3.7%) and lung(3.4%). The most common type of morphology of malignant neoplasms was adenocarcinoma(47.4%) in males an squamous cell carcinoma(58.0%) in females. Among the cancer patients initially diagnosed in this hospital, the proportion of malignant neoplasms by the exent of disease was 2.5% for patient with carcinoma-in-situ, 54.1% for patients with localized involvement, 13.3% for patients with regional involvement and 8.5% for patients with distant involvement. Among the cancer patients initially treatment in this hospital, the proportion of malignant neoplasms by the method of treatment was 23.6% for surgery, 25.3% for radiotherapy and 30.3% for chemotherapy. Among the cancer patients confirmed by medical records, 7.7% was traced more than 5 years. (Author)
Park, Joon Ho; Park, Eun-Cheol; Lee, Myung Ha; Kim, Yun-Mi; Choi, Soo Mi
A financial aid program for low income cancer patients in Korea was initiated in 2005, which required a web-based system. Therefore, the Cancer Patient Financial Aid System (CPFAS) was developed. To improve the CPFAS, we evaluated the nationwide satisfaction of public health center users.
Kwast, A.B.G.; Drossaert, Constance H.C.; Siesling, Sabine
Increased breast cancer incidence and better survival have raised the number of patients requiring follow-up care. Despite guidelines, there is controversy about appropriate breast cancer follow-up. Therefore, semi-structured interviews were conducted in two hospitals with 23 patients and 18 health
M.J. Uitdehaag (Madeleen)
textabstractThis thesis explores palliative care provided to patients with advanced upper gastrointestinal (GI) cancer. The 5-year survival rates for these cancer sites range between 4 and 17%, which implies that many of these patients require palliative care. Considering the fact that there is no
Kabir, M.F.; Nahar, N.; Haque, F.S.; Alam, F.; Hasan, M.
Full text: The coexistence of hyperthyroidism and thyroid cancer is a rare event. The aim of this study was to evaluate the relevance of the association of hyperthyroidism and thyroid cancer. Method: From 1st January 2006 to 31st December 2006, a total of 388 new hyperthyroid patients attended the Institute of Nuclear Medicine and Ultrasound for radioiodine therapy. Eighty-two of them were selected before radioiodine therapy, on the basis of findings on palpation and ultrasound (USG) examination, to undergo fine needle aspiration cytology (FNAC) for cytological diagnosis. USG examination was performed to localize and mark the position of nodule/nodules for FNAC and, in cases of nonpalpable nodules, USG guided FNAC was done. In the case of non-nodular patients, guided FNAC was done in sonographically suspicious areas. Results: FNAC report was positive for thyroid cancer in 4 patients. Histopathology examination revealed the presence of papillary carcinoma. Among the four positive cases, one had multi-nodular goitre, two had uni-nodular goiters and one had no nodule. Another patient had a negative FNAC report but due to a huge goiter, the patient underwent surgery and histopathology revealed the presence of papillary carcinoma. Conclusion: Although the occurrence of thyroid cancer in hyperthyroid patients is rare, the presence of a nodule should be carefully evaluated to exclude the presence of concurrent malignancy. FNAC (USG guided in case of non-palpable nodules) is found helpful before radioiodine therapy or surgery. (author)
Cancer and its treatments frequently have a negative impact on the weight and nutritional status of patients. Weight loss is associated with reduced survival and poorer outcomes of treatment but is not well characterized and frequently confused with cachexia, which may complicate the interpretation of studies of nutritional support. The aims of this review were to examine the impact of cancer on nutritional status and to review the role of simple oral nutritional interventions and novel agents. The terms weight loss, malnutrition and cachexia refer to different entities and new definitions have recently been proposed that take account of the role of the underlying inflammatory processes. Oral nutritional interventions are widely recommended for malnourished cancer patients, but the evidence for their benefits to clinical, nutritional and patient-centred outcomes is limited. Meta-analysis has highlighted the variability in response to simple nutritional interventions of different cohorts of cancer patients and suggested that improvements in nutritional endpoints and aspects of quality of life may be achieved in some patients. Recent research has largely focused on treatments aiming to modulate the inflammatory processes associated with cachexia, but to date has not identified a single treatment with clear efficacy. Studies characterizing the potential for nutritional support in combination with anti-inflammatory agents in defined patient groups are defined to advance the evidence base in this area.
Lozins'ka, Yi.M.; Yakimova, T.P.
248 patients with mammary gland cancer (stages 2 and 3) were studied. In 3 stage patients, inhibition of the thyroid gland function, increase of somatotropic hormones (STH) and carcinoembryonic antigen (CEA) concentration, when compared with the respective data in stage 2 patients, were noted. Radiotherapy at stages 2 and 3 of the disease causes various changes of the above-mentioned values. Increase of CEA blood concentration results in inhibition of cellular immune reactions in the tumor stroma and its bed, which influences 5-years' survival of the patients. The authors suggest that at stage 3 mammary gland cancer, homeostasis state occurs in the organism; it differs from that occurring at stage 3 of the disease. Thus, different approaches to treatment at these two stages of the disease are required
J. R. Gardanova
Full Text Available Diagnostics of psycho-emotional disorders of patients with malignant diseases of the prostate is not doubt, because timely correction contributes to the shortening of rehabilitation period and restoration of the quality of life of patients after treatment. Detection and diagnosis of prostate cancer for many patients is stressful and causes changes in the affective sphere, and manifests itself in increased levels of anxiety and depression in men. To cope with stress is possible due to the used coping strategies.Purpose. Studying the coping mechanisms in prostate cancer patients.Materials and methods. 56 men treated in FGBU "LRTS" Russian Ministry of Health. The average age was 65.7 ± 6.1 years. The average duration of the disease prostate cancer is 3 ± 2 months. All men were subjected to the standard algorithm for the evaluation of hormonal status, the PSA, taking a history, inspection and physical examination, magnetic resonance imaging and scintigraphy of bones of a skeleton. All the patients underwent laparoscopic radical prostatectomy. Psychological testing with the use of the method of "Coping test" the scale of reactive and personal anxiety for the differentiated evaluation of anxiety. Results. The most common for prostate cancer revealed constructive coping strategies are "planning solve", "selfcontrol" and "search of social support". According to the scale Spielberg–Hanin a high level of situational anxiety was revealed.Conclusion. According to the results of the research, patients with prostate cancer are likely to use constructive coping strategies, that leads to stabilization of psycho-emotional state of men and promotes more effective adaptation in the terms of stress, that is caused by treatment of prostate cancer.
May 23, 2016 ... Purpose: The aim of this study was to analyze the blood glucose (BG) variations in cancer patients .... cancer, brain tumor, cervical cancer, and leukemia were the ... excess glucose supply for these glucose‑hungry cells and it.
Meijer, Anna; Roseman, Michelle; Milette, Katherine; Coyne, James C.; Stefanek, Michael E.; Ziegelstein, Roy C.; Arthurs, Erin; Leavens, Allison; Palmer, Steven C.; Stewart, Donna E.; de Jonge, Peter; Thombs, Brett D.
Background: Several practice guidelines recommend screening for depression in cancer care, but no systematic reviews have examined whether there is evidence that depression screening benefits cancer patients. The objective was to evaluate the potential benefits of depression screening in cancer
Maura Gabriela FELEA
Full Text Available Negative emotions (distress are recognized as part of the psychological profile of patients diagnosed with advanced stage cancer. However, most patients are not accustomed to verbalize feelings towards their physician, and generally towards family and medical care personnel. The purpose of this paper is to analyze the expression of emotions by patients in advanced stages of cancer, respectively the means by which they get to express emotions. To this respect, we identified the most common types of emotions expressed, or metaphors used by patients to describe their emotions and topics that trigger emotions. Words and phrases most commonly used are in relation to: fear, anxiety, depression, guilt, negligence, concern. They are uttered in order to depict the network created between disclosed emotions and topics on health status, symptoms, adverse effects and therapeutic choice, patient privacy, and social and family issues.
Dellson, Pia; Nilbert, Mef; Carlsson, Christina
Background Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed consent is possible to provide. We explored patient representatives? views and perceptions on the written trial information used in clinical cancer trials. Methods Written patient information leaflet...
Barret, JP; Desai, MH; Herndon, DN
Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.
This study was designed to describe cancer patient’s experience of kundalini yoga and its effect on their internal coping resources. The intention of this study is to put forward kundalini yoga as a support therapy for cancer patients for improving their wellbeing during active cancer treatment. This is a descriptive study. An academic literature review was conducted for cancer, cancer treatment, internal coping resources and yoga as therapy topics. Four voluntary female cancer patients (...
Anandavadivelan, Poorna; Lagergren, Pernilla
Oesophageal cancer is a debilitating disease with a poor prognosis, and weight loss owing to malnutrition prevails in the majority of patients. Cachexia, a multifactorial syndrome characterized by the loss of fat and skeletal muscle mass and systemic inflammation arising from complex host-tumour interactions is a major contributor to malnutrition, which is a determinant of tolerance to treatment and survival. In patients with oesophageal cancer, cachexia is further compounded by eating difficulties owing to the stage and location of the tumour, and the effects of neoadjuvant therapy. Treatment with curative intent involves exceptionally extensive and invasive surgery, and the subsequent anatomical changes often lead to eating difficulties and severe postoperative malnutrition. Thus, screening for cachexia by means of percentage weight loss and BMI during the cancer trajectory and survivorship periods is imperative. Additionally, markers of inflammation (such as C-reactive protein), dysphagia and appetite loss should be assessed at diagnosis. Routine assessments of body composition are also necessary in patients with oesophageal cancer to enable assessment of skeletal muscle loss, which might be masked by sarcopenic obesity in these patients. A need exists for clinical trials examining the effectiveness of therapeutic and physical-activity-based interventions in mitigating muscle loss and counteracting cachexia in these patients.
Frascà, Giovanni M; Sandrini, Silvio; Cosmai, Laura; Porta, Camillo; Asch, William; Santoni, Matteo; Salviani, Chiara; D'Errico, Antonia; Malvi, Deborah; Balestra, Emilio; Gallieni, Maurizio
Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.
Younge, D; Moreau, P; Ezzat, A; Gray, A
The following factors are relevant to the communication problems that exist in this country: 1. The impression is that patients here cope better with terminal illness at home than do patients elsewhere. The extended family, with its strong ties, and the strong Islamic faith that encourages its members to provide for parents and children in case of need mean that any input by health professionals is magnified by the family in the care of the patient. At first, it was uncertain if foreign health professionals would be accepted into Saudi homes (which are intensely private and protected for the family) for the purpose of caring for patients. This has proved unfounded. Hospitality is a very important part of Saudi society; nurses and doctors are welcomed and respected. Much of this success is due to the use of Saudi men as drivers and translators. These people provide 24-hour service, act as social workers assessing the needs of the family, and are the link between the patient and family, the nurse, and the doctor. 2. "CURE" OR "PALLIATION": The emphasis for cancer patients in Saudi Arabia is still on "curative treatment," even after any realistic hope of a cure is gone. The problem this causes is compounded by many patients being excluded from the decision-making process. Decisions made by the family may not always reflect the patient's wishes. Greater communication is needed to guide treatment decisions. 3. TRUTH-TELLING: Denying information of the patient's illness is probably more a historical than a cultural phenomenon. Similar attitudes prevailed until very recently in practically all other countries. In this very conservative country, people are committed to preserving Islamic culture in the face of Western technology. As medicine continues to demonstrate its effectiveness as well as its limitations, people will come to realize that the right of patients to know and understand their illness allows them to cope much better, and is compatible with the
Pedersen, Anette Fischer; Hansen, Rikke P; Vedsted, Peter
Blødning fra endetarmen ses normalt som et alarmsymptom på kolorektalkræft. Alligevel vælger mange patienter at lade være med at opsøge lægen. Denne artikel ser nærmere på sammenhængen mellem et alarmsymptom (rektal blødning), forsinkelser i patientforløbet og tanker om kræft. Resultaterne viser,...
Varlotto, John; Stevenson, Mary Ann
Purpose: To review the impact of anemia/tumor hypoxemia on the quality of life and survival in cancer patients, and to assess the problems associated with the correction of this difficulty. Methods: MEDLINE searches were performed to find relevant literature regarding anemia and/or tumor hypoxia in cancer patients. Articles were evaluated in order to assess the epidemiology, adverse patient effects, anemia correction guidelines, and mechanisms of hypoxia-induced cancer cell growth and/or therapeutic resistance. Past and current clinical studies of radiosensitization via tumor oxygenation/hypoxic cell sensitization were reviewed. All clinical studies using multi-variate analysis were analyzed to show whether or not anemia and/or tumor hypoxemia affected tumor control and patient survival. Articles dealing with the correction of anemia via transfusion and/or erythropoietin were reviewed in order to show the impact of the rectification on the quality of life and survival of cancer patients. Results: Approximately 40-64% of patients presenting for cancer therapy are anemic. The rate of anemia rises with the use of chemotherapy, radiotherapy, and hormonal therapy for prostate cancer. Anemia is associated with reductions both in quality of life and survival. Tumor hypoxemia has been hypothesized to lead to tumor growth and resistance to therapy because it leads to angiogenesis, genetic mutations, resistance to apoptosis, and a resistance to free radicals from chemotherapy and radiotherapy. Nineteen clinical studies of anemia and eight clinical studies of tumor hypoxemia were found that used multi-variate analysis to determine the effect of these conditions on the local control and/or survival of cancer patients. Despite differing definitions of anemia and hypoxemia, all studies have shown a correlation between low hemoglobin levels and/or higher amounts of tumor hypoxia with poorer prognosis. Radiosensitization through improvements in tumor oxygenation/hypoxic cell
Du, Yan-ping; Li, Ling-ling; He, Qing; Li, Yun; Song, Hu; Lin, Yi-jia; Peng, Jun-sheng
To investigate the nutritional status, and provide evidence for nutritional treatment option. A total of 452 patients with gastrointestinal cancer were selected, including 156 gastric cancer,117 colon cancer, and 180 rectal cancer. The nutritional risk screening 2002(NRS2002) was applied to grade the nutritional risk. A multi-frequency bioelectrical impedance analysis was used to measure the patients' body composition. Albumin (Alb), prealbumin(PA), transferring(Tf), retinol binding protein(RBP), red blood cell(RBC), hemoglobin (Hb), haematocrit(Hct) were measured after fasting. The rate of patients with NRS2002 score more than 3 was 70.5%(110/156) for gastric cancer, 53.8%(63/117) for colon cancer, and 46.7%(86/180) for rectal cancer. The score for impaired nutritional status more than 1 for gastric cancer was higher than that for colorectal cancer(Pgastric cancer(Pgastric cancer patients as compared to colorectal cancer patients(Pgastric cancer patients(Pgastric cancer and colon cancer(Pgastric cancer are prone to fat loss and therefore have a higher nutritional risk and malnutrition than those with colorectal cancer. Combination of body composition analysis and laboratory examination may achieve comprehensive evaluation of the nutritional status of patients, and provide the evidence of nutritional therapy by being combined with NRS2002 score.
Dellson, Pia; Nilbert, Mef; Carlsson, Christina
of future simplified and more attractive informed consent forms. CONCLUSIONS: The emotional and cognitive responses to written patient information reported by patient representatives provides a basis for revised formats in future trials and add to the body of information that support use of plain language......BACKGROUND: Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed...... consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. METHODS: Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I...
Saber, M.M.; Shouman, T.
To assess whether clodronate can reduce frequency of skeletal morbidity in women with lytic bone metastases from breast cancer. Methods: Between 1997 and 2001,167 patients with stage IV breast cancer with bone metastases, were randomly assigned to receive clodronate at a dose of 1600 mg per day orally for 12 months, in addition to the standard specific anti cancer therapy (87 patients) or standard anti cancer therapy only (80 patients). Skeletal complications, including pathological fractures, the need for radiation to bone or bone surgery, spinal cord compression and hypercalcaemia (a serum calcium concentration above 12 mg per deci liter (3.0 mmol per liter) or elevated to any degree and requiring treatment) were assessed monthly. Bone pam. use of analgesic drugs, performance status and quality of life were assessed throughout the trial. Results: There was no significant difference between the two groups at study entry regarding clinical characteristics. The median time for first skeletal complication was ,significantly less in the control group (6.1 vs 9.7 months, ρ=0.05). The proportion of patients who had any skeletal complication in the clodronate group than the control group, but the difference was insignificant (ρ 0.09). Clodronate was generally well tolerated and the main side effects were constipation (32%) flatulence/dyspepsia (17%) and anorexia (8%). The overall survival was not affected by clodronate therapy. The median survival was 14 months In the clodronate group and 13.8 months in the control group. Conclusions: Clodronate is an effective supplement to conventional anticancer treatment for breast cancer with bone metastasis. It reduces skeletal complications and relieves symptoms associated with lytic bone lesions. Further clinical trials that recruit a larger number of patients will be needed to clearly define the role of clodronate in metastatic breast cancer
Behan, James W; Sutton, Adam; Wysong, Ashley
Skin cancer is the most common of human cancers and outnumbers all other types of cancer combined in the USA by over threefold. The majority of non-melanoma skin cancers are easily treated with surgery or locally destructive techniques performed under local anesthesia in the cost-effective outpatient setting. However, there is a subset of "high-risk" cases that prove challenging in terms of morbidity, mortality, adjuvant treatment required, as well as overall cost to the health care system. In our opinion, the term "high risk" when applied to skin cancer can mean one of three things: a high-risk tumor with aggressive histologic and/or clinical features with an elevated risk for local recurrence or regional/distant metastasis, a high-risk patient with the ongoing development of multiple skin cancers, and a high-risk patient based on immunosuppression. We have recently proposed classifying NMSC as a chronic disease in a certain subset of patients. Although no consensus definition exists for a chronic disease in medicine, there are three components that are present in most definitions: duration of at least 1 year, need for ongoing medical care, and functional impairment and/or alteration of activities of daily living (ADLs) and quality of life (QOL). Immunosuppression can refer to exogenous (organ or stem cell transplant patients,) or endogenous (HIV, leukemia, lymphoma, genodermatoses with DNA mismatch repair problems or other immunosuppression) causes. These patients are at risk for high-risk tumors and/or the development of multiple tumors.
Niederer, D; Vogt, L; Thiel, C; Schmidt, K; Bernhörster, M; Lungwitz, A; Jäger, E; Banzer, W
The present study evaluated the effects of physical exercise on heart rate variability (HRV) in cancer patients. 3 matched groups of each 15 tumour patients (60.4±8.9 years, 27 male, 18 female) were recruited: Physical exercise group 1 (acute treatment), Physical exercise group 2 (post treatment) and non-intervention group (acute treatment, no exercise). Exercise group patients received counselling for exercise and participated in a Nordic-Walking program. Short-term HRV-recordings, assessments of fatigue and quality of life (QoL) were performed prior to and 16 weeks after the exercise program initiation. MANCOVA revealed group × time differences in total power frequency domain of HRV and QoL (pHRV-parameters and prolonged survival in cancer patients, improvement in autonomic control may be an important goal of exercise. © Georg Thieme Verlag KG Stuttgart · New York.
Velenik, V.; Oblak, I.; Kodre, V.
Background. Anemia is one of the most challenging problems in clinical oncology due to its high prevalence among the patients with malignant diseases. The purposes of our study were: (1) to assess the potential of epoetin alfa therapy to prevent the decline in Hb concentrations that typically accompanies chemotherapy/ radiotherapy (ChT/RT) of the patients with rectal cancer; (2) to test the hypothesis that the use of epoetin alfa significantly reduces the transfusion requirements in the patients with rectal cancer treated with ChT/RT after surgery, and (3) to evaluate the safety profile of the administration of epoetin alfa in the clinical setting. Methods. Sixty patients who underwent surgery for rectal cancer were prospectively enrolled. Group A consisted of 39 patients with Hb concentrations ≤13 g/dl at the start of ChT/RT following surgery, and group B of 17 patients with Hb concentrations ≥13 g/dl at the start of ChT/RT following surgery, but whose Hb concentrations fell below 13 g/dl during the ChT/RT protocol. The starting dose of epoetin alfa in both groups was 10,000 IU subcutaneously (sc) three times a week (tiw). The following major parameters were evaluated: (1) change in Hb concentrations relative to the baseline as measured at 4-week intervals, (2) allogenic blood transfusion requirements in relation to Hb concentrations, and (3) incidence and severity of adverse events and their potential relationship to epoetin alfa administration. Results. The study protocol was completed in 56/60 patients. In group A, a statistically significant increase in Hb concentration (p<0.001) was observed after the first 4 weeks of epoetin alfa treatment compared to the baseline values, with the mean increase of Hb concentration of 1.97 g/dl ± 0.91 g/dl and Hb concentrations remained significantly increased through the whole study (p=0.0017). In group B, a continuous decrease in Hb concentrations was observed during the first weeks of therapy, reaching the level of
Parenteral nutrition may be considered when oral intake and/or enteral nutrition are not sufficient to maintain nutritional status and the patient is likely to die sooner from starvation than from the cancer. A detailed assessment should be made prior to the decision about whether parenteral nutrition should be started. A follow up plan should be documented with objective and patient centred treatment goals as well as specific time points for evaluation. Copyright © 2015 Elsevier Inc. All rights reserved.
Pfeiffer, Per; Qvortrup, Camilla; Tabernero, Josep
Recent modalities and strategies have increased the complexity of treatment choice in patients with colorectal cancer (CRC), and therefore all cases should be assessed at a multidisciplinary conference. Adjuvant chemotherapy for 6 months increases the chance of cure by absolutely 5 % in stage II...
Kjær, Andreas; Loft, Annika; Law, Ian
Combined PET/MRI systems are now commercially available and are expected to change the medical imaging field by providing combined anato-metabolic image information. We believe this will be of particular relevance in imaging of cancer patients. At the Department of Clinical Physiology, Nuclear Me...
Several Studies have indicated the existence of thrombo-embolic complications in cancer patients and that this could be associated with changes in heamorheological parameters. Packed cell volume (PCV), heamoglobin (Hb), relative plasma viscosity (RPV) and plasma Fibrinogen concentration (PFC) were measured in ...
Paaschburg, B.; Pedersen, A.; Tuxen, M.K.
The latest investigations have been searched in order to present new guidelines for the treatment of elderly patients with primary breast cancer. It is concluded that breast-conserving surgery should be offered as well as the sentinel node technique. Axillary lymph node dissection is not necessary...
populations of patients with HIV infection that a causal relationship is difficult to exclude. These cancers are associated with declining immune function and are considered to be ... the chemotherapy or radiotherapy is strongly associated with response rates. ... organ dysfunction such as hepatitis, renal failure and respiratory ...
Iachina, M; Brønserud, M M; Jakobsen, E
. To estimate the effect of depression on the diagnostic process and the choice of treatment in lung cancer we fitted a logistic regression model and a Cox regression model adjusting for age, gender, resection and stage. RESULTS: Depression in a patient's anamnesis had no significant effect on the delay...
Brouwers, Barbara; Dalmasso, Bruna; Hatse, Sigrid; Laenen, Annouschka; Kenis, Cindy; Swerts, Evalien; Neven, Patrick; Smeets, Ann; Schöffski, Patrick; Wildiers, Hans
Older cancer patients are a highly heterogeneous population in terms of global health and physiological reserves, and it is often difficult to determine the best treatment. Moreover, clinical tools currently used to assess global health require dedicated time and lack a standardized end score. Circulating markers of biological age and/or fitness could complement or partially substitute the existing screening tools. In this study we explored the relationship of potential ageing/frailty biomarkers with age and clinical frailty. On a population of 82 young and 162 older non-metastatic breast cancer patients, we measured mean leukocyte telomere length and plasma levels of interleukin-6 (IL-6), regulated upon activation, normal T cell expressed and secreted (RANTES), monocyte chemotactic protein 1 (MCP-1), insulin-like growth factor 1 (IGF-1). We also developed a new tool to summarize clinical frailty, designated Leuven Oncogeriatric Frailty Score (LOFS), by integrating GA results in a single, semi-continuous score. LOFS' median score was 8, on a scale from 0=frail to 10=fit. IL-6 levels were associated with chronological age in both groups and with clinical frailty in older breast cancer patients, whereas telomere length, IGF-1 and MCP-1 only correlated with age. Plasma IL-6 should be further explored as frailty biomarker in cancer patients.
Methadone is commonly used in the treatment of heroin addiction. Patients with a history of opioid misuse or on methadone maintenance therapy (MMT) with cancer often have difficult to manage pain. We studied 12 patients referred to the palliative care service with cancer pain who were on MMT. All had difficult to control pain, and a third required 5 or more analgesic agents. Two patients had documented \\'\\'drug-seeking\\'\\' behavior. Methadone was used subcutaneously as an analgesic agent in 1 patient. We explore why patients on MMT have difficult to manage pain, the optimal management of their pain, and the increasing role of methadone as an analgesic agent in cancer pain.
Kuriyama, Hiroko; Shigemori, Ichiro; Watanabe, Satoko; Aihara, Yuka; Kita, Masakazu; Sawai, Kiyoshi; Nakajima, Hiroo; Yoshida, Noriko; Kunisawa, Masahiro; Kawase, Masanori; Fukui, Kenji
We examined how aromatherapy massage influenced psychologic and immunologic parameters in 12 breast cancer patients in an open semi-comparative trial. We compared the results 1 month before aromatherapy massage as a waiting control period with those during aromatherapy massage treatment and 1 month after the completion of aromatherapy sessions. The patients received a 30 min aromatherapy massage twice a week for 4 weeks (eight times in total). The results showed that anxiety was reduced in one 30 min aromatherapy massage in State-Trait Anxiety Inventory (STAI) test and also reduced in eight sequential aromatherapy massage sessions in the Hospital Anxiety and Depression Scale (HADS) test. Our results further suggested that aromatherapy massage ameliorated the immunologic state. Further investigations are required to confirm the anxiolytic effect of aromatherapy in breast cancer patients. PMID:18955225
Knutsen, L.; Quist, M; Midtgaard, J
BACKGROUND: Over the past few years there has been a growing interest in the field of physical exercise in rehabilitation of cancer patients, leading to requirements for objective maximum physical capacity measurement (maximum oxygen uptake (VO(2max)) and one-repetition maximum (1RM)) to determin...... early in the treatment process. However, the patients were self-referred and thus highly motivated and as such are not necessarily representative of the whole population of cancer patients treated with chemotherapy....... in performing maximum physical capacity tests as these motivated them through self-perceived competitiveness and set a standard that served to encourage peak performance. CONCLUSION: The positive attitudes in this sample towards maximum physical capacity open the possibility of introducing physical testing...
Full Text Available We examined how aromatherapy massage influenced psychologic and immunologic parameters in 12 breast cancer patients in an open semi-comparative trial. We compared the results 1 month before aromatherapy massage as a waiting control period with those during aromatherapy massage treatment and 1 month after the completion of aromatherapy sessions. The patients received a 30 min aromatherapy massage twice a week for 4 weeks (eight times in total. The results showed that anxiety was reduced in one 30 min aromatherapy massage in State-Trait Anxiety Inventory (STAI test and also reduced in eight sequential aromatherapy massage sessions in the Hospital Anxiety and Depression Scale (HADS test. Our results further suggested that aromatherapy massage ameliorated the immunologic state. Further investigations are required to confirm the anxiolytic effect of aromatherapy in breast cancer patients.
Echteld, M.A.; Passchier, J.; Teunissen, S.; Claessen, S.; Wit, R. de; Rijt, C.C.D. van der
Although fatigue is a multidimensional concept, multidimensional fatigue is rarely investigated in hospitalised cancer patients. We determined the levels and correlates of multidimensional fatigue in 100 advanced cancer patients admitted for symptom control. Fatigue dimensions were general fatigue
David P. Kodack
Full Text Available Personalized cancer therapy is based on a patient’s tumor lineage, histopathology, expression analyses, and/or tumor DNA or RNA analysis. Here, we aim to develop an in vitro functional assay of a patient’s living cancer cells that could complement these approaches. We present methods for developing cell cultures from tumor biopsies and identify the types of samples and culture conditions associated with higher efficiency of model establishment. Toward the application of patient-derived cell cultures for personalized care, we established an immunofluorescence-based functional assay that quantifies cancer cell responses to targeted therapy in mixed cell cultures. Assaying patient-derived lung cancer cultures with this method showed promise in modeling patient response for diagnostic use. This platform should allow for the development of co-clinical trial studies to prospectively test the value of drug profiling on tumor-biopsy-derived cultures to direct patient care.
Duggleby, Wendy; Ghosh, Sunita; Cooper, Dan; Dwernychuk, Lynne
Hope is important to cancer patients as it helps them deal with their diagnosis. Little is known about hope in newly diagnosed cancer patients. Based on the Transcending Possibilities conceptual model of hope, the purpose of this study was to examine the relationship of hope with pain, energy, and psychological and demographic characteristics in newly diagnosed adult oncology outpatients. Data from 310 New Patient Assessment Forms from cancer outpatients' health records were collected. Health records from the first six months of 2009 were reviewed and data were collected on hope, energy, pain, depression, anxiety, feeling overwhelmed, and demographic variables. A generalized linear modeling approach was used to study the relationship of hope scores with these variables. Hypothesized variables and variables that were significant at the P = 0.01 level from the univariate analysis were entered into the multivariate model, with hope scores as the dependent variable. Hope scores were significantly negatively related to age (P = 0.02). More specifically, oncology patients who were 65 years of age or older had significantly less hope than those under the age of 65 years (P = 0.01). Gender (P = 0.009) also was a significant factor, with men having higher hope scores than women. No other variables were significant. Older adults comprise the majority of persons in Canada with cancer. The lower hope scores found in this age group compared with their younger counterparts underscore the importance of further research. This study provides a foundation for future research in this important area for oncology patients. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Tatsiy, Vasyl; Gutorova, Nataliya; Pashkov, Vitalii
Introduction: In accordance with Resolution on Cancer Control WHA58.22 Cancer prevention and control The Fifty-eighth World Health Assembly it is obvious technology for diagnosis and treatment of cancer is mature, and that many cases of cancer may be cured, especially if detected earlier Some key points on concept of legal regulation of abovementioned sphere is a base of this study. However, the problems of using an effective mechanism for protecting the rights of patients in certain types of disease, in particular cancer patients, by providing early diagnosis, are not fully developed by medical law specialists. The aim of the article is to determine the means of ensuring the right to health and life of cancer patients in particular through early diagnosis. Material and Methods: This study is based on regulation acts, World health report (2013), The Fifty-eighth World Health Assembly, WHA58.22 Cancer prevention and control, Universal Declaration of Human Rights, International Covenant on Civil and Political Rights, International Covenant on Economic, Social and Cultural Rights, European Convention for the Protection of Human Rights and Fundamental Freedoms, Charter of Fundamental Rights of the European Union, research papers and views of progressive-minded people in this sphere. Article is grounded on dialectical, comparative, analytic, synthetic and comprehensive research methods. Review: Most countries have declared a compliance of their national legislation with international standards regarding the right to life and health. The analysis of the abovementioned international acts in context of protection of the rights of patients with cancer leads to the conclusion that countries that have undertaken international legal obligations to protect the right to life are required to take the necessary measures to ensure the effective treatment of cancer patients. Taking into account that the lack of such treatment due to the specificity of the disease entails the death
Zhang, Liyan; Lu, Yuhan; Fang, Yu
The scored Patient-Generated Subjective Global Assessment (PG-SGA) is considered to be the most appropriate tool for detecting malnutrition in cancer patients. In particular, malignant tumours derived from the gastrointestinal tract may impair nutrient intake and absorption and cause malnutrition. We carried out a cross-sectional study to assess the nutritional status and related factors of patients with gastrointestinal cancer. Nutritional status was determined using the scored PG-SGA in patients (n 498) with advanced gastrointestinal cancer admitted to the Gastrointestinal Medical Oncology Unit at Beijing Cancer Hospital between 1 August 2012 and 28 February 2013. The possible related factors including age, sex, hospitalisation frequency and pathology were explored. We found that 98% of the patients required nutrition intervention and 54% of the patients required improved nutrition-related symptom management and/or urgent nutritional support (PG-SGA score ≥9). Factors related to malnutrition were age (r 0.103, Pcancer had a lower risk of malnutrition than patients with other types of gastrointestinal cancer (F=35.895, Pnutritional status of gastrointestinal patients, especially those at a higher risk of malnutrition, such as elderly patients, those hospitalised for the first time, male patients and those with other types of gastrointestinal cancer except rectal cancer. The nutritional status of these patients should be evaluated and they should be given proper nutrition education and nutritional support in a timely manner.
Full Text Available Objective: In oncology practice, nutrition and also metabolic activity are essential to support the nutritional status and prevent malignant cachexia. It is important to evaluate the patients and plan the maneuvers at the start of the therapy. The primary objective of the study is to define the nutritional status of hospitalized patients and the factors affecting it in order to define the most susceptible patients and maneuvers for better nutritional support. Methods: Patients hospitalized in oncology clinic for therapy were evaluated for food intake and nutritional status through structured interviews. The clinical properties, medical therapies, elements of nutritional support were noted and predictors of inadequate nutritional status (INS were analyzed. Results: Four hundred twenty three patients, between 16-82 years old (median: 52 were evaluated. Nearly half of the patients (185, 43% reported a better appetite at home than in hospital and declared that hospitalization is an important cause of loss of appetite (140/185, 75.6%. Presence of nausea/vomiting (N/V, depression, age less than 65 and use of non-steroidal anti-inflammatory drugs (NSAIDs were associated with increased risk of INS in hospitalized cancer patients. On the contrary, steroid medication showed a positive impact on nutritional status of cancer patients. Conclusion: N/V, younger age, presence of depression and NSAIDs medication were associated with INS in hospitalized cancer patients. Clinicians should pay more attention to this group of patients. In addition, unnecessary hospitalizations and medications that may disturb oral intake must be avoided. Corticosteroids are important tools for managing anorexia and INS.
Butt, T.; Afzal, R.K.; Ahmad, R.N.; Hussain, I.; Anwar, M.
Objective: To determine the frequency of central venous catheter-related bloodstream infections (CR-BSI) in cancer patients and the antimicrobial susceptibility pattern of the isolates. Subjects and Methods: Cancer patients requiring short or long-term central venous catheterization at the time of admission or thereafter were included. Catheter tips on removal were cultured quantitatively; specimens of blood and pus were cultured qualitatively. Isolates were identified and antimicrobial susceptibility testing was performed by standard techniques. Results: Eighty-nine patients were included in the study. The frequency of CR-BSI was 17%. Out of the 19 organisms isolated, 10 (53%) were Gram-positive cocci, 8 (42%) were Gram-negative rods and 1 (5%) was a fungus. Coagulase negative staphylococci (27%) were the predominant pathogens. Among the staphylococci, 46% of the isolates were methicillin-resistant. All Gram-positive isolates were susceptive to glycopeptides. Gram-negative rods were resistant to most of the commonly used antimicrobial groups. Conclusion: Central venous catheter is an important source of bloodstream infections in cancer patients. Most of the infections are caused by Gram-positive cocci. Rigorous infection control measures and continuous surveillance is required to curb the frequency of these infections. (author)
A. O. Rasulov
Full Text Available Objective: explore the use of enhanced recovery after surgery (ERAS in the treatment of patients with colorectal cancer, evaluate its efficacy and safety.Materials and methods. Prospective, single-site, randomized study for the implementation of enhanced recovery after surgery in patients with colorectal cancer has been conducted from October 2014 till the present time. All patients after laparoscopic surgeries undergo treatment according to ERAS protocol, patients after open surgeries are randomized (1:1 in groups of the standard treatment or treatment according to ERAS protocol. The study included patients with localized and locally disseminated colorectal cancer aged from 18 to 75 years, ECOG score ≤ 2. The primary evaluated parameters were the following: the number of postoperative complications (according to Clavien– Dindo classification, postoperative hospital days, incidence of complications and mortality in the 30-day period, timing of activation.Results. Up to date, the study includes 105 patients: laparoscopic group – 51 patients, open-surgery group of patients treated by ERAS protocol – 27 patients, open-surgery group of patients with the standard post-op treatment – 26 patients. Complications requiring emergency surgery for anastomotic leak (p = 0.159 developed in 3.7 % of patients with the standard post-op treatment and in 3.9 % of patients after laparoscopic surgery, while 1 patient required repeat hospitalization. The total number of complications was significantly lower in opensurgery group of patients treated by ERAS protocol compared with the standard post-op treatment (p = 0.021. However, there were no differences between laparoscopic and open-surgery group with the standard post-op treatment (p = 0.159. An average hospitalization stay in patients with the standard post-op treatment was equal to 10 days compared to 7 days in patients treated by ERAS protocol (p = 0.067 and 6 days after laparoscopic
Wagholikar, Amol S; Fung, Maggie; Nelson, Colleen C
Effective management of chronic diseases is a global health priority. A healthcare information system offers opportunities to address challenges of chronic disease management. However, the requirements of health information systems are often not well understood. The accuracy of requirements has a direct impact on the successful design and implementation of a health information system. Our research describes methods used to understand the requirements of health information systems for advanced prostate cancer management. The research conducted a survey to identify heterogeneous sources of clinical records. Our research showed that the General Practitioner was the common source of patient's clinical records (41%) followed by the Urologist (14%) and other clinicians (14%). Our research describes a method to identify diverse data sources and proposes a novel patient journey browser prototype that integrates disparate data sources.
Jones, P H; Shakdher, S; Singh, P
Salient findings and interpretations from the canimpact clinical cancer research study are visually represented in two synthesis maps for the purpose of communicating an integrated presentation of the study to clinical cancer researchers and policymakers. Synthesis maps integrate evidence and expertise into a visual narrative for knowledge translation and communication. A clinical system synthesis map represents the current Canadian primary care and cancer practice systems, proposed as a visual knowledge translation from the mixed-methods canimpact study to inform Canadian clinical research, policy, and practice discourses. Two synthesis maps, drawn together from multiple canimpact investigations and sources, were required to articulate critical differences between the clinical system and patient perspectives. The synthesis map of Canada-wide clinical cancer systems illustrates the relationships between primary care and the full cancer continuum. A patient-centred map was developed to represent the cancer (and primary care) journeys as experienced by breast and colorectal cancer patients.
Brunelli, Cinzia; Bennett, Michael I; Kaasa, Stein
and on the relevance of patient-reported outcome (PRO) descriptors for the screening of NP in this population. An international group of 42 experts was invited to participate in a consensus process through a modified 2-round Internet-based Delphi survey. Relevant topics investigated were: peculiarities of NP...... in patients with cancer, IASP NeuPSIG diagnostic criteria adaptation and assessment, and standardized PRO assessment for NP screening. Median consensus scores (MED) and interquartile ranges (IQR) were calculated to measure expert consensus after both rounds. Twenty-nine experts answered, and good agreement...... was proposed. Clinical research on PRO in the screening phase and on the application of the algorithm will be needed to examine their effectiveness in classifying NP in cancer patients....
Full Text Available In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia.
Full Text Available Nicole Kiss1,2 1Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; 2Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia Abstract: Malnutrition and weight loss are prevalent in patients with lung cancer. The impact of malnutrition on patients with cancer, and specifically in patients with lung cancer, has been demonstrated in a large number of studies. Malnutrition has been shown to negatively affect treatment completion, survival, quality of life, physical function, and health care costs. Emerging evidence is providing some insight into which lung cancer patients are at higher nutritional risk. In lung cancer patients treated with radiotherapy, stage III or more disease, treatment with concurrent chemotherapy and the extent of radiotherapy delivered to the esophagus appear to confer a higher risk of weight loss during and post-treatment. Studies investigating nutrition interventions for lung cancer patients have examined intensive dietary counseling, supplementation with fish oils, and interdisciplinary models of nutrition and exercise interventions and show promise for improved outcomes from these interventions. However, further research utilizing these interventions in large clinical trials is required to definitively establish effective interventions in this patient group. Keywords: lung cancer, nutrition, malnutrition
This patent describes an apparatus for irradiating a patient comprising: a source of a radiation beam directed along a radiation axis; means mounting the source for pivotal movement about a first horizontal axis which intersects the source, is stationary with respect to the apparatus, and extends in a direction substantially normal to the radiation axis, whereby the beam is capable of an angular scan in a vertical plane; table means adapted to support a patient to be irradiated; and suspension means mounted the table means for arcuate movement to any positions angularly spaced about the first horizontal axis and for pivoting movement about a second horizontal axis displacement from and substantially parallel to the first horizontal axis. The suspension means maintain the second horizontal axis in substantially intersecting relation to the radiation axis in each of the positions while maintaining a fixed angular position of the table means with respect to the environment
Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye
Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...
Hong, Youngki; Nam, Soomin; Kang, Jung Gu
The aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate. This retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes. Twenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8-39 days). Intraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.
Handberg, Charlotte; Lomborg, Kirsten; Nielsen, Claus Vinther
The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors...
Rodriguez, Elizabeth S
To review patient portals which serve as a tool for patient engagement by increasing access to electronic health care information and expanding ways to communicate with health care providers. Reviews of the literature and first-hand experience. Meaningful Use requirements propelled the design and development of patient portals in recent years. Patient engagement in oncology can improve quality of life and outcomes. Oncology nurses facilitate patient adoption of patient portals and support usage. Patient education helps manage communication expectations and understanding of online medical information. Copyright © 2018 Elsevier Inc. All rights reserved.
Lopes, Joana Pedro; de Castro Cardoso Pereira, Paula Manuela; dos Reis Baltazar Vicente, Ana Filipa; Bernardo, Alexandra; de Mesquita, María Fernanda
The present study intended to evaluate the nutritional status of Portuguese colorectal patients and associated it with surgery type as well as quality of life outcomes. Malnutrition can affect up to 85% of cancer patients and specifically 30-60% in colorectal cancer and can significantly influence health outcomes. A sample of 50 colorectal cancer patients was evaluated in what refers to several anthropometric measures, food intake, clinical history, complications rate before and after surgery procedure. The sample was divided between convention and fast-track procedures. Most of the individuals were overweight or obese but had lost weight on the past six months. Despite mild, there were signs of malnutrition in this sample with high losses of fat free mass, weight and also fat mass during the hospitalization period. These results reinforce the importance of malnutrition assessment in colorectal patients as well as consider weight loss on the past months and body composition in order to complement nutritional status evaluation. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.
Osagiede, Osayande; Colibaseanu, Dorin T; Spaulding, Aaron C; Frank, Ryan D; Merchea, Amit; Kelley, Scott R; Uitti, Ryan J; Ailawadhi, Sikander
Palliative care has been increasingly recognized as an important part of cancer care but remains underutilized in patients with solid cancers. There is a current gap in knowledge regarding why palliative care is underutilized nationwide. To identify the factors associated with palliative care use among deceased patients with solid cancer tumors. Using the 2016 National Cancer Data Base, we identified deceased patients (2004-2013) with breast, colon, lung, melanoma, and prostate cancer. Data were described as percentages. Associations between palliative care use and patient, facility, and geographic characteristics were evaluated through multivariate logistic regression. A total of 1 840 111 patients were analyzed; 9.6% received palliative care. Palliative care use was higher in the following patient groups: survival >24 months (17% vs 2%), male (54% vs 46%), higher Charlson-Deyo comorbidity score (16% vs 8%), treatment at designated cancer programs (74% vs 71%), lung cancer (76% vs 28%), higher grade cancer (53% vs 24%), and stage IV cancer (59% vs 13%). Patients who lived in communities with a greater percentage of high school degrees had higher odds of receiving palliative care; Central and Pacific regions of the United States had lower odds of palliative care use than the East Coast. Patients with colon, melanoma, or prostate cancer had lower odds of palliative care than patients with breast cancer, whereas those with lung cancer had higher odds. Palliative care use in solid cancer tumors is variable, with a preference for patients with lung cancer, younger age, known insurance status, and higher educational level.
Pang, J; Assaad, D; Breen, D; Fialkov, J; Antonyshyn, O; Balogh, J; Tsao, M; Kamra, J; Czarnota, G; Barnes, E A
Extramammary Paget disease (EMPD) is a rare skin disease commonly found in the anogenital region. In this study, we aimed to identify EMPD patients seen in the non-melanoma skin cancer clinic at Odette Cancer Centre and to describe the treatments delivered and outcomes achieved. From 2000 to 2009, 14 patients were seen. Initial treatment recommendations included imiquimod and surgical excision, although half the patients required more than one treatment modality, highlighting the difficulty of achieving complete eradication of this disease.
Moghadamyeghaneh, Zhobin; Hanna, Mark H; Hwang, Grace; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J; Carmichael, Joseph C
Patients with advanced colorectal cancer have a high incidence of postoperative complications. We sought to identify outcomes of patients who underwent resection for colon cancer by cancer stage. The National Surgical Quality Improvement Program database was used to evaluate all patients who underwent colon resection with a diagnosis of colon cancer from 2012 to 2014. Multivariate logistic regression analysis was performed to investigate patient outcomes by cancer stage. A total of 7,786 colon cancer patients who underwent colon resection were identified. Of these, 10.8% had metastasis at the time of operation. Patients with metastatic disease had significantly increased risks of perioperative morbidity (adjusted odds ratio [AOR]: 1.44, P = .01) and mortality (AOR: 3.72, P = .01). Patients with metastatic disease were significantly younger (AOR: .99, P colon cancer have metastatic disease. Postoperative morbidity and mortality are significantly higher than in patients with localized disease. Published by Elsevier Inc.
Radiotherapy to treat cancer was given for the first time exactly one hundred years ago. Today, radiotherapy and surgery are the two main modes of treating cancer. One in two cancer patients receives radiotherapy at some point during the course of treatment for the disease. Radiotherapy is applied most commonly in cases where surgery is not possible. Moreover, these two modes of treatment are often used together to supplement each other. About half of new cancer cases detected today can be ordered. The estimate given by the EU for cancers cured is 45 per cent, which is divided between the various treatment modes as follows: surgery 22 %, radiotherapy 12 %, surgery plus radiotherapy 6 %, and drug therapy 6 %. In addition to curative treatment, radiotherapy plays a crucial role in palliative treatment, i.e. treatment that alleviates symptoms. The sensitivity of malignant tumours to radiotherapy varies over a wide range; the same is true for healthy tissues. Radiotherapy can only be used to cure a tumour that is more sensitive to radiation than the surrounding healthy tissue. The tumour must also be sufficiently small in size and limited to a relatively small area. (orig.)
Wallace, S.; Charnsangavej, C.
The contributions of the interventional radiologist in the diagnosis and management of the cancer patient include angiography and intraarterial CT-angiography, intraarterial infusion therapy, embolization, chemoembolization, biopsy and drainage procedures, central venous catheter reposition and retrieval, and stent dilation of stenotic tubular structures in the following organ systems: (1) Kidney. Arterial embolization, therapeutic delay, enphrectomy, and medroxyprogesterone yield a response rate of 28% in patients with renal cell carcinoma and pulmonary parenchymal metastases. (2) Liver. The carcinoid syndrome secondary to hepatic metastases can be controlled by embolization in 87% of patients. Islet cell carcinoma of the pancreas with hepatic metastases is successfully managed in 75% of patients. Chemoembolization (Ivalon and cisplatin) has been effective in 60% of patients with hepatic metastases from ocular melanoma. (3) Bone. A 73% 3-year survival rate is now possible with the inraarterial infusion of cisplatin, while Adriamycin is given intravenously in patients with osteosarcoma. Limb salvage is now possible in 80% of cases. Cancers of the vulva, vagina, urethra, and penis have been successfully treated with intraarterial infusion of chemotherapy followed by radiation therapy. (5) An expansile metallic stent is available to alleviate obstructions of the vena cava, the aorta and its major branches, the tracheobronchial tree, and the common duct. These techniques are demonstrated and results discussed
Shadiya Mohamed Saleh Baqutayan
Cancer is a disease wherein abnormal cells divide without control and are able to attack other tissues. Most of the patients and their families face some degree of depression, anxiety, and fear when cancer becomes a part of their lives. They feel helpless and eager to find ways on how to get rid of it. The study focuses on anxiety among breast cancer patients. It aims at investigating cancer, its symptoms, and effects the disease has on the anxiety level of patients.
Full Text Available Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or “bomoh” at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1 recommendation from family and friends, (2 sanction from family, (3 perceived benefit and compatibility, (4 healer credibility, and (5 reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities.
Muhamad, M.; Merriam, Sh.; Merriam, Sh.; Suhami, N.
Traditional healing is a common practice in low and middle income countries such as Malaysia. Eighty percent of Malaysians consult traditional healers or bomoh at some time in their life for health-related issues. The purpose of our study was to explore why breast cancer patients visit traditional healers. This is a qualitative study utilizing in-depth interviews with 11 cancer survivors who sought both traditional and Western medicine. The findings revealed the following reasons for which patients seek traditional healers: (1) recommendation from family and friends, (2) sanction from family, (3) perceived benefit and compatibility, (4) healer credibility, and (5) reservation with Western medicine and system delay. These factors work together and are strongly influenced by the Malaysian cultural context. The issue with the Western health system is common in a developing country with limited health facilities
van der Meer, Dania M; Weiland, Tracey J; Philip, Jennifer; Jelinek, George A; Boughey, Mark; Knott, Jonathan; Marck, Claudia H; Weil, Jennifer L; Lane, Heather P; Dowling, Anthony J; Kelly, Anne-Maree
People with cancer attend emergency departments (EDs) for many reasons. Improved understanding of the specific needs of these patients may assist in optimizing health service delivery. ED presentation and hospital utilization characteristics were explored for people with cancer and compared with those patients without cancer. This descriptive, retrospective, multicentre cohort study used hospital administrative data. Descriptive and inferential statistics were used to summarise and compare ED presentation characteristics amongst cancer and non-cancer groups. Predictive analyses were used to identify ED presentation features predictive of hospital admission for cancer patients. Outcomes of interest were level of acuity, ED and inpatient length of stay, re-presentation rates and admission rates amongst cancer patients and non-cancer patients. ED (529,377) presentations occurred over the 36 months, of which 2.4% (n = 12,489) were cancer-related. Compared with all other attendances, cancer-related attendances had a higher level of acuity, requiring longer management time and length of stay in ED. Re-presentation rates for people with cancer were nearly double those of others (64 vs 33%, p < 0.001), with twice the rate of hospital admission (90 vs 46%, p < 0.001), longer inpatient length of stay (5.6 vs 2.8 days, p < 0.001) and had higher inpatient mortality (7.9 vs 1.0%, p < 0.001). Acuity and arriving by ambulance were significant predictors of hospital admission, with cancer-related attendances having ten times the odds of admission compared to other attendances (OR = 10.4, 95% CI 9.8-11.1). ED presentations by people with cancer represent a more urgent, complex caseload frequently requiring hospital admission when compared to other presentations, suggesting that for optimal cancer care, close collaboration and integration of oncology, palliative care and emergency medicine providers are needed to improve pathways of care.
Klausen, O.G.; Olofsson, J.; Rosengren, B.
Radiotherapeutical resources in Norway are inadequate, which was further verified in this retrospective study of 73 patients with cancer of head and neck. The average duration of symptoms before the first ear-nose-throat examination was 153 days, and it took about 10 days after the examination to get the diagnosis. An unacceptably long time (mean 30 days) elapsed between the decision on therapy until the radiotherapy was initiated. There is no doubt that radiotherapy departments in Norway need better resources
Dellson, Pia; Nilbert, Mef; Carlsson, Christina
Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I-III trials, randomized and non-randomized trials that evaluated chemotherapy/targeted therapy in the neoadjuvant, adjuvant and palliative settings. Data were collected through focus groups and were analysed using inductive content analysis. Two major themes emerged: emotional responses and cognitive responses. Subthemes related to the former included individual preferences and perceptions of effect, while subthemes related to the latter were comprehensibility and layout. Based on these observations the patient representatives provided suggestions for improvement, which largely included development of future simplified and more attractive informed consent forms. The emotional and cognitive responses to written patient information reported by patient representatives provides a basis for revised formats in future trials and add to the body of information that support use of plain language, structured text and illustrations to improve the informed consent process and thereby patient enrolment into clinical trials.
Morimoto, Masahiro; Nishiyama, Kinji; Nakamura, Satoaki
The efficacy of endoscopic screening for esophageal cancer in patients with hypopharyngeal cancer remains controversial and its impact on prognosis has not been adequately discussed. We studied the use of endoscopic screening to detect esophageal cancer in hypopharyngeal cancer patients by analyzing the incidence, stage and prognosis. We included 64 patients with hypopharyngeal cancer who received radical radiotherapy at our institute. Chromoendoscopic esophageal examinations with Lugol dye solution were routinely performed at and after treatment for hypopharyngeal cancer. Twenty-eight esophageal cancers were detected in 28 (41%) patients (18 synchronous and 10 metachronous cancers). Of the 28 cancers, 23 were stage 0 or I cancer and 15 of these were treated with endoscopic resection. Local control was achieved in all of these 23 stage 0 or I cancers. The 5-year overall survival rates with esophageal cancer were 83% in stage 0, 47% in stage I and 0% in stage IIA-IVB. This study showed a strikingly high incidence of esophageal cancer in hypopharyngeal cancer patients. We suppose that the combination of early detection by chromoendoscopic examination and endoscopic resection for associated esophageal cancer in hypopharyngeal cancer patients improve prognosis and maintain quality of life. (author)
Dzebo, Senada; Mahmutovic, Jasmina; Erkocevic, Hasiba
In recent years the quality of life of patients is very important in monitoring the treatment and therapeutic procedure success. It has become a significant factor in assessing the therapeutic procedure accomplishment, and for the first time the patient alone can access the success of the respective therapy. Cancer of the oral cavity is one of the most common cancers of the head and neck, and is one of the ten most common causes of death in the world. In the majority of cases, cancer of the oral cavity is detected in an advanced stage when therapeutic options are reduced, and the prognosis is much worse. Cancer of the oral cavity is 10 times more common in men. Assessment of quality of life should be an indicator of the multidisciplinary treatment success and it should point to areas in which the affected person requires support. To examine the quality of life of patients with oral cavity cancer. The study was conducted at the Clinic of Maxillofacial Surgery of the Clinical Center University of Sarajevo (CCUS), through a survey on patients with verified oral cavity cancer, questionnaire related to socio-demographic characteristics of the patients and the University of Washington Quality of Life Questionnaire (UW-QOL). The results were included in the database and statistically processed in the SPSS program, 19.0 version for Windows. Afterwards, the results were thoroughly analyzed and documented, presented in absolute numbers and statistical values using statistical indicators in simple and understandable tables and figures. The study results showed that out of the total score of 100, the median value of quality of life of patients with oral cavity cancer, for the physical health component in the definition of quality was M=69.75 ±29.12 and for social-emotional health M=65.11 ± 27.47. This could be considered as satisfactory quality of life, in the sphere above half of the rating scale, although both values significantly deviate from the UW-QOL scale norm
Fu, Yun; Zhuang, Zhigang; Dewing, Michelle; Apple, Sophia; Chang, Helena
Background: In recent years, radical breast cancer surgery has been largely replaced by breast conservation treatment, due to early diagnosis and more effective adjuvant treatment. While breast conservation is mostly preferred, the trend of bilateral mastectomy has risen in the United States. The aim of this study is to determine factors influencing patients’ choice for having contralateral prophylactic mastectomy (CPM). Methods: This is a retrospective study of 373 patients diagnosed with primary invasive breast cancer who were treated by bilateral or unilateral mastectomy (BM or UM) at the Revlon/UCLA Breast Center between Jan. 2002 and Dec. 2010. In the BM group, only those with unilateral breast cancer who chose CPM were included in the analysis. Results: When compared with the UM group, the following factors were found to be associated with BM: younger age, pre-menopausal, a family history of breast/ovarian cancer, BRCA mutation, more breast biopsies, history of breast augmentation, having MRI study within 6 months before the surgery, more likely to have reconstruction and sentinel lymph node biopsy (SLNB) and fewer had neoadjuvant/adjuvant chemotherapy/radiation. When patients with bilateral breast cancer were excluded, multivariate logistic regression analysis indicated younger patients with negative nodes, SLNB as the only nodal surgery and positive family history were significant factors predicting CPM and immediate reconstruction using tissue expanders or implants. Conclusion: Younger age, lower TN stage, requiring only SLNB and high risk family history predict contralateral prophylactic mastectomy. Tissue expander/implant-based reconstructions were more frequently chosen by patients with BM. PMID:26097557
One of the most common cancer in females is breasts cancer. This cancer can has high impact on the women including health and social dimensions. One of the most common social dimension is depression caused by breast cancer. Depression can impairs life quality. Depression is one of the symptom among the breast cancer patients. One of the solution is to eliminate the depression in breast cancer patients is by treatments but these treatments can has different unpredictable impacts on the patients. Therefore it is suitable to develop algorithm in order to predict the depression range.
Invasive fungal infections are important causes of morbidity and mortality in cancer patients with prolonged neutropenia following chemotherapy. Recent trends indicate a change toward infections by Aspergillus species, non-albicans species of Candida, and previously uncommon fungal pathogens. These have decreased susceptibility to current antifungal agents. In the last decade there has been much effort to find solutions for these changing trends. This article reviews current approaches to prevention and treatment of opportunistic fungal infections in postchemotherapy neutropenic patients and discussion future antifungal approaches and supportive methods. (author)
Aguero, M.; Gauna, C.; Pereira, R.
Objective: To demonstrate the profile that comes to query the patient with cancer Lung in Paraguay, as well as therapeutic limitations found in stadiums advanced. Material and Methods: A retrospective analysis of medical records of patients who consulted was held at the Institute of Cancer in 2008. Inclusion criteria: patients with histologically confirmed attending their first consultation in the period from January 2008 to December 2008. Data Collection: sex, age, origin, occupation, toxic habits, reason was analyzed consultation, ECOG, histology, stage and treatment performed. Results: Of 59 patients studied there is a predominance of males (83%) from mostly in rural areas. The average age is 61 years. Of risk factors (Snuff, environmental exposure) 100% of women do not have such and only 2.3% of men; It is more frequent association of the two factors cited. Dyspne a (44%) is The most common symptom, followed by pain (20.3%), Cough / hemoptysis (17%) and finally headache (6.7%). The histological prevalence is a non-small cell cancer (98.3%) and among the Adenocarcinoma heads the frequency (56.8%), Squamous Cell Carcinoma (24.1%) and carcinoma differentiated ((19.1%), there is only one record of a Oat Cell Carcinoma. The stadium's presentation common is the Est. IV (44%) being the most frequent sites Liver metastases (26.7%) and Brain (23%) come in relatively general condition, mostly with ECOG 2 (30.5%) .. In As for treatment: one patient was performing a partial lobectomy operable; They performed chemotherapy or radiotherapy alone 24.5% and 16.9% respectively, the combination of both 10% and made no treatment, rejected or made exclusive palliative care 46% of the sample. Of 25 patients who received chemotherapy and 92% received 1st line Paclitaxel + Carboplatin and of them only 16% showed greater than 50% response. Only 6 patients performed 2nd line with Gemzitabina + cisplatin; and only one patient performed The 3rd line (Vinorelbine + Gemzitabina) and 4
Moule, Pam; Pollard, Katherine; Armoogum, Julie; Messer, Simon
The number of men diagnosed with prostate cancer is increasing and internationally there are high incidence rates. It is important that nurses and healthcare professionals are enabled to provide appropriate care to those men affected by prostate cancer and their families. Despite this need, there is recognition that many professionals feel ill prepared and lack knowledge in a number of areas. This paper presents the development of a Virtual Patient (VP) online resource to support practitioner learning. To develop five online VP simulation scenarios to meet the learning needs of nurses and health-care professionals caring for men with prostate cancer. Topic areas for the VPs were taken from previous work exploring the needs of health care professionals working with men with prostate cancer. An initial scoping exercise involving nursing practitioners, students and a prostate cancer charity confirmed the focus of the case study scenarios. Service users and specialist practitioners reviewed an outline of each case study to ensure fidelity of the simulations scenarios. Cases were entered into UChoose, a web based interactive VP player and authoring tool. The final case studies were reviewed by a sample of both registered and non-registered nurses and nursing students. The majority of respondents reported an increase in knowledge and suggested that they would recommend the resource to others. A number of positive aspects of the resource were highlighted. Respondents also commented about areas of weakness, a number of which have been addressed subsequently. The VP case studies provided an opportunity to develop knowledge and confidence in caring for men with prostate cancer. The mode of delivery and the content was acceptable for less experienced and knowledgeable staff. Copyright © 2015 Elsevier Ltd. All rights reserved.
Brambatti, Michela; Mathew, Rebecca; Strang, Barbara; Dean, Joan; Goyal, Anuja; Hayward, Joseph E; Long, Laurene; DeMeis, Patty; Smoke, Marcia; Connolly, Stuart J; Morillo, Carlos A; Amit, Guy; Capucci, Alessandro; Healey, Jeff S
Radiation therapy (RT) may pose acute and long-term risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). However, the frequency of these problems has not been accurately defined. The purpose of this study was to determine the prevalence of CIEDs among patients requiring RT and report the common CIED-related problems when patients are managed according to a standard clinical care path. In a single tertiary-care center, we prospectively screened all patients requiring RT and identified patients with ICDs or PMs. We collected clinical data about their cancer, RT treatment plan, and CIED. Radiation dose to the device was estimated in all patients, and any device malfunction during RT was documented. Of the 34,706 consecutive patients receiving RT, 261 patients (0.8%, mean age 77.9 ± 9.4 years) had an implantable cardiac device: 54 (20.7%) ICDs and 207 (79.3%) PMs. The site of RT was head and neck (27.4%), chest (30.0%), and abdomen/pelvis (32.6%). Using our care path, 63.2% of patients required continuous cardiac monitoring, 14.6% required device reprogramming, 18.8% required magnet application during RT, and 3.4% required device repositioning to the contralateral side before RT. Four patients (1.5%) had inappropriate device function during RT: 3 experienced hemodynamically tolerated ventricular pacing at the maximum sensor rate, and 1 experienced a device power-on-reset. No patient died or suffered permanent device failure. Nearly 1% of patients receiving RT in this series has a PM or ICD. However, with a systematic policy of risk assessment and patient management, significant device-related complications are rare. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Ripamonti, C; Bruera, E
Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including a syringe pump, disposable plastic cylinder, and battery-operated computer-driven pump. These devices allow patients to choose an intermittent (demand) bolus, continuous infusion, or both modes of administration. Parameters, such as route, drug concentration dose, frequency, and maximum daily or hourly dose, are programmed by the physician. The patient decides whether or not to take a dose. Devices can be used to deliver the drug into a running intravenous infusion, the epidural space, or subcutaneously. Controlled trials indicate that PCA is probably superior to regular opioid administration in postoperative pain. Reported advantages include greater patient satisfaction, decreased sedation and anxiety, and reduced nursing time and hospitalization. Preliminary experience suggests that PCA is also useful and safe for cancer pain, but further research is greatly needed.
Violeta María Sastre-Lozano
Full Text Available Gastric involvement with the varicella-zoster virus is an uncommon clinical condition where early suspicion and diagnosis are important to prevent the consequences deriving from its high morbidity and mortality, which in immunocompromised patients oscillate between 9% and 41% according to the various series. Two cases of gastric involvement with the varicella-zoster virus (VZV in two patients with blood cancer are reported below. Gastric lesions are usually preceded by typical papulovesicular skin lesions. When gastric involvement is the first symptom of the disease its diagnosis and management may be delayed, which may entail severe consequences for immunocompromised patients. It is therefore that we suggest its inclusion in the algorithm for immunocompromised patients with abdominal pain and ulcer-like endoscopic lesions.
Smoking cessation in patients with cancer is accompanied by significant success, although this outcome is poorer compared with non-cancer smokers. Cancer patients must follow well-organized smoking cessation programs as soon as diagnosis is made, in order to have a successful and prolong smoking cessation.
Kamphuisen, Pieter W.; Beyer-Westendorf, Jan
Patients with cancer have an increased risk of bleeding complications, of which some are fatal. This risk is influenced by chemotherapy, cancer type and stage, thrombocytopenia, renal function, and previous bleeding. Since many cancer patients receive anticoagulant treatment for prophylaxis or
Factors affecting quality of life in cancer patients undergoing chemotherapy. ... Objective: The aim of this study was to evaluate the QoL in cancer patients with solid tumors and at the different chemotherapy cycles (CT). ... Results: A significant relationship between the cancer type, pain intensity, and fatigue was found.
Each symptom can contribute to ... and emotional side-effects experienced by cancer patients include stress, fear of ... the role of psychological factors in cancer survival and emphasises ... Current treatments for anxiety and depression in cancer patients ... evidence that physical activity and exercise have positive effects on.
Full Text Available Estrogen receptor α (ERα is the key transcriptional driver in a large proportion of breast cancers. We report that APOBEC3B (A3B is required for regulation of gene expression by ER and acts by causing C-to-U deamination at ER binding regions. We show that these C-to-U changes lead to the generation of DNA strand breaks through activation of base excision repair (BER and to repair by non-homologous end-joining (NHEJ pathways. We provide evidence that transient cytidine deamination by A3B aids chromatin modification and remodelling at the regulatory regions of ER target genes that promotes their expression. A3B expression is associated with poor patient survival in ER+ breast cancer, reinforcing the physiological significance of A3B for ER action.
Forty-seven percent of the cervical cancer patients were referred to Ocean Road Cancer Institute for radiotherapy and or chemotherapy. Patients discharged home for palliative care were 30% and 17% patients died at the hospital. Known HIV positive patients were significantly associated with death and terminal care seen ...
Roland N. Dickerson
Full Text Available Critically ill older patients with sarcopenia experience greater morbidity and mortality than younger patients. It is anticipated that unabated protein catabolism would be detrimental for the critically ill older patient. Healthy older subjects experience a diminished response to protein supplementation when compared to their younger counterparts, but this anabolic resistance can be overcome by increasing protein intake. Preliminary evidence suggests that older patients may respond differently to protein intake than younger patients during critical illness as well. If sufficient protein intake is given, older patients can achieve a similar nitrogen accretion response as younger patients even during critical illness. However, there is concern among some clinicians that increasing protein intake in older patients during critical illness may lead to azotemia due to decreased renal functional reserve which may augment the propensity towards worsened renal function and worsened clinical outcomes. Current evidence regarding protein requirements, nitrogen balance, ureagenesis, and clinical outcomes during nutritional therapy for critically ill older patients is reviewed.
Valdagni, Riccardo; Albers, Peter; Bangma, Chris; Drudge-Coates, Lawrence; Magnani, Tiziana; Moynihan, Clare; Parker, Chris; Redmond, Kathy; Sternberg, Cora N; Denis, Louis; Costa, Alberto
The widely recognised benefits of a multidisciplinary approach to treating cancer may be particularly important in prostate cancer, where there are so many treatment options to choose from. It offers patients the best chance of receiving high-quality medical procedures administered by a team of specialists in prostate disease, which is able to tailor treatment and observational strategies to their needs, and ensure access to specialist counselling, supportive care and rehabilitation. This article proposes Prostate Cancer Units as the most suitable structures for organising specialist multidisciplinary care for patients at all stages, from newly diagnosed to advanced disease, including preventing and managing the main complications, whether physical, emotional or psychological, arising from the disease and its treatment. Following the German example with prostate cancer, the British example with urological malignancies and the European breast cancer units, this article proposes general recommendations and mandatory requirements for Prostate Cancer Units, with a view to laying the basis for a network of certified units across Europe. Such a network could help improve standards of care throughout the region, providing patients, practitioners and health authorities with a means of identifying high-quality units and providing a system of quality control and audit. The article is intended as a contribution to the debate within the European uro-oncologic community on the best way to organise prostate cancer care. Copyright © 2010 Elsevier Ltd. All rights reserved.
Chan, Alexandre; Chiang, Yu Yan; Low, Xiu Hui; Yap, Kevin Yi-Lwern; Ng, Raymond
With the expected rise in newly diagnosed cancer cases among the elderly in Singapore, the affordability of cancer treatments, particularly of targeted therapies, will be a growing concern for patients. This study examines the perspectives of aging cancer patients on the financial burden of their cancer treatments. A single-center, prospective study was conducted in the largest ambulatory cancer center in Singapore. Older (50 years old and above) cancer patients receiving treatment were recruited. Patients completed three sets of self-reporting tools assessing their (a) demographics and lifestyles, (b) health-related quality of life, and (c) perceptions of cancer treatment costs. The association between targeted therapy utilities and their perceived financial burden was evaluated using a multivariable logistic regression. Five hundred and sixteen patients were included in the study. The majority of the respondents (69.6 %) were between 50 and 64 years old. The majority were Singaporeans (97.7 %), belonged to the ethnic Chinese group (88.4 %), and most were female (59.1 %). The users of targeted therapies were 2.92 times more likely to perceive that the amount of cash that they spent on cancer treatment was more than expected and 2.52 times more likely to have difficulty paying for cancer treatments. Fortunately, the majority of the respondents (70.6 %) found their existing financial schemes helpful in reducing the necessary out-of-pocket expenses. Although aging cancer patients feel that the financial schemes in Singapore have helped them tremendously, the general perception is that they require further help to offset their out-of-pocket expenses. This is especially true for users of targeted therapies and those who have a poorer health status.
A new phase I clinical trial conducted by researchers at the Center for Cancer Research (CCR) is evaluating the safety and tolerability, or the degree to which any side effects can be tolerated by patients, of a two-drug combination as a potential alternative to bladder removal for bladder cancer patients. The trial targets patients with non-muscle invasive bladder cancer (NMIBC) whose cancers have stopped responding to traditional therapies. Read more...
Yao Wanxia; Lin Miao; Lü Ye; Yang Biao; Yao Cong; Liu Juan; Wang Wenru
Objective To examine self-reported symptoms by the patients receiving cancer therapy, and find out the symptoms that should be coped with and managed during the treatment. Methods A pilot study was conducted on self-reported symptoms on 185 patients receiving chemotherapy and/or radiotherapy for different cancers. The Therapy-Related Symptoms Checklist (TRSC) was used. Results Severe symptoms on the TRSC subscales: loss of appetite,feeling sluggish, weight loss, nausea and hair loss, were reported by the patients. The frequently reported symptoms by those on chemotherapy were nausea, feeling sluggish, weight loss, vomiting, and taste change. The frequently reported symptoms by those on radiotherapy were feeling sluggish, weight loss, loss of appetite, difficult sleeping, and changing taste. The symptoms of loss of appetite, feeling sluggish, weight loss, hair loss, and nausea were both frequently reported by those on radiotherapy and those on chemotherapy. Conclusion Symptom monitoring may be facilitated by TRSC, based on the severity and frequency of reported symptoms, more patients and caregivers could know which symptoms should be preferential interventions.
Walsh, Linda [Federal Office for Radiation Protection, Department ' ' Radiation Protection and Health' ' , Oberschleissheim (Germany); University of Zurich, Medical Physics Group, Institute of Physics, Zurich (Switzerland); Zhang, Wei [Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Oxford (United Kingdom)
In the assessment of health risks after nuclear accidents, some health consequences require special attention. For example, in their 2013 report on health risk assessment after the Fukushima nuclear accident, the World Health Organisation (WHO) panel of experts considered risks of breast cancer, thyroid cancer and leukaemia. For these specific cancer types, use was made of already published excess relative risk (ERR) and excess absolute risk (EAR) models for radiation-related cancer incidence fitted to the epidemiological data from the Japanese A-bomb Life Span Study (LSS). However, it was also considered important to assess all other types of solid cancer together and the WHO, in their above-mentioned report, stated ''No model to calculate the risk for all other solid cancer excluding breast and thyroid cancer risks is available from the LSS data''. Applying the LSS models for all solid cancers along with the models for the specific sites means that some cancers have an overlap in the risk evaluations. Thus, calculating the total solid cancer risk plus the breast cancer risk plus the thyroid cancer risk can overestimate the total risk by several per cent. Therefore, the purpose of this paper was to publish the required models for all other solid cancers, i.e. all solid cancers other than those types of cancer requiring special attention after a nuclear accident. The new models presented here have been fitted to the same LSS data set from which the risks provided by the WHO were derived. Although it is known already that the EAR and ERR effect modifications by sex are statistically significant for the outcome ''all solid cancer'', it is shown here that sex modification is not statistically significant for the outcome ''all solid cancer other than thyroid and breast cancer''. It is also shown here that the sex-averaged solid cancer risks with and without the sex modification are very similar once breast and
Walsh, Linda; Zhang, Wei
In the assessment of health risks after nuclear accidents, some health consequences require special attention. For example, in their 2013 report on health risk assessment after the Fukushima nuclear accident, the World Health Organisation (WHO) panel of experts considered risks of breast cancer, thyroid cancer and leukaemia. For these specific cancer types, use was made of already published excess relative risk (ERR) and excess absolute risk (EAR) models for radiation-related cancer incidence fitted to the epidemiological data from the Japanese A-bomb Life Span Study (LSS). However, it was also considered important to assess all other types of solid cancer together and the WHO, in their above-mentioned report, stated ''No model to calculate the risk for all other solid cancer excluding breast and thyroid cancer risks is available from the LSS data''. Applying the LSS models for all solid cancers along with the models for the specific sites means that some cancers have an overlap in the risk evaluations. Thus, calculating the total solid cancer risk plus the breast cancer risk plus the thyroid cancer risk can overestimate the total risk by several per cent. Therefore, the purpose of this paper was to publish the required models for all other solid cancers, i.e. all solid cancers other than those types of cancer requiring special attention after a nuclear accident. The new models presented here have been fitted to the same LSS data set from which the risks provided by the WHO were derived. Although it is known already that the EAR and ERR effect modifications by sex are statistically significant for the outcome ''all solid cancer'', it is shown here that sex modification is not statistically significant for the outcome ''all solid cancer other than thyroid and breast cancer''. It is also shown here that the sex-averaged solid cancer risks with and without the sex modification are very similar once breast and thyroid cancers are factored out. Some other notable model
The increasing importance of targeting drugs and check-point inhibitors in the treatment of several tumor entities (breast, colon, lung, malignant melanoma, lymphoma, etc.) and the necessity of a companion diagnostic (HER2, (pan)RAS, EGFR, ALK, BRAF, ROS1, MET, PD-L1, etc.) is leading to new challenges for surgical pathology. Since almost all the biomarkers to be specifically detected are tissue based, a precise and reliable diagnostic is absolutely crucial. To meet this challenge surgical pathology has adapted a number of molecular methods (semi-quantitative immunohistochemistry, fluorescence in situ hybridization, PCR and its multiple variants, (pyro/Sanger) sequencing, next generation sequencing (amplicon, whole exome, whole genome), DNA arrays, methylation analyses, etc.) to be applicable for formalin-fixed paraffin-embedded tissue. Reading a patient's tissue as 'deeply' as possible and obtaining information on the morphological, genetic, proteomic and epigenetic background are the tasks of pathologists and molecular biologists and provide the clinicians with information relevant for precision medicine. Intensified cooperation between clinicians and pathologists will provide the basis of improved clinical drug selection and guide development of new cancer gene therapies and molecularly targeted drugs by research units and the pharmaceutical industry. © 2016 S. Karger GmbH, Freiburg.
Wiskar, Katie J; Celi, Leo Anthony; McDermid, Robert C; Walley, Keith R; Russell, James A; Boyd, John H; Rush, Barret
Palliative care is recommended for advanced heart failure (HF) by several major societies, though prior studies indicate that it is underutilized. To investigate patterns of palliative care referral for patients admitted with HF exacerbations, as well as to examine patient and hospital factors associated with different rates of palliative care referral. Retrospective nationwide cohort analysis utilizing the National Inpatient Sample from 2006 to 2012. Patients referred to palliative care were compared to those who were not. Patients ≥18 years of age with a primary diagnosis of HF requiring mechanical ventilation (MV) were included. A cohort of non-HF patients with metastatic cancer was created for temporal comparison. Between 2006 and 2012, 74 824 patients underwent MV for HF. A referral to palliative care was made in 2903 (3.9%) patients. The rate of referral for palliative care in HF increased from 0.8% in 2006 to 6.4% in 2012 ( P care referral in patients with cancer increased from 2.9% in 2006 to 11.9% in 2012 ( P care ( P care. The use of palliative care for patients with advanced HF increased during the study period; however, palliative care remains underutilized in this setting. Patient factors such as race and SES affect access to palliative care.
Conclusions. Age, smoking, and HIV are important risk factors for the 3 commonest cancer types (oesophageal, KS, and cervical) at this teaching .... cancer (95%) patients had no history of smoking or alcohol ..... Africa: a current perspective.
hypercalcaemia at cancer diagnosis or during cancer treatment. About 25 % of the hypercalcaemic ... The main mechanism of hypercalcaemia in these patients involves pathological bone resorption through secretion of cytokines such as ...
Schenker, J.G.; Levinsky, R.; Ohel, G.
The data of an epidemiologic study of multiple primary malignant neoplasms in breast cancer patients in Israel are presented. During the 18-year period of the study 12,302 cases of breast carcinoma were diagnosed, and, of these, 984 patients (8%) had multiple primary malignant tumors. Forty-seven of these patients developed two multiple primary cancers. A significantly higher than expected incidence of second primary cancers occurred at the following five sites: the opposite breast, salivary glands, uterine corpus, ovary, and thyroid. Cancers of the stomach and gallbladder were fewer than expected. Treatment of the breast cancer by irradiation was associated with an increased risk of subsequent cancers of lung and hematopoietic system. The prognosis was mainly influenced by the site and malignancy of the second primary cancer. The incidence of multiple primary malignancies justifies a high level of alertness to this possibility in the follow-up of breast cancer patients
A four-drug chemotherapy regimen has produced the longest improvement in survival ever seen in a phase III clinical trial of patients with metastatic pancreatic cancer, one of the deadliest types of cancer.
McRobbie, M.L.; Riches, A.; Baxby, K.
Full text: Radiosensitivity of peripheral blood lymphocytes from prostate cancer patients is being investigated using the G2 assay and the Cytokinesis Block Micronucleus(CBMN)assay. The G2 assay evaluates chromosomal damage caused by irradiating cells in the G2 phase of the cell cycle. The CBMN assay quantifies the post mitotic micronuclei, which are the expression of damage incurred during G0. An association between hypersensitivity to the chromosome damaging effects of ionising radiation and cancer predispostion has been demonstrated in a number of heritable conditions by using the aforementioned techniques. Recently, increased chromosomal radiosensitivity has been demonstrated in a significant proportion of patients with no obvious family history of malignancy. The aim of this study is to establish whether a group of prostatic carcinoma patients exists and if so whether there are any correlations between their G2 and G0 sensitivities. The study has shown there is no correlation between G2 and G0 sensitivity, confirming the general trend that individuals exhibiting chromosomal radiosensitivity are defective in only one mechanism and G2 and G0 sensitivity are largely independent. Current data indicates that there is an identifiable group of men within the prostate cancer population with increased chromosomal radiosensitivity. Using the G2 assay and the 90th percentile of the controls as a cut off point for sensitivity, no significant difference between the controls and the patient population has been found. However, using the CBMN assay and again the 90th percentile, approximately 11% of the control group are sensitive compared with approximately 40% of the carcinoma cases. The implications of this increased radiosensitivity are as yet unclear, but it is indicative of increased chromosomal fragility and therefore, possibly associated with malignant transformation. Hence, it may prove a useful tool in identifying individuals at increased risk of developing
Full Text Available Abstract Background Most of the studies about invasive Candida infections in cancer patients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia in patients with solid tumours. Methods Retrospective cohort study. During a 9-year period (1995–2003 we reviewed all cases of candidaemia that affected cancer patients in Santa Casa Complexo Hospitalar, Brazil. Results During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%. The majority of patients with cancer had solid tumours (77.1%, mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%. Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13, high grade non-Hodgkin lymphoma (n = 5 and Hodgkin's disease (n = 1. Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034. Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers. The overall mortality in cancer patients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour. Conclusion Cancer patients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases
Mahkovic-Hergouth, Ksenija; Novakovic, Barbara Jezersek; Seruga, Bostjan
Abstract Background In some neutropenic cancer patients fever may be absent despite microbiologically and/or clinically confirmed infection. We hypothesized that afebrile neutropenic cancer patients with severe infections have worse outcome as compared to cancer patients with febrile neutropenia. Patients and methods We retrospectively analyzed all adult cancer patients with chemotherapy-induced neutropenia and severe infection, who were admitted to the Intensive Care Unit at our cancer center between 2000 and 2011. The outcome of interest was 30-day in-hospital mortality rate. Association between the febrile status and in-hospital mortality rate was evaluated by the Fisher’s exact test. Results We identified 69 episodes of severe neutropenic infections in 65 cancer patients. Among these, 9 (13%) episodes were afebrile. Patients with afebrile neutropenic infection presented with hypotension, severe fatigue with inappetence, shaking chills, altered mental state or cough and all of them eventually deteriorated to severe sepsis or septic shock. Overall 30-day in-hospital mortality rate was 55.1%. Patients with afebrile neutropenic infection had a trend for a higher 30-day in-hospital mortality rate as compared to patients with febrile neutropenic infection (78% vs. 52%, p = 0.17). Conclusions Afebrile cancer patients with chemotherapy-induced neutropenia and severe infections might have worse outcome as compared to cancer patients with febrile neutropenia. Patients should be informed that severe neutropenic infection without fever can occasionally occur during cancer treatment with chemotherapy. PMID:27904453
Müller-Richter, Urs; Betz, C; Hartmann, S; Brands, R C
Up to 80% of patients with head and neck cancers are malnourished because of their lifestyle and the risk factors associated with this disease. Unfortunately, nutrition management systems are not implemented in most head and neck cancer clinics. Even worse, many head and neck surgeons as well as hospital management authorities disregard the importance of nutrition management in head and neck cancer patients. In addition, the often extensive resection and reconstruction required for tumors in the upper aerodigestive tract pose special challenges for swallowing and sufficient food intake, placing special demands on nutrition management. This article presents the basics of perioperative metabolism and nutrition management of head and neck cancer patients and makes recommendations for clinical practice. Implementing a nutrition management system in head and neck cancer clinics will improve the clinical outcome and the survival of the patients. Copyright © 2017 Elsevier Inc. All rights reserved.
Handberg, Charlotte; Maribo, Thomas; Jensen, Charlotte Maria
and the specifics of needs and plans facilitates targeted rehabilitation interventions. Implications: Systematic needs assessment in cancer rehabilitation unveil the requirement of physical rehabilitation. Supervised physical activity renders an intervention possible tailored the special needs cancer patients have......Background: Systematic assessment of rehabilitation needs is prerequisite for sufficient rehabilitation, but little is known about patients' needs. Purpose: The aim of this study was to describe specific stated rehabilitation needs and plans among patients with cancer at hospitals when diagnosed...... and when municipal rehabilitation begins. Methods: Needs-assessment-forms for rehabilitation from 188 cancer patients from two hospitals and two municipal cancer rehabilitation programmes were analysed. The forms included 1) stated needs: 58 fixed areas categorised in six domains and 2) an area to document...
Wielopolski, L.; Meek, A.G.; Reinstein, L.E.
Cancer patients are treated with high energy (8 to 30 MeV) gamma radiation. This treatment modality provides better depth dose distribution than more conventional low-energy gamma treatments, in particular for deeply located tumors. A by-product of the high-energy treatment is gamma-induced activity in the treatment volume following photonuclear reactions. These reactions are endogenic and require that the gamma radiation energy be above threshold value in order for the reaction to take place. For most elements, the threshold value is above 8 MeV; however, for low Z elements, this threshold may reach 18 MeV as is the case for oxygen. The cross sections for the (γ, n) reactions are few millibarns for low Z elements and increases up to few hundreds of millibarns for the heavy elements. The radionuclides resulting from photonuclear reaction are typically positron emitter or decay by electron capture. Thus, it is possible to monitor either the annihilation radiation (511 KeV) or the characteristic gamma radiation. The present work demonstrates that the activity induced in cancer patients following a single treatment (300 rad) enables the monitoring of nitrogen and phosphorus in the irradiated volume. The results from measurements in phantom, cadavers, and cancer patients from different regions in the body are presented. The hypothesis to be tested is whether there are local changes in these two elements during the course of radiation treatment which might correlate with the efficacy of the treatment
Conclusion: Gastrectomy according to the gastric treatment guidelines for elderly patients with gastric cancer is recommended. Elderly male patients with poor nutrition have poor prognosis; prognostic nutrition index <40. Limited surgery is a treatment option for such patients.
Donia, Marco; Pedersen, Magnus; Svane, Inge Marie
Patients with preexisting active autoimmune disorders were excluded from clinical trials of immune checkpoint inhibitors. However, patients with autoimmune disorders are diagnosed with cancer at least as frequently as the global population, and clinicians treating patients outside clinical trials...
Paximadis, Peter, E-mail: firstname.lastname@example.org [Department of Radiation Oncology, Wayne State University, Detroit, MI (United States); Yoo, George; Lin, Ho-Sheng; Jacobs, John [Department of Otolaryngology, Barbara Ann Karmanos Cancer Institute, Detroit, MI (United States); Sukari, Ammar [Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI (United States); Dyson, Greg [Department of Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI (United States); Christensen, Michael; Kim, Harold [Department of Radiation Oncology, Wayne State University, Detroit, MI (United States)
Purpose: To retrospectively review our institutional experience with hypopharyngeal carcinoma with respect to treatment modality. Methods and Materials: A total of 70 patients with hypopharyngeal cancer treated between 1999 and 2009 were analyzed for functional and survival outcomes. The treatments included surgery alone (n = 5), surgery followed by radiotherapy (RT) (n = 3), surgery followed by chemoradiotherapy (CRT) (n = 13), RT alone (n = 2), CRT alone (n = 22), induction chemotherapy followed by RT (n = 3), and induction chemotherapy followed by CRT (n = 22). Results: The median follow-up was 18 months. The median overall survival and disease-free survival for all patients was 28.3 and 17.6 months, respectively. The 1- and 2-year local control rate for all patients was 87.1% and 80%. CRT, given either as primary therapy or in the adjuvant setting, improved overall survival and disease-free survival compared with patients not receiving CRT. The median overall survival and disease-free survival for patients treated with CRT was 36.7 and 17.6 months vs. 14.0 and 8.0 months, respectively (p < .01). Of the patients initially treated with an organ-preserving approach, 4 (8.2%) required salvage laryngectomy for local recurrence or persistent disease; 8 (16.3%) and 12 (24.5%) patients were dependent on a percutaneous gastrostomy and tracheostomy tube, respectively. The 2-year laryngoesophageal dysfunction-free survival rate for patients treated with an organ-preserving approach was estimated at 31.7%. Conclusions: Concurrent CRT improves survival in patients with hypopharyngeal cancer. CRT given with conventional radiation techniques yields poor functional outcomes, and future efforts should be directed at determining the feasibility of pharyngeal-sparing intensity-modulated radiotherapy in patients with hypopharyngeal tumors.
Shuman, Andrew G.; Terrell, Jeffrey E.; Light, Emily; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas; Jiang, Yunyun; McLean, Scott; Ghanem, Tamer A.; Duffy, Sonia A.
Objective Pain is a strong contributor to cancer patients’ quality of life. The objective of this study was to determine predictors of pain 1 year after the diagnosis of head and neck cancer. Design Prospective, multi-site cohort study. Setting Three academically-affiliated medical centers. Patients Previously untreated patients with carcinoma of the upper aerodigestive tract (n=374). Main Outcome Measures Participants were surveyed pre-treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the SF-36 bodily pain score 1 year after diagnosis. Results The mean SF-36 bodily pain score at 1 year was 65, compared to 61 at diagnosis (p=.004), compared to 75 among population norms (lower scores indicate worse pain). Variables independently associated with pain included pre-treatment pain score (p<0.001), less education (p=0.02), neck dissection (p=0.001), feeding tube (p=0.05), xerostomia (p<0.001), depressive symptoms (p<0.001), taking more pain medication (p<0.001), less physical activity (p=.02), and poor sleep quality (p=0.006). Current smoking and problem drinking were marginally significant (p=0.07 and 0.08, respectively). Conclusions Aggressive pain management may be indicated for head and neck cancer patients who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco and alcohol abuse may also reduce pain and improve quality of life among head and neck cancer patients. PMID:23165353
Tanna, Nuttan; Buijs, Helene; Pitkin, Joan
Breast cancer survivors can be expected to suffer from menopause symptoms with estrogen deprivation due to cancer treatments, in addition to natural menopause-related estrogen loss. To gain an understanding of what support breast cancer patients have when they suffer from menopausal symptoms, and utilize findings to further inform National Health Service (NHS) care provision for breast cancer survivors. Qualitative study with focus group sessions targeting Caucasian and Asian women with breast cancer. Patient stories, with women describing their breast cancer journey and speaking about support received for any menopausal symptoms. Thematic data analysis of transcription. Breast cancer patients were not sure if they had menopausal symptoms or whether this was due to their breast cancer condition or treatment. Patients had an attitude of acceptance of menopausal symptoms and reported trying to cope with these by themselves. This research identifies a need for more information that is culturally sensitive on managing menopause symptoms, both as side-effects of breast cancer treatments as well as for affect on quality of life during the survivorship phase. Our work also gives insight into cultural remedies used for hot flushes by Asian patients, which they consider as 'cooling' foods. Breast cancer patients want to know whether side-effects of cancer treatment persist long term and how these can be managed. There is a need for improved patient support within any new NHS service models that are developed along breast cancer patient pathways, and inclusion of personalized advice for menopause symptoms.
The purpose of the study is to modify a type of counseling called "Individual Meaning Centered Psychotherapy" to meet the needs of Chinese cancer patients. Many cancer patients use counseling or other resources to help cope with the emotional burden of their illnesses. Counseling often helps them cope with cancer by giving them a place to express their feelings.
Aldaz, Bruno E; Treharne, Gareth J; Knight, Robert G; Conner, Tamlin S; Perez, David
This study explored oncology healthcare professionals' perspectives on the psychosocial support needs of diverse cancer patients during oncology treatment. Six themes were identified using thematic analysis. Healthcare professionals highlighted the importance of their sensitivity, respect and emotional tact during appointments in order to effectively identify and meet the needs of oncology patients. Participants also emphasised the importance of building rapport that recognises patients as people. Patients' acceptance of treatment-related distress and uncertainty was described as required for uptake of available psychosocial supportive services. We offer some practical implications that may help improve cancer patients' experiences during oncology treatment.
Miyahara, Hiroshi; Tsuruta, Yoshihiro; Sato, Takeo; Yoshino, Kunitoshi; Umatani, Katunori
Three patients developed hypopharyngo-cervical esophageal carcinoma, 6.5, 13, and 12 years after total laryngectomy. The first patient had received irradiation (60 Gy) for hypopharyngeal carcinoma. The recurrent tumor was removed with total pharyngolaryngoesophagectomy and reconstruction was performed with a local skin flap. After 6 years and 6 months, she developed progressive dysphagia. A new cervical esophageal skin cancer was diagnosed by pharyngoesophagography and treated. The second patient had had total laryngectomy for laryngeal carcinoma and received irradiation (100 Gy) post-operatively. After 13 years, he developed progressive dysphagia. Pharyngoesophagography revealed cervical esophageal carcinoma. The third patient had received irradiation for laryngeal carcinoma (60 Gy) and underwent total laryngectomy because of recurrence. After 12 years she developed dysphagia, and was treated for hypopharyngeal carcinoma. These three patients seemed to have radiation-induced carcinoma. Patients treated with total laryngectomy and irradiation who later complain of progressive dysphagia should be examined carefully to differentiate between postoperative stenosis due to scarring and a new carcinoma. (author)
Geinitz, H.; Zimmermann, F.B.; Kuzmany, A.; Kneschaurek, P.
Background: In the irradiation of prostate cancer internal organ movement leads to uncertainties in the daily localization of the clinical target volume. Therefore more or less large safety margins are added when designing the treatment portals. With daily CT planning internal organ movement can be compensated to some extent, safety margins can be reduced and irradiated normal tissue can be spared. The feasibility of daily CT-based 3D treatment planning is studied in a patient with localized prostate carcinoma using a new patient positioning system. Methods: Daily CT planning was applied during boost irradiation of a patient with prostate cancer: After patient immobilization the pelvis was scanned in 3 mm CT slices. Planning was done with the BrainSCAN planning system for stereotactic body irradiation. The prostate was contoured in all slices and the safety margins of the micromultileafs were automatically set to the distance chosen by the physician (0.8 cm). Patient positioning was done with the BrainLAB ExacTrac positioning system on the basis of skin attached stereotactic body markers. Before each treatment verification images of the isocenter were taken. Results: The total time requirement for planning and irradiation was about 1 hour 15 minutes. Patient positioning on the treatment couch took about 10 minutes. The accuracy of the positioning system was good (75% of the deviations were smaller than 3 mm). The shift of the single markers from CT scan to CT scan was more extensive than those of the center of all 7 markers combined (47% of the deviations were smaller than 3 mm). The location of the markers seems to influence the magnitude of their dislocation. Conclusion: Daily CT planning is feasible but time consuming. The new patient positioning system ExacTrac is an interesting tool especially for daily CT planning since conventional simulation can be omitted. (orig.) [de
Kurita, Geana Paula; Sandvad, Marlene; Lundorff, Lena
OBJECTIVE: This study aimed at analyzing the validity and reliability of the continuous reaction time (CRT) test, the finger-tapping test (FTT), the Digit Span Test (DST), the Trail Making Test - part B (TMTB), and the Mini-Mental State Examination (MMSE) in patients with metastatic cancer. METHO......: The findings of the full validation analyses were not clear-cut. However, CRT test, DST, FTT, and TMTB demonstrated partial positive results, indicating that these tests have good potential for use in clinical settings and require further study....
Huang, Dong-Sheng; Tao, Hou-Quan; He, Xu-Jun; Long, Ming; Yu, Sheng; Xia, Ying-Jie; Wei, Zhang; Xiong, Zikai; Jones, Sian; He, Yiping; Yan, Hai; Wang, Xiaoyue
Besides CDH1, few hereditary gastric cancer predisposition genes have been previously reported. In this study, we discovered two germline ATM mutations (p.Y1203fs and p.N1223S) in a Chinese family with a history of gastric cancer by screening 83 cancer susceptibility genes. Using a published exome sequencing dataset, we found deleterious germline mutations of ATM in 2.7% of 335 gastric cancer patients of different ethnic origins. The frequency of deleterious ATM mutations in gastric cancer patients is significantly higher than that in general population (p=0.0000435), suggesting an association of ATM mutations with gastric cancer predisposition. We also observed biallelic inactivation of ATM in tumors of two gastric cancer patients. Further evaluation of ATM mutations in hereditary gastric cancer will facilitate genetic testing and risk assessment.
Hopfer, R.L.; Orengo, A.; Chesnut, S.; Wenglar, M.
During a 12-month period, 19,457 blood cultures were collected. Yeasts were isolated from 193 cultures derived from 76 cancer patients. Candida albicans or Candida tropicalis accounted for 79% of isolates. Of the three methods compared, the radiometric method required 2.9 days to become positive, blind subculture required 2.6 days, and Gram stains required 1 day. However, the radiometric method was clearly superior in detecting positive cultures, since 73% of all cultures were first detected radiometrically, 22% were detected by subculture, and only 5% were detected by Gram stain. Although 93% of the isolates were detected by aerobic culture, five (7%) isolates were obtained only from anaerobic cultures. Seven days of incubation appear to be sufficient for the radiometric detection of yeasts
Longo, C.J.; Bereza, B.G.
Background Monthly out-of-pocket costs (oopc) for Ontario patients with cancer have previously been reported, but little detail has been provided on differences based on tumour type. Methods A questionnaire administered in cancer clinics in the province of Ontario, with a mix of urban and rural patients, was analyzed using descriptive statistics and a regression analysis of cross-sectional data. The dependent variable was oopc (Canadian dollars), analyzed separately for total oopc (excluding imputed travel costs), and for each of the individual cost categories. Results Compared with colorectal, lung, and prostate cancer patients combined, breast cancer patients had statistically significantly higher total oopc ($393 vs. $149, p = 0.02), device costs ($142 vs. $12, p = 0.018), and family care costs ($38 vs. $3, p = 0.01). By contrast, they trended toward lower costs for travel ($225 vs. $426, p = 0.055) and had lower costs for parking ($32 vs. $53, p = 0.0198). Compared with non-breast cancer patients, patients with breast cancer reported a greater perceived financial burden (31% vs. 17% p = 0.0133). Interpretation These findings highlight that financial burden for cancer patients can vary by tumour type, and that patients with breast cancer may require a different mix of supportive services than do patients with other common tumour types. Supportive care programs related to financial burden should consider the likelihood and nature of financial burden when counselling breast cancer patients. PMID:21331267
Ren, Meng; Wu, Mu Chao; Shang, Chang Zhen; Wang, Xiao Yi; Zhang, Jing Lu; Cheng, Hua; Xu, Ming Tong; Yan, Li
The best preoperative examination in Graves' disease with thyroid cancer still remains uncertain. The objectives of the present study were to investigate the prevalence of thyroid cancer in Graves' disease patients, and to identify the predictive factors and ultrasonographic features of thyroid cancer that may aid the preoperative diagnosis in Graves' disease. This retrospective study included 423 patients with Graves' disease who underwent surgical treatment from 2002 to 2012 at our institution. The clinical features and ultrasonographic findings of thyroid nodules were recorded. The diagnosis of thyroid cancer was determined according to the pathological results. Thyroid cancer was discovered in 58 of the 423 (13.7 %) surgically treated Graves' disease patients; 46 of those 58 patients had thyroid nodules, and the other 12 patients were diagnosed with incidentally discovered thyroid carcinomas without thyroid nodules. Among the 58 patients with thyroid cancer, papillary microcarcinomas were discovered in 50 patients, and multifocality and lymph node involvement were detected in the other 8 patients. Multivariate regression analysis showed younger age was the only significant factor predictive of metastatic thyroid cancer. Ultrasonographic findings of calcification and intranodular blood flow in thyroid nodules indicate that they are more likely to harbor thyroid cancers. Because the influencing factor of metastatic thyroid cancers in Graves' disease is young age, every suspicious nodule in Graves' disease patients should be evaluated and treated carefully, especially in younger patients because of the potential for metastasis.
Konstantis, Apostolos; Exiara, Triada
In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital. 59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic. Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59%) had specific training on breaking bad news. 20 doctors (33.90%) were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66%) had a consistent plan for breaking bad news. 57 (96.61%) delivered bad news in a quiet place, 53 (89.83%) ensured no interruptions and enough time, 53 (89.83%) used simple words and 54 (91.53%) checked for understanding and did not rush through the news. 46 doctors (77.97%) allowed relatives to determine patient's knowledge about the disease. There were low rates of specific training in breaking bad news. However, the selected location, the physician's speech and their plan were according to current guidelines.
Andersen, Andreas Holst; Vinther, Anders; Poulsen, Lise-Lotte
Patients with lung cancer are often burdened by dyspnoea, fatigue, decreased physical ability and loss of weight. Earlier studies of physical exercise of patients with COPD have shown promising results. The aim of this study was to investigate, if a well-documented COPD rehabilitation protocol can...... improve physical fitness and quality of life (QoL) in patients with lung cancer....
African patients are more likely to be premenopausal at diagnosis and the ... of whether a patient had a mastectomy or breast conserving therapy. Breast conserving treat- ment is an option for treatment of breast cancer in a young patient given the ... family and society as a whole. ... breast cancer, from the perspective of.
Jansen, J.; Weert, J. van; Meulen, N. van der; Dulmen, S. van; Heeren, T.; Bensing, J.
PURPOSE: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient
Jansen, J.; van Weert, J.; van der Meulen, N.; van Dulmen, S.; Heeren, T.; Bensing, J.
Purpose: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients' recall of information after patient
Purpose: To assess the patterns of use of bisphosphonate therapies for hypercalcaemia in breast cancer patients, and their outcomes. Methods: A retrospective chart review study of breast cancer patients hospitalised between 2009 and 2014 at Penang Hospital, a public tertiary hospital in Malaysia was conducted. Patients ...
Saunders, C L; Abel, G A; Lyratzopoulos, G
Patient experience is a critical dimension of cancer care quality. Understanding variation in experience among patients with different cancers and characteristics is an important first step for designing targeted improvement interventions. We analysed data from the 2011/2012 English Cancer Patient Experience Survey (n = 69,086) using logistic regression to explore inequalities in care experience across 64 survey questions. We additionally calculated a summary measure of variation in patient experience by cancer, and explored inequalities between patients with cancers treated by the same specialist teams. We found that younger and very old, ethnic minority patients and women consistently reported worse experiences across questions. Patients with small intestine/rarer lower gastrointestinal, multiple myeloma and hepatobiliary cancers were most likely to report negative experiences whereas patients with breast, melanoma and testicular cancer were least likely (top-to-bottom odds ratio = 1.91, P patients with cancers treated by the same specialty for five of nine services (P patients with ovarian, multiple myeloma, anal, hepatobiliary and renal cancer reported notably worse experiences than patients with other gynaecological, haematological, gastrointestinal and urological malignancies respectively. Initiatives to improve cancer patient experience across oncology services may be suitably targeted on patients at higher risk of poorer experience. © 2014 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.
Bermejo, J Lorenzo; Sundquist, J; Hemminki, K
Background: This study quantified the risk of urinary bladder neoplasms in cancer patients taking into account the age at first diagnosis, the gender of the patients and the lead time between diagnoses. Methods: We used standardised incidence ratios (SIRs) to compare the incidence of bladder tumours in 967?767 cancer patients with the incidence rate in the general Swedish population. A total of 3324 male and 1560 female patients developed bladder tumours at least 1 year after first cancer dia...
Farjou, G; Sinha, R; Dix, D; Shahbaz, A; Klaassen, R J; Klassen, A F
Despite literature supporting a client and family-centred approach to healthcare delivery in paediatric facilities, there is little information about healthcare delivery from the perspective of teenagers in the oncology setting. The objective of this study is to describe the healthcare experiences of teenagers with cancer. As part of a larger study on teen-centred care delivery in paediatric oncology, a survey included several open-ended questions to learn about the following: (1) what teenagers liked about the cancer care they received; (2) what they disliked about the cancer care received; and (3) what they would include if they could design the perfect cancer centre for teenagers. The survey was completed by 200 teenagers (aged 12-20 years) from three paediatric hospitals in Canada. Answers to these questions were coded and developed into themes and subthemes using a thematic analysis approach. The number of patients providing answers was 89% for question 1, 63% for question 2 and 68.5% for question 3. Likes and dislikes were conceptualized in terms of four key themes as follows: (1) staff at the treatment centre; (2) the cancer care they received; (3) the treatment centre itself; and (4) social activities. The most common suggestions for the perfect cancer centre included having access to better entertainment, more social opportunities to interact with peers, and a more comfortable environment for themselves and their families. Understanding teenagers' experiences in the paediatric oncology setting provides information that could be used to shape the delivery of healthcare in a way that is tailored to their needs. Further research in this area is required in order to improve existing oncology care. © 2013 John Wiley & Sons Ltd.
Nielsen, Kirsten Melgaard; Borchsenius, Julie I Helene; Offersen, Birgitte Vrou
Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects...... of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients....
Shim, Hongjin; Cheong, Jae Ho; Lee, Kang Young; Lee, Hosun; Lee, Jae Gil; Noh, Sung Hoon
The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (pgastric cancer patients, postoperative severe malnourishment increased significantly (p60, pgastric cancer (pgastric cancer, and open surgery remained significant as risk factors of severe malnutrition. The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.
suffering in addition to feelings of powerlessness, guilt , anger, ambivalence, and fear for the patient and themselves. Another task for the family is...patients had breast cancer, five patients had lung cancer, five more had cancer of the gastrointestinal tract, three had cancer of the liver or pancreas ...the patient 3.03 1.07 E 14. To talk about feelings such as anger or guilt 3.03 1.07 E 15. To have comfortable furniture in the waiting room 2.82 0.90 P
Z. V. Grigoryevskaya
Full Text Available Lung cancer (LC annually afflicts 63–65 thousand people in Russia and 1.04 million worldwide, which amounts to 12.8% of all notified cases of neoplasms. In LC patients, infectious complications are characterized by a severe course; destruction foci, decay cavities, and abscess may form.All give rise to difficulties in making a diagnosis and in choosing a treatment policy. Infections caused by P. aeruginosa, A. baumanii, bacteria of the family Enterobacteriacae, S. aureus, and Enterococcus spp present the greatest problem in inpatients with LC. The early diagnosis of infectiouscomplications and the use of adequate schemes of antibiotic prevention and therapy promote a reduction in mortality from infection in this categoryof patients and expand the possibilities of their specific antitumor treatment.
Z. V. Grigoryevskaya
Full Text Available Lung cancer (LC annually afflicts 63–65 thousand people in Russia and 1.04 million worldwide, which amounts to 12.8% of all notified cases of neoplasms. In LC patients, infectious complications are characterized by a severe course; destruction foci, decay cavities, and abscess may form.All give rise to difficulties in making a diagnosis and in choosing a treatment policy. Infections caused by P. aeruginosa, A. baumanii, bacteria of the family Enterobacteriacae, S. aureus, and Enterococcus spp present the greatest problem in inpatients with LC. The early diagnosis of infectiouscomplications and the use of adequate schemes of antibiotic prevention and therapy promote a reduction in mortality from infection in this categoryof patients and expand the possibilities of their specific antitumor treatment.
Mssrouri, R; Benamr, S; Essadel, A; Mdaghri, J; Mohammadine, El H; Lahlou, M-K; Taghy, A; Belmahi, A; Chad, B
To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.
Dorland, Heleen F; Abma, Femke I; Roelen, Corné A M; Stewart, Roy E; Amick, Benjamin C; Ranchor, Adelita V; Bültmann, Ute
More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work. © 2017 UICC.
Su, Shu-Chih; Kanarek, Norma; Fox, Michael G; Guseynova, Alla; Crow, Shirley; Piantadosi, Steven
We examined the geographic distribution of patients to better understand the service area of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, a designated National Cancer Institute (NCI) comprehensive cancer center located in an urban center. Like most NCI cancer centers, the Sidney Kimmel Comprehensive Cancer Center serves a population beyond city limits. Urban cancer centers are expected to serve their immediate neighborhoods and to address disparities in access to specialty care. Our purpose was to learn the extent and nature of the cancer center service area. Statistical clustering of patient residence in the continental United States was assessed for all patients and by gender, cancer site, and race using SaTScan. Primary clusters detected for all cases and demographically and tumor-defined subpopulations were centered at Baltimore City and consisted of adjacent counties in Delaware, Pennsylvania, Virginia, West Virginia, New Jersey and New York, and the District of Columbia. Primary clusters varied in size by race, gender, and cancer site. Spatial analysis can provide insights into the populations served by urban cancer centers, assess centers' performance relative to their communities, and aid in developing a cancer center business plan that recognizes strengths, regional utility, and referral patterns. Today, 62 NCI cancer centers serve a quarter of the U.S. population in their immediate communities. From the Baltimore experience, we might project that the population served by these centers is actually more extensive and varies by patient characteristics, cancer site, and probably cancer center services offered.
Full Text Available Objective: In a regional hospital, many patients are newly diagnosed with cancer. Breaking the bad news in these patients and their relatives is a tough task. Many doctors are not experienced in talking to patients about death or death-related diseases. In recent years, there have been great efforts to change the current situation. The aim of this study was to investigate the experience and education of medical personnel in breaking bad news in a secondary hospital. Materials and Methods: 59 doctors from General Hospital of Komotini, Greece were included in the study. All the doctors were in clinical specialties that treated cancer patients. A brief questionnaire was developed based on current guidelines such as Baile/SPIKES framework and the ABCDE mnemonic. Results: Residents are involved in delivering bad news less frequently than specialists. Only 21 doctors (35.59% had specific training on breaking bad news. 20 doctors (33.90% were aware of the available techniques and protocols on breaking bad news. 47 doctors (79.66% had a consistent plan for breaking bad news. 57 (96.61% delivered bad news in a quiet place, 53 (89.83% ensured no interruptions and enough time, 53 (89.83% used simple words and 54 (91.53% checked for understanding and did not rush through the news. 46 doctors (77.97% allowed relatives to determine patient′s knowledge about the disease. Conclusions: There were low rates of specific training in breaking bad news. However, the selected location, the physician′s speech and their plan were according to current guidelines.
Hanchanale, Sarika; Adkinson, Lucy; Daniel, Sunitha; Fleming, Michelle; Oxberry, Stephen G
Dry mouth (xerostomia) is one of the commonest symptoms in cancer patients and can adversely affect quality of life. The aim of this review was to determine the effectiveness of pharmacological and non-pharmacological interventions in treating xerostomia in adult advanced cancer patients. The literature search was performed in February 2014 using databases including EMBASE, MEDLINE, CINAHL, BNI and Cochrane library. The search was carried out using standard MeSH terms and was limited to adult population and English language. Studies investigating xerostomia secondary to head and neck cancer treatment and autoimmune disease were excluded. Titles and abstracts were screened and reviewed for eligibility. Only studies involving primary research were included in the analysis. Six studies met the eligibility criteria for review: three randomized controlled trials and three prospective studies. The quality assessment and reporting was performed using PRISMA, Jadad and STROBE. These studies compared acupuncture, pilocarpine, Saliva Orthana and chewing gum with each other or with placebo. All interventions were considered effective in treating xerostomia. However, effectiveness versus placebo could not be demonstrated for Saliva Orthana. Meta-analysis could not be performed due to heterogeneity of the study type and intervention. Limited published data exists reporting the effectiveness of measures in the treatment of xerostomia in cancer patients. Based on primary research of low quality, firm conclusions cannot be drawn. However, pilocarpine, artificial saliva, chewing gum and acupuncture can be tried based on the available data. This highlights the explicit need to improve our evidence base. Properly constructed randomized controlled trials demonstrating effectiveness of pharmacological and non-pharmacological interventions for dry mouth are required.
Fitch, Margaret I; Miller, Debbie; Sharir, Sharon; McAndrew, Alison
Patients being treated for bladder cancer share issues in common with other cancer patients, but also experience issues that are unique to their surgical treatment. This study used a descriptive qualitative approach to explore the experiences of patients who had undergone radical cystectomy for bladder cancer Twenty-two participants were interviewed in-depth on one occasion and were invited to attend a focus group session following the analysis of the interview transcripts. Participants described the shock of their diagnosis, their lack of information about bladder cancer, the importance of clear communication with care providers, and the types of adjustments they had to make following surgery. Specifically, changes in bodily function, body image, sexual relationships, and intimacy presented challenges for these participants. Although there was a sense of acceptance about the treatment-related events, there were still significant adjustments required by individuals following their surgery. Information, open communication, and support from family and friends were seen as important factors in helping patients adjust after surgery. Patients require clear, concise and consistent information about their cancer, treatment options, and course of care. Nurses caring for patients following surgery for bladder cancer need to understand the unique needs of these patients.
Møller, Naja Holten; Bjørn, Pernille
for a particular patient. Due to the limited resources within the Danish healthcare system, initiating cancer pathways for all patients with a remote suspicion of cancer would crash the system, as it would be impossible for healthcare professionals to commit to the prescribed schedules and times defined...... they show that sorting patients before initiating a standardized cancer pathway is not a simple process of deciding on a predefined category that will stipulate particular dates and times. Instead, these informal sorting mechanisms show that the process of sorting patients prior to diagnosis......In the last couple of years, widespread use of standardized cancer pathways has been seen across a range of countries, including Denmark, to improve prognosis of cancer patients. In Denmark, standardized cancer pathways take the form of guidelines prescribing well-defined sequences where steps...
Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Søndergaard, Jens
Priority setting in patients with cancer and comorbidities Background and aim As both the cancer incidence and the number of patients diagnosed with chronic diseases are increasing, a growing population of cancer survivors will also deal with comorbid chronic diseases. The period after completed...... to comorbidities. Some studies show that participation in regular follow-up consultations concerning comorbid chronic diseases and lifestyle are lower among cancer survivors than non-cancer patients. This could be explained by changes in the patient’s priority setting or in the doctor’s priority and attempt...... to spare the patient for further treatment burden, perhaps resulting in comorbidities falling down the agenda. The overall purpose is to explore patients’ and doctors’ priority settings of comorbidities in patients who have been diagnosed with non-metastatic cancer. Method: The study will consist of three...
Ayatollahi, Haleh; Nazemi, Zahra; Haghani, Hamid
A patient accounting system is a subsystem of a hospital information system. This system like other information systems should be carefully designed to be able to meet users' requirements. The main aim of this research was to investigate users' requirements and to determine whether current patient accounting systems meet users' needs or not. This was a survey study, and the participants were the users of six patient accounting systems used in 24 teaching hospitals. A stratified sampling method was used to select the participants (n = 216). The research instruments were a questionnaire and a checklist. The mean value of ≥3 showed the importance of each data element and the capability of the system. Generally, the findings showed that the current patient accounting systems had some weaknesses and were able to meet between 70% and 80% of users' requirements. The current patient accounting systems need to be improved to be able to meet users' requirements. This approach can also help to provide hospitals with more usable and reliable financial information.
Ayatollahi, Haleh; Nazemi, Zahra
Objectives A patient accounting system is a subsystem of a hospital information system. This system like other information systems should be carefully designed to be able to meet users' requirements. The main aim of this research was to investigate users' requirements and to determine whether current patient accounting systems meet users' needs or not. Methods This was a survey study, and the participants were the users of six patient accounting systems used in 24 teaching hospitals. A stratified sampling method was used to select the participants (n = 216). The research instruments were a questionnaire and a checklist. The mean value of ≥3 showed the importance of each data element and the capability of the system. Results Generally, the findings showed that the current patient accounting systems had some weaknesses and were able to meet between 70% and 80% of users' requirements. Conclusions The current patient accounting systems need to be improved to be able to meet users' requirements. This approach can also help to provide hospitals with more usable and reliable financial information. PMID:26893945
Guan, Xu; Chen, Wei; Liu, Zheng; Jiang, Zheng; Hu, Hanqing; Zhao, Zhixun; Wang, Song; Chen, Yinggang; Wang, Guiyu; Wang, Xishan
Despite the adequacy of nodal evaluation was gradually improved for colon cancer, the disparity in nodal examination for right colon cancer (RCC) and left colon cancer (LCC) still begs the question of whether 12 nodes is an appropriate threshold for both RCC and LCC. From Surveillance, Epidemiology, and End-Results (SEER) database, we identified 53897 RCC patients and 11822 LCC patients. Compared with LCC patients, RCC patients examined more lymph nodes (18.7 vs 16.3), and more likely to examine ≥12 nodes (Pcancer specific survival (CSS) was calculated according to the optimal node number in RCC and LCC patients, Cox's regression model were used to further assess the prognostic value of this revised nodal evaluation. The results showed that 5-year CSSs were significantly improved for RCC patients with ≥15 lymph nodes, and also for LCC patients with ≥11 lymph nodes (Pcolon cancer as a whole.
Introduction: Breast cancer patients are presenting at advanced stages for oncological treatment in Nigeria and World Health Organization predicted developing countries' breast cancer incidence and mortality to increase by year 2020. Methods: Prospective observational hospital based study that enrolled breast cancer ...
Two case studies are reported to illustrate the use of a comprehensive cognitive-behavioral approach to treat claustrophobia in cancer patients undergoing external beam radiation therapy. Hypnosis was an essential component of the cognitive-behavioral approach. Both patients responded favorably to the psychological intervention and completed the required external beam radiation therapy.
Shizgal, H.M.; Martin, M.F.
The caloric requirement of the critically ill septic patient was determined by measuring body composition, by multiple isotope dilution, before and at 2-wk intervals while receiving total parenteral nutrition (TPN) in 86 septic and 57 nonseptic malnourished patients. All patients received a TPN solution containing 25% dextrose and 2.75% crystalline amino acids. The body composition of the nonseptic patients, who received 51.9 +/- 1.5 kcal/kg.day, improved significantly, while that of the septic patients, receiving 46.8 +/- 1.1 kcal/kg.day was only maintained. The relationship between caloric intake and the restoration of a malnourished body cell mass (BCM) was determined for each group by correlating, using multiple linear regression, the mean daily change in the BCM with the caloric intake and the nutritional state, as determined by body composition. According to the resultant regressions, an intake of 35.1 and 50.7 kcal/kg.day was required to maintain the BCM of the septic and nonseptic patients, respectively. To restore a depleted BCM, caloric intakes in excess of this amount are required
ter Hoeven, Claartje L.; Zandbelt, Linda C.; Fransen, Sanne; de Haes, Hanneke; Oort, Frans; Geijsen, Debby; Koning, Caro; Smets, Ellen
Objectives: This paper describes the further development and psychometric properties of an instrument to measure cancer patients' reasons to want complete or limited information: the Considerations Concerning Cancer Information questionnaire (CCCI). Understanding cancer patients' reasons to want
Liu, Xiaowen; Cai, Hong; Yu, Lin; Huang, Hua; Long, Ziwen; Wang, Yanong
Family history of cancer is a risk factor for gastric cancer. In this study, we investigated the prognoses of gastric cancer patients with family history of cancer. A total of 1805 gastric cancer patients who underwent curative gastrectomy from 2000 to 2008 were evaluated. The clinicopathologic parameters and prognoses of gastric cancer patients with a positive family history (PFH) of cancer were compared with those with a negative family history (NFH). Of 1805 patients, 382 (21.2%) patients had a positive family history of cancer. Positive family history of cancer correlated with younger age, more frequent alcohol and tobacco use, worse differentiation, smaller tumor size, and more frequent tumor location in the lower 1/3 of the stomach. The prognoses of patients with a positive family history of cancer were better than that of patients with a negative family history. Family history of cancer independently correlated with better prognosis after curative gastrectomy in gastric cancer patients.
Innovative new drugs have improved outcomes for many cancer patients. But spending on cancer drugs has increased dramatically in recent years, placing a burden on cancer patients and a strain on health system and societal resources.
blood diseases and conditions; parasitic infections; rheumatic and inflammatory diseases; and rare and neglected diseases. CMRP’s collaborative approach to clinical research and the expertise and dedication of staff to the continuation and success of the program’s mission has contributed to improving the overall standards of public health on a global scale. The Clinical Monitoring Research Program (CMRP) provides comprehensive, dedicated clinical research, study coordination, and administrative support to the National Cancer Institute’s (NCI’s), Center for Cancer Research (CCR), Urologic Oncology Branch (UOB) located at the National Institutes of Health (NIH) in Bethesda, Maryland. KEY ROLES/RESPONSIBILITIES - THIS POSITION IS CONTINGENT UPON FUNDING APPROVAL The Patient Care Coordinator III (PCC III) provides administrative services, as well as patient care coordination. Responsibilities will include: Communicates with various clinical administrative support offices/clinics/diagnostic centers concerning scheduling of patient appointments, new and existing work scopes and clinical protocols (Surgery, X-ray, etc.). Consults with the patient, chooses the appropriate appointment, and enters ID and demographic data supplied by patient to secure an appointment in order to update clinic and physician schedules. Composes correspondence on various administrative issues including patient letters and notices to the patient’s home and physicians. Provides patients with information about their appointments, including medical materials the patient will need to bring, dates and times, clinic information, hospital maps and appropriate travel and hotel information. Arranges Admission Travel Voucher (ATV) travel, including lodging, meals and direct bill requests and enters data in the ATV system daily. Obtains up-to-date patient records and other pertinent information prior to patient appointments or admission. Maintains a roster of all patients and tracks their appointments
Ebel, Marie-Desiree; Stellamanns, Jan; Keinki, Christian; Rudolph, Ivonne; Huebner, Jutta
An increasing number of patients and relatives use the Internet to get additional or initial information about their disease. The aim of the study was to reevaluate the Internet usage among German cancer patients. Using a standardized questionnaire, we did an anonymous survey on patients attending a series of lectures on complementary medicine in 2014. We received 255 questionnaires. Nearly 80 % of the participants stated that they used the Internet to read up information about health or medicine issues. There was no significant difference regarding gender, age, or status (patient, current treatment/former treatment; relatives). Most users use the Internet in order to get additional information after a consultation with a physician (82.2 %). Important qualities from the view of the patient are a trustable source (65.3 %), information from experts (59.6 %), and actual information (52.8 %). There is an increasing number of patients in Germany looking for information in the Internet mostly in the intention of getting additional information. Yet, as the quality of information is heterogeneous, false information may lead to distrust in the doctor or wrong decision-making. Accordingly, organizations working on improving quality of cancer care should engage in conveying comprehensive and actual information adapted to the needs of patients. Physicians should know trustful websites for referral of patients.
de Vries, Y C; van den Berg, M M G A; de Vries, J H M; Boesveldt, S; de Kruif, J Th C M; Buist, N; Haringhuizen, A; Los, M; Sommeijer, D W; Timmer-Bonte, J H N; van Laarhoven, H W M; Visser, M; Kampman, E; Winkels, R M
Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect dietary habits. This study assessed the intake of energy, macronutrients and food groups before and during chemotherapy in breast cancer patients compared with women without cancer, and determined the association between symptoms and energy and macronutrient intake. This study included 117 newly diagnosed breast cancer patients scheduled for chemotherapy and 88 women without cancer. Habitual intake before chemotherapy was assessed with a food frequency questionnaire. Two 24-h dietary recalls were completed on random days for each participant during the whole chemotherapy treatment for patients and within 6 months after recruitment for women without cancer. Shortly, after the dietary recall, participants filled out questionnaires on symptoms. Before chemotherapy, habitual energy and macronutrient intake was similar for breast cancer patients and women without cancer. During chemotherapy, breast cancer patients reported a significantly lower total energy, fat, protein and alcohol intake than women without cancer, as shown by a lower intake of pastry and biscuits, cheese, legumes and meat products. A decline in subjective taste perception, appetite and hunger and experiencing a dry mouth, difficulty chewing, lack of energy and nausea were associated with a lower energy intake. Symptoms induced by chemotherapy are associated with lower dietary intake and manifested by a lower intake of specific food groups. To ensure an optimal dietary intake during chemotherapy, it is important to monitor nutritional status and symptom burden during chemotherapy in breast cancer patients.
Kirchheiner, K.; Czajka, A.; Luetgendorf-Cacig, C.; Schmid, M.P.; Komarek, E.; Poetter, R. [Medical Univ. of Vienna, Comprehensive Cancer Center, Vienna (Austria). Dept. of Radiation Oncology; Ponocny-Seliger, E. [Sigmund Freud Private Univ. Vienna (Austria). Dept. of Psychology; Doerr, W. [Medical Univ. of Vienna, Comprehensive Cancer Center, Vienna (Austria). Dept. of Radiation Oncology; Medical Univ. of Vienna (Austria). Christian Doppler Lab. for Medical Radiation Research for Radiation Oncology
Background. The need for psychosocial support in cancer patients is estimated in the literature at 14-50%. At the Department of Radiation Oncology, Medical University of Vienna, approximately 3,000 patients are seen annually. Due to limited staff resources, highly distressed patients need to be selected for focused support. A multidisciplinary screening questionnaire covering physical, social and psychological problems and needs was successfully implemented in clinical routine. We present the results of a representative sample of 1,500 heterogeneous cancer patients before beginning radiotherapy. Patients and methods. The prevalence rates of physical, social and psychological problems and needs were evaluated. Independent risk factors for critical psychological distress were analyzed in a multivariate logistic regression model, in order to identify vulnerable subgroups for focused psychosocial support. Results. Critical psychological distress was found in 22% of the overall cohort, of whom only 26% reported a need for psychological information. Clinically relevant pain was suffered by 31%. Patients' most frequent complaints were weakness, sleeping difficulties and exhaustion. Consequently, 40% were impaired in activities and 35% reported a requirement for support in daily life. A need for further information was expressed by 37% of patients. Significant risk factors for critical psychological distress included pain, functional status, support requirements and patient-reported symptoms. Differences in tumor type, metastases and sociodemographic variables had no impact on critical psychological distress. Conclusion. Approximately one third of all patients beginning radiotherapy have physical, social and psychological problems and should receive focused psychosocial support. Multivariate analysis reveals that patients with impaired ''physical integrity'' are at a significantly higher risk of experiencing critical psychological distress. (orig.)
Kirchheiner, K.; Czajka, A.; Luetgendorf-Cacig, C.; Schmid, M.P.; Komarek, E.; Poetter, R.; Ponocny-Seliger, E.; Doerr, W.; Medical Univ. of Vienna
Background. The need for psychosocial support in cancer patients is estimated in the literature at 14-50%. At the Department of Radiation Oncology, Medical University of Vienna, approximately 3,000 patients are seen annually. Due to limited staff resources, highly distressed patients need to be selected for focused support. A multidisciplinary screening questionnaire covering physical, social and psychological problems and needs was successfully implemented in clinical routine. We present the results of a representative sample of 1,500 heterogeneous cancer patients before beginning radiotherapy. Patients and methods. The prevalence rates of physical, social and psychological problems and needs were evaluated. Independent risk factors for critical psychological distress were analyzed in a multivariate logistic regression model, in order to identify vulnerable subgroups for focused psychosocial support. Results. Critical psychological distress was found in 22% of the overall cohort, of whom only 26% reported a need for psychological information. Clinically relevant pain was suffered by 31%. Patients' most frequent complaints were weakness, sleeping difficulties and exhaustion. Consequently, 40% were impaired in activities and 35% reported a requirement for support in daily life. A need for further information was expressed by 37% of patients. Significant risk factors for critical psychological distress included pain, functional status, support requirements and patient-reported symptoms. Differences in tumor type, metastases and sociodemographic variables had no impact on critical psychological distress. Conclusion. Approximately one third of all patients beginning radiotherapy have physical, social and psychological problems and should receive focused psychosocial support. Multivariate analysis reveals that patients with impaired ''physical integrity'' are at a significantly higher risk of experiencing critical psychological distress. (orig.)
Modern therapeutic modalities and emphasis on early detection have made oral cancer a treatable, and in many cases, a curable disease. The role of the dentist in cancer patient management is two-fold. Early detection of oral lesions during routine dental examination has been shown to be a significant factor in cancer diagnosis. The dentist's other role comes after cancer treatment, specifically therapeutic radiation. Ionizing radiation can have permanent effects on both hard and soft tissues. Prescription and use of fluoride gel in topical applicators can aid in assuring oral health for post-cancer patients
Dreyer, L; Olsen, J H
We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977...... and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the categories of cancer not related to tobacco smoking. Specifically, the rates of colorectal cancer...... in acute myocardial infarct patients were similar to those of the general population, as were the rates for hormone-related cancers, including endometrial and postmenopausal breast cancers. We found a moderate increase in the risk for tobacco-related cancers, which was strongest for patients with early...
Thavanesan, N; Abdalkoddus, M; Yao, C; Lai, C W; Stubbs, B M
Counselling patients and their relatives about non-curative management options in colorectal cancer is difficult because of a paucity of published data. This study aims to determine outcomes in patients unsuitable for curative surgery and the rates of subsequent surgical intervention. This was an analysis of all colorectal cancers managed without curative surgery in a district general hospital from a prospectively maintained cancer registry between 2009 and 2016, as decided by a multidisciplinary team. Primary outcomes were overall survival and secondary outcomes were subsequent intervention rates and impact of tumour stage. In all, 183 patients out of 976 patients (18.8%) were identified. The median age at diagnosis was 81 years [interquartile range (IQR) 71-87 years]. Overall median survival from diagnosis was 205 days (IQR 60-532 days). One-year mortality was 62.3%. Patients were classified into two groups depending on the reason for a non-curable approach: patient-related (PR) or disease-related (DR). The difference in survival between PR (median 277 days, IQR 70-593) and DR (median 179 days, IQR 51-450) was 98 days (P = 0.023). Twenty-four patients were alive at the end of the study period; 19 out of 91 cases in PR (20.8%) and five out of 92 cases in DR (5.4%). Overall intervention rates were 11.9%, with higher rates in the DR group (P = 0.005). Disease stage was not associated with subsequent surgical intervention between the two groups (P = 0.392). Life expectancy for non-curatively managed patients within our unit was 6.8 months with one in nine patients requiring subsequent surgical admission for palliation. This information may be useful when counselling patients with incurable colorectal malignancy. Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.
Full Text Available Background. We study the clinical significance and management of pulmonary venous obstruction in cancer patients. Methods. We conducted a prospective cohort study to characterize the syndrome that we term “pulmonary vein obstruction syndrome” (PVOS between January 2005 and March 2014. The criteria for inclusion were (1 episodes of shortness of breath; (2 chest X-ray showing abnormal pulmonary hilum shadow with or without presence of pulmonary edema and/or pleural effusion; (3 CT scan demonstrating pulmonary vein thrombosis/tumor with or without tumor around the vein. Results. Two hundred and twenty-two patients developed PVOS. Shortness of breath was the main symptom, which was aggravated by chemotherapy in 28 (13%, and medical/surgical procedures in 21 (9% and showed diurnal change in intensity in 32 (14%. Chest X-rays all revealed abnormal pulmonary hilum shadows and presence of pulmonary edema in 194 (87% and pleural effusion in 192 (86%. CT scans all showed pulmonary vein thrombosis/tumor (100% and surrounding the pulmonary veins by tumor lesions in 140 patients (63%. PVOS was treated with low molecular weight heparin in combination with dexamethasone, and 66% of patients got clinical/image improvement. Conclusion. Physicians should be alert to PVOS when shortness of breath occurs and chest X-ray reveals abnormal pulmonary hilum shadows.
Parvez, T.; Saeed, N.; Pervaiz, K.
Objective: Knowledge, information and communication, within oncology, are a core clinical strength for the out-come of the disease and inadequate communication, can cause distress for the patient and their families. Design: A senior doctor conducted this study by filling in the performa after interviewing the subject of the study. Place and duration of study: This study was done in Oncology Department of Service Hospital, Lahore and was completed in four months. Subjects and Method: One hundred cancer patients were interviewed regarding their knowledge about their disease, its causes, prognosis, and information supplied by the health-care providers. They were also asked about their satisfaction regarding this information, deficiencies and pitfalls in this information, need for more information, which should supply the information from among the hospital team or their relative, attitude of the family and their communication regarding the disease. Results: Study revealed that the knowledge about the disease and its causes was present in 53% and 7% respectively. The patients (59%) wanted more information. Majority perceived that the information was not adequate and needed more information and 68% thought that more information would reduce their anxiety. The attitude of family was found encouraging in 87% of patients and 42% were communicating with other family members regarding their diseases. Conclusion: Knowledge about the disease and its cause should be increasingly supplied by the doctors, as it will reduce the anxiety and have a good effect on health. Communication among the family members needs to be improved. (author)
Full Text Available Abstract Background The evaluation of cancer patients needs, especially during that delicate period when they are hospitalized, allows the identification of those areas of care that require to be improved. Aims of the study were to evaluate the needs in cancer inpatients and to improve the understanding of the meanings of the needs expressed. Methods The study was conducted during a "sample day", with all the cancer patients involved having been hospitalized at the Istituto Nazionale Tumori of Milan (INT for at least 48 hours beforehand. The study was carried out using quantitative and qualitative methodologies. The quantitative part of the study consisted in making use of the Needs Evaluation Questionnaire (NEQ, a standardized questionnaire administered by the INT Psychology Unit members, supported by a group of volunteers from the Milan section of the Italian League Against Cancer. The aim of the qualitative part of the study, by semi-structured interviews conducted with a small sample of 8 hospitalized patients, was to improve our understanding of the meanings, implications of the needs directly described from the point of view of the patients. Such an approach determines the reasons and conditions of the dissatisfaction in the patient, and provides additional information for the planning of improvement interventions. Results Of the 224 eligible patients, 182 (81% completed the questionnaire. Four of the top five needs expressed by 40% or more of the responders concerned information needs (diagnosis, future conditions, dialogue with doctors, economic-insurance solutions related to the disease. Only one of the 5 was concerned with improved "hotel" services (bathrooms, meals, cleanliness. Qualitative analysis showed that the most expressed need (to receive more information on their future conditions has the meaning to know how their future life will be affected more than to know his/her actual prognosis. Conclusions Some of the needs which
Imko-Walczuk, Beata; Piesiaków, Maria Luiza; Okuniewska, Aleksandra; Jaśkiewicz, Janusz; Lizakowski, Sławomir; Dębska-Ślizień, Alicja; Rutkowski, Bolesław
Cancer has become the second most common cause of death in patients after organ transplantation. Among all cancers arising de novo after transplantation skin cancers are the most common, accounting for 95% of all skin neoplasms. Due to the significantly higher morbidity, aggressive, rapid progression of cancer and unfavorable prognosis, the population requires a specific oncological approach. Therefore, special attention should be paid to factors predisposing to the development of cancer, including skin cancer, in patients after organ transplantation. Some of these factors are well understood, while the role of others is still ambiguous. Among the etiological factors mentioned are those that are associated with the recipient. These include genetic factors such as male sex, fair skin and inability to be tanned, and compatibility of the HLA system, and non genetic factors such as patient age, chronic skin ulcers and scars, the type of transplanted organ, immunosuppression, and particularly the type and cumulative doses of drugs. In addition, the pathogenesis of cancer is influenced by environmental factors such as exposure to sunlight and therefore latitude, ionizing radiation, chemical carcinogens and viral infections. Knowledge of etiological factors and mechanisms of etiopathogenesis allow for indication and observation of patients with increased risk of cancer as well as faster healing in these patients.
Suk Jae Kim
Full Text Available BACKGROUND: We hypothesized that hidden malignancy could be detected in patients with cryptogenic stroke without active cancer when they showed the distinctive characteristics of cancer-related stroke. METHODS AND FINDINGS: Among 2,562 consecutive patients with acute ischemic stroke, patients with cryptogenic stroke were analyzed and categorized into two groups according to the presence of active cancer: cryptogenic stroke with active cancer (cancer-related stroke, CA-stroke group and without active cancer (CR-stroke group. Patients with active lung cancer without stroke were also recruited for comparison purposes (CA-control. Clinical factors, lesion patterns on diffusion-weighted MRI (DWI, and laboratory findings were analyzed among groups. A total of 348 patients with cryptogenic stroke were enrolled in this study. Among them, 71 (20.4% patients had active cancer at the time of stroke. The D-dimer levels were significantly higher in patients with CA-stroke than those with CR-stroke or CA-control (both p<0.001. Regarding lesion patterns, patients with CA-stroke mostly had multiple lesions in multiple vascular territories, while more than 80% of patients with CR-stroke had single/multiple lesions in a single vascular territory (P<0.001. D-dimer levels (OR 1.11 per 1 µg/mL increase; 95% CI 1.06-1.15; P<0.001 and DWI lesion patterns (OR 7.13; 95% CI 3.42-14.87; P<0.001 were independently associated with CA-stroke. Workup for hidden malignancy was performed during hospitalization in 10 patients who showed elevated D-dimer levels and multiple infarcts involving multiple vascular territories but had no known cancer, and it revealed hidden malignancies in all the patients. CONCLUSION: Patients with CA-stroke have distinctive D-dimer levels and lesion patterns. These characteristics can serve as clues to occult cancer in patients with cryptogenic stroke.
Shirai, Katsuyuki; Tamaki, Yoshio; Kitamoto, Yoshizumi
Esophageal cancer patients are often associated with multiple primary cancers (MPC). The aim of this study is to evaluate the effect of MPC on prognosis in esophageal cancer patients treated by radiotherapy. Between 2001 and 2008, esophageal cancer patients treated by definitive radiotherapy at Gunma Cancer Center were retrospectively reviewed. Exclusion criteria were preoperative or postoperative radiotherapy, palliative radiotherapy, follow-up of <6 months, radiation dose of <50 Gy and no information on MPC. We analyzed 167 esophageal cancer patients and 56 (33.5%) were associated with MPC. Gastric cancer was the most frequent tumor (38.2%), followed by head and neck cancer (26.5%). Median follow-up time was 31.5 months (range 6.1-87.3 months). Patients with MPC included more stage I/II esophageal cancer than those without MPC (66.1% vs. 36.9%, P<0.01). The 5-year overall survival rate for esophageal cancer with MPC was relatively better than those without MPC (46.1% vs. 26.7%), although the difference did not reach statistical significance in univariate analysis (P=0.09). Stage I/II esophageal cancer patients had a significantly better overall survival than stage III/IV patients (P<0.01). Among esophageal cancer patients with MPC, there was no difference in overall survival between antecedent and synchronous cancer (P=0.59). Our study indicated that the prognosis of esophageal cancer patients treated by radiotherapy was primarily determined by the clinical stage itself, but not the presence of MPC. (author)
Peeters, C; Stewart, A; Segal, R; Wouterloot, E; Scott, C G; Aubry, T
Participation in an exercise intervention during cancer treatment diminishes the side effects associated with cancer therapies, although such benefits vary according to the disease and the patient characteristics. A structured exercise program providing an individualized fitness program tailored to the patients' illness, treatment, and fitness level would address this variability. However, the need, desired components, and anticipated barriers of such a program have not been systematically explored from either the point of view of cancer patients or treating oncologists. Sixty-six cancer patients and 18 medical and radiation oncologists were surveyed on the above variables. Cancer patients and oncologists alike perceived a need for a structured exercise program during and after medical treatment for cancer. Among cancer patients, the most commonly preferred feature was access to consultation with an exercise specialist who could take into account the patient's previous exercise and medical history. Over a third of patients reported interest in a hospital-based fitness program. Oncologists were in favor of appropriate supervision of patients during exercise, and noted insufficient time to discuss exercise in their practice. Respondents noted time and parking as barriers to participation. Overall, results support the need for a supervised exercise program during active treatment for cancer and highlight the desired features of such a program.
Takahashi, Takeo; Machida, Kikuo; Honda, Norinari; Hosono, Makoto; Murata, Osamu; Osada, Hisato; Omichi, Masahide
Evaluation of quality of life (QOL) in cancer patients is an important theme. However, we do not have an established method to assess QOL in cancer patients during radiotherapy in Japan. We evaluated both the changes of QOL and the factors affecting QOL in radiotherapy patients. Three hundred fifty-five cancer patients, who filled in a questionnaire at the beginning, middle, and end of radiotherapy between 1998 and 2001, were studied. We used The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD)'' devised by Kurihara et al, the Ministry of Health and Welfare. The QOL Questionnaire had five categories: physical activity, physical condition, mental state, social interaction, and face scale. The total score, sum of the score of five categories, were established synthetically (maximum score is 110). The mean of total QOL scores were 75.8, 77.6, and 78.2 at the beginning, middle, and end of radiotherapy respectively. Patients with symptoms related to cancer had apparent improvement of QOL score. Patients receiving chemotherapy had a decreased QOL score at the end of radiotherapy. The score of physical condition was reduced improvement. It was suggested that radiotherapy could be performed without losing QOL of cancer patients, including older patients. However, patients receiving chemotherapy and those with head and neck cancer may lose their QOL, therefore, we should treat such patients carefully. (author)
Huang, Wen-Kuan; Juang, Yeong-Yuh; Chung, Chia-Chi; Chang, Shu-Hao; Chang, John Wen-Cheng; Lin, Yung-Chang; Wang, Hung-Ming; Chang, Hsien-Kun; Chen, Jen-Shi; Tsai, Chieh-Sheng; Yu, Kuang-Hui; Kuo, Chang-Fu; See, Lai-Chu
The increasing number of long-term cancer survivors over the past few decades poses the challenge of mental health care needs. However, little is known about risks of mood disorders in long-term cancer survivors. Long-term survivors (≥5 years) of adult cancers (LSAC) (n = 190,748) newly diagnosed between January 1, 2000 and December 31, 2007 were matched with one control. The primary outcome was diagnosis of mood disorders requiring psychotropics. Cumulative incidences and sub-hazard ratios (SHR) were calculated and multivariate analyses were conducted after accounting for mortality. The mood disorder risk was significantly higher in the LSAC cohort than in the control cohort (adjusted SHR = 1.16, 95% confidence interval [CI] = 1.13-1.18, P < 0.001). Patients with certain cancer types were at increased risk, particularly in the first 2 years after diagnosis. However, patients with head and neck cancers or esophageal cancers had a higher risk after the 5-year follow-up period. Multivariate analysis indicated that being female, aged 40-59 years, with more than two primary cancers, receiving two or more treatment modalities, having CCI scores higher than 3, a higher urbanization level, and lower monthly income were independently associated with an increased risk of mood disorders. Some potential confounders such as lifestyle factors were not available in the study. These findings call for increased mental health awareness not only in the early years after the cancer diagnosis, but also during long-term follow-up for certain cancer subtypes. Copyright © 2018 Elsevier B.V. All rights reserved.
Maristela Santini Martins
Full Text Available Objective: analyzing the rights of patients required in a public service ombudsmen. Methods: an exploratory, descriptive study of documentary research. 109 complaint forms coming from the basic network were analyzed, related to 12 Basic Health Units located within the Southern Health Technical Supervision. Results: grouped into four categories of required rights: access to goods and services (62.4% being, access to specialized exams (28.7%, access to consultations (16.6%, referral to a specialist (5.7%, referral for urgent/emergency cases (1.3%, monitoring through home visits (7.6%, guaranteed medications (2.5%. Quality of health services (36.9% divided into: decent, considerate and respectful care (26.8%, guidance/clarification (9.6%, and public disclosure of government programs (0.6% and adequate infrastructure (0.6%. Conclusion: the rights that patients required are related to access, quality, treatment and adequate infrastructure.
Ocón Bretón, María Julia; Luengo Pérez, Luis Miguel; Virizuela, Juan Antonio; Álvarez Hernández, Julia; Jiménez Fonseca, Paula; Cervera Peris, Mercedes; Sendrós Madroño, María José; Grande, Enrique; Camblor Álvarez, Miguel
Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.
Supoken, Amornrat; Chaisrisawatsuk, Thitima; Chumworathayi, Bandit
Complementary and alternative medicine (CAM) for treatment of cancer and for supportive care of cancer patients must be clearly separated. There is encouraging evidence for CAM in the latter area, such as acupuncture and progressive muscle relaxation for chemotherapy-related nausea and vomiting, and aromatherapy for decreasing anxiety and increasing quality of life. However, there are limited data about CAM used by gynecologic cancer patients, especially in Thai women. Therefore, the authors aimed to investigate the proportion and types of CAM using in our gynecologic cancer patients. This cross-sectional survey was conducted between October to December, 2008. Totals of 50 admitted and 50 walk-in gynecologic cancer patients 1 month after diagnosis, aged more than 20 years and able to give informed consent, were selected for one-by-one interview by random walking survey. Among the 100 interviewed patients, aged 21-69 (mean=50.12), there were 46 cases of cervical cancers, 35 of ovarian cancers, 18 of endometrial cancers (two of these also had ovarian cancers), 2 of malignant gestational trophoblastic diseases, 1 of vulvar cancer, and 1 liver cancer (in a patient with ovarian cancer). Some 67% (95% CI, 57.8-76.2%) of them used CAM. As diet modifications, 11 used Chinese vegetarian, 8 common vegetarian, 5 Cheewajit, and 1 macrobiotics. Five of them used dietary supplements while colonic detoxification was emplyed in three. As herbal medicines, 27 used Thai herbs, 4 Chinese herbs, and 1 a herbal sauna. Twelve were receiving Thai massage. As exercises, 23 used aerobics and 5 stretching. Interestingly, 62 of them used Buddhist praying while only 3 employed native magic. The three most common forms of CAM used by our gynecologic cancer patients were Buddhist praying (62/67, 92.5%), followed by herbal medicines (27/67, 40.3%) and exercises (25/67, 37.3%).
Klikovac, T; Djurdjevic, A
In order to assess the impact of cancer diagnosis on several psychological dimensions, this study was undertaken with the aim to understand, identify and document the psychological responses of cancer patients - their common thoughts, feelings, body sensations and behavior when they faced the cancer diagnosis. The sample consisted of 80 patients who attended psychological lectures during the implementation of the European Educational Programme (EEP) "Learning to live with cancer". At the beginning of the lectures, the patients were asked to fulfill the self-describing questionnaire with 4 open questions: "Describe your common thoughts, feelings, behavior, and body reactions in the first 6 weeks when you learned that you were affected by cancer". A significant proportion of patients reported disease denial (65%) and reexamination in relation to past life experiences, stressful events and bad habits (60%). Depressive feelings and disappointment were reported by 90% of the patients, while 85% of them reported fear, hopelessness and emptiness. They also reported sadness (70%), anger and anxiety (65%), nervousness and irritability (90%). Positive thoughts and attitude in the sense of optimism concerning a successful treatment outcome were reported by 20% and 15% of patients, respectively. The diagnosis of cancer and cancer treatment can cause distress, emotional turmoil and different psychosocial disorders. Taking into consideration different psychological reactions of cancer patients can be helpful for organizing adequate psycho-educational and psychosocial support, and psychotherapy for cancer patients and their families.
To capture the perspectives from lesbian, gay, bisexual and transgender (LGBT) individuals diagnosed treated for cancer. Four LGBT individuals diagnosed and treated for cancer. Care for the LGBT patient is based on sensitivity and awareness to LGBT issues and concerns. Nurses caring for the LGBT cancer patient provide that care in a context of awareness and sensitivity. The nurse's approach to LGBT patient and family care is based on open communication, establishing trusting relationships and honoring the patient's preferences. Excellent oncology nursing care for LGBT patients is excellent oncology nursing care. Copyright © 2017 Elsevier Inc. All rights reserved.
investigation was a prospective study that was conducted in cancer patients receiving Inj. Doxorubicin .... patients. Pre-Chem o. I - Cycle. II - Cycle III - Cycle. IV - Cycle. 0. 1. 2. 3. 4 .... vitamin E, vitamin C, vitamin A, antioxidant components.
NCI scientists have studied cells of patients with an extremely rare genetic disease that is characterized by drastic premature aging and discovered a new protective cellular mechanism against cancer. They found that cells from patients with Hutchinson Gi
Teunissen, Saskia C.; de Graeff, Alexander; de Haes, Hanneke C.; Voest, Emile E.
To assess the prognostic value of symptoms in hospitalised advanced cancer patients. A prospective analysis was performed of 181 hospitalised patients referred to a Palliative Care Team. Comprehensive symptom questionnaire, functional status, estimated life expectancy and survival were assessed.
Malmstrom, M. L.; Brisling, S.; Klausen, T. W.
Purpose Accurate staging of colonic cancer is important for patient stratification. We aimed to correlate the diagnostic accuracy of preoperative computed tomography (CT) with final histopathology as reference standard. Methods Data was collected retrospectively on 615 consecutive patients operated...
Kang Min Lee
Full Text Available Hepatic infarction is known as a rare disease entity in nontransplant patients. Although a few cases of hepatic infarction have been reported to be linked with invasive procedures, trauma, and hypercoagulability, a case of spontaneous hepatic infarction in a nontransplanted patient has hardly ever been reported. However, many clinical situations of patients with cancer, in particular biliary cancer, can predispose nontransplant patients to hepatic infarction. Besides, the clinical outcome of hepatic infarction in patients with cancer can be worse than in patients with other etiologies. As for treatment, anticoagulation treatment is usually recommended. However, because of its multifactorial etiology and combined complications, treatment of hepatic infarction is difficult and not simple. Herein, we report a case of fatal hepatic infarction that occurred spontaneously during the course of treatment in a patient with gallbladder cancer. Hepatic infarction should be considered as a possible fatal complication in patients during treatment of biliary malignancies.
Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug, according to an interim analysis
Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah
Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.
Lyatskaya, Yulia; James, Steven; Killoran, Joseph H.; Soto, Ricardo; Mamon, Harvey J.; Chin, Lee; Allen, Aaron M.
Purpose: To evaluate the utility of an infrared-guided patient setup (iGPS) system to reduce the uncertainties in the setup of lung cancer patients. Methods and Materials: A total of 15 patients were setup for lung irradiation using skin tattoos and lateral leveling marks. Daily electronic portal device images and iGPS marker locations were acquired and retrospectively reviewed. The iGPS-based shifts were compared with the daily electronic portal device image shifts using both the central axis iGPS marker and all five iGPS markers. For shift calculation using the five markers, rotational misalignment was included. The level of agreement between the iGPS and portal imaging to evaluate the setup was evaluated as the frequency of the shift difference in the range of 0-5 mm, 5-10 mm, and >10 mm. Results: Data were obtained for 450 treatment sessions for 15 patients. The difference in the isocenter shifts between the weekly vs. daily images was 0-5 mm in 42%, 5-10 mm in 30%, and >10 mm in 10% of the images. The shifts seen using the iGPS data were 0-5 mm in 81%, 5-10 mm in 14%, and >10 mm in 5%. Using only the central axis iGPS marker, the difference between the iGPS and portal images was 10 mm in 7% in the left-right direction and 73%, 18%, and 9% in the superoinferior direction, respectively. When all five iGPS markers were used, the disagreements between the iGPS and portal image shifts >10 mm were reduced from 7% to 2% in the left-right direction and 9% to 3% in the superoinferior direction. Larger reductions were also seen (e.g., a reduction from 50% to 0% in 1 patient). Conclusion: The daily iGPS-based shifts correlated well with the daily electronic portal device-based shifts. When patient movement has nonlinear rotational components, a combination of surface markers and portal images might be particularly beneficial to improve the setup for lung cancer patients
Alireza Mohajjel Aghdam
Full Text Available Context: Fear of cancer recurrence (FOCR is one of the most important psychological problems among cancer patients. In extensive review of related literature there were no articles on FOCR among Iranian cancer patients. Aim: The aim of present study was to investigation FOCR and its predictive factors among Iranian cancer patients. Materials and Methods: In this descriptive-correlational study 129 cancer patients participated. For data collection, the demographic checklist and short form of fear of progression questionnaire was used. Logistic regression was used to determine predictive factors of FOCR. Result: Mean score of FOCR among participants was 44.8 and about 50% of them had high level of FOCR. The most important worries of participants were about their family and the future of their children and their lesser worries were about the physical symptoms and fear of physical damage because of cancer treatments. Also, women, breast cancer patient, and patients with lower level of education have more FOCR. Discussion: There is immediate need for supportive care program designed for Iranian cancer patients aimed at decreasing their FOCR. Especially, breast cancer patients and the patient with low educational level need more attention.
Naumann, Fiona L; Hunt, Mitchell; Hunt, Mitchel; Ali, Dulfikar; Wakefield, Claire E; Moultrie, Kevin; Cohn, Richard J
The improved treatment protocols and subsequent improved survival rates among childhood cancer patients have shifted the focus toward the long-term consequences arising from cancer treatment. Children who have completed cancer treatment are at a greater risk of delayed development, diminished functioning, disability, compromised fundamental movement skill (FMS) attainment, and long-term chronic health conditions. The aim of the study was to compare FMS of childhood cancer patients with an aged matched healthy reference group. Pediatric cancer patients aged 5-8 years (n = 26; median age 6.91 years), who completed cancer treatment (<5 years) at the Sydney Children's Hospital, were assessed performing seven key FMS: sprint, side gallop, vertical jump, catch, over-arm throw, kick, and leap. Results were compared to the reference group (n = 430; 6.56 years). Childhood cancer patients scored significantly lower on three out of seven FMS tests when compared to the reference group. These results equated to a significantly lower overall score for FMS. This study highlighted the significant deficits in FMS within pediatric patients having completed cancer treatment. In order to reduce the occurrence of significant FMS deficits in this population, FMS interventions may be warranted to assist in recovery from childhood cancer, prevent late effects, and improve the quality of life in survivors of childhood cancer. © 2015 Wiley Periodicals, Inc.
Suk, Hyoam; Kwon, Oh Kyung; Yu, Wansik
Purpose We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. Materials and Methods The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9?12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (E...
MATSUDA, AYAKO; KOBAYASHI, MIKA; SAKAKIBARA, YUMI; TAMAOKA, MEIYO; FURUIYE, MASASHI; INASE, NAOHIKO; MATSUSHIMA, EISUKE
An increasing number of cancer patients receive outpatient chemotherapy as an alternative to inpatient chemotherapy. The aim of this study was to investigate whether quality of life (QOL) during outpatient chemotherapy was better than QOL prior to hospital discharge, and to explore possible related factors prior to hospital discharge that affected the QOL of lung cancer patients who received outpatient chemotherapy. Lung cancer inpatients who were scheduled for outpatient chemotherapy were as...
Lee, Gina; Gardner, Brian K; Elashoff, David A; Purcell, Colleen M; Sandha, Harpavan S; Mao, Jenny T; Krysan, Kostyantyn; Lee, Jay M; Dubinett, Steven M
Despite advances in treatments, lung cancer has been the leading cause of cancer-related deaths in the United States for the past several decades. Recent findings from the National Lung Screening Trial reveal that low-dose helical computed tomography (CT) scan screening of high-risk individuals reduces lung cancer mortality. This suggests that early detection is of key importance to improving patient outcome. However, of those screened with CT scans, 25% had positive scans that require further follow-up studies which often involve more radiation exposure and invasive tests to reduce false positive results. The purpose of this study was to identify candidate plasma biomarkers to aid in diagnosis of lung cancer in at-risk individuals. We found increased expression of the CXC chemokine connective tissue-activating peptide (CTAP)-III from plasma specimens of lung cancer patients compared to at-risk control subjects. Identification of the peptide was confirmed by the addition of an anti-NAP-2 antibody that recognizes CTAP-III and NAP-2. We also quantified and verified the increased levels of plasma CTAP-III with ELISA in patients with lung cancer (mean ± SD, 1859 ± 1219 ng/mL) compared to controls (698 ± 434 ng/mL; Pcancer patients. Further studies are required to determine if this chemokine could be utilized in a blood-based biomarker panel for the diagnosis of lung cancer.
Full Text Available BACKGROUND: JCV is a DNA polyomavirus very well adapted to humans. Although JCV DNA has been detected in colorectal cancers (CRC, the association between JCV and CRC remains controversial. In China, the presence of JCV infection in CRC patients has not been reported. Here, we investigated JCV infection and viral DNA load in Chinese CRC patients and to determine whether the JCV DNA in peripheral blood (PB can be used as a diagnostic marker for JCV-related CRC. METHODOLOGY/PRINCIPAL FINDINGS: Tumor tissues, non-cancerous tumor-adjacent tissues and PB samples were collected from 137 CRC patients. In addition, 80 normal colorectal tissue samples from patients without CRC and PB samples from 100 healthy volunteers were also harvested as controls. JCV DNA was detected by nested PCR and glass slide-based dot blotting. Viral DNA load of positive samples were determined by quantitative real-time PCR. JCV DNA was detected in 40.9% (56/137 of CRC tissues at a viral load of 49.1 to 10.3×10(4 copies/µg DNA. Thirty-four (24.5% non-cancerous colorectal tissues (192.9 to 4.4×10(3 copies/µg DNA and 25 (18.2% PB samples (81.3 to 4.9×10(3 copies/µg DNA from CRC patients were positive for JCV. Tumor tissues had higher levels of JCV than non-cancerous tissues (P = 0.003 or PB samples (P<0.001. No correlation between the presence of JCV and demographic or medical characteristics was observed. The JCV prevalence in PB samples was significantly associated with the JCV status in tissue samples (P<0.001. Eleven (13.8% normal colorectal tissues and seven (7.0% PB samples from healthy donors were positive for JCV. CONCLUSIONS/SIGNIFICANCE: JCV infection is frequently present in colorectal tumor tissues of CRC patients. Although the association between JCV presence in PB samples and JCV status in tissue samples was identified in this study, whether PB JCV detection can serve as a marker for JCV status of CRC requires further study.
Jiang, Pinglan; Wang, Shuhong; Jiang, Dongmei; Yu, Lingli
To study the relevance between cancer related fatigue and coping styles in breast cancer patients after chemotherapy. A survey was conducted in 396 patients with breast cancer after chemotherapy on cancer related fatigue scale and Jalowiec coping scale, and the relation was analyzed. The rate of overall fatigue in breast cancer patients was 96.97%, mostly moderate fatigue. The rate of fatigue dimensions from high to low was physical fatigue, feeling fatigue and cognitive fatigue, respectively. The score of coping styles in patients with breast cancer after chemotherapy from high to low was optimistic coping, facing bravely, support seeking, self-reliance, emotional catharsis, avoidance, fatalism, and conservation. The most widely used coping style was optimistic coping style, and the least was emotional catharisis. There was a positive correlation between coping style of emotional catharsis and cancer related fatigue of all dimensions (Pself-reliance, or conservation (P<0.05). There was also a negative correlation between physical fatigue and optimistic or support seeking (P<0.05), but there was a positive correlation between avoidance or fatalism and the dimensions of general fatigue, physical fatigue, and cognitive fatigue (P<0.05). There is prevalent cancer related fatigue in patients with breast cancer after chemotherapy. We should guide the patients to more active coping styles, to enhance the ability of psychological adaption in patients, reduce cancer related fatigue, and improve the quality of life.
Full Text Available Cancer diagnosis is a very unpleasant and unbelievable experience. Appropriate management and treatment of these diseases require a high degree of patient engagement. Interactive health electronic games are engaging, fun, challenging, and experiential and have the potential to change the attitude and behavior, which can improve the player's health. The use of these digital tools, as one of the most attractive and entertaining modern technologies, canem power patients, provide suitable palliative care, promote health behavior change strategies, increase patient engagement, enhance healthy lifestyle habits, improve self.management, and finally improve the quality of life of the patients. Finally, the aim of this article was to describe electronic games and their effects on the promotion of behavior change in cancer patients. In addition, this article describes categories, characteristic features, and benefits of this digital media in the lifestyle modification of cancer patients.
Swart, S.J.; Rietjens, J.A.C.; van Zuylen, L.; Zuurmond, W.W.A.; Perez, R.S.G.M.; van der Maas, P.J.; van Delden, J.J.M.; van der Heide, A.
Context: Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. Objectives: To study the practice of continuous palliative sedation for both cancer and noncancer patients. Methods: In 2008,
de Boer, Angela G. E. M.; Taskila, Tyna K.; Tamminga, Sietske J.; Feuerstein, Michael; Frings-Dresen, Monique H. W.; Verbeek, Jos H.
Cancer patients are 1.4 times more likely to be unemployed than healthy people. Therefore it is important to provide cancer patients with programmes to support the return-to-work (RTW) process. This is an update of a Cochrane review first published in 2011. To evaluate the effectiveness of
Depression is the most frequent psychiatric comorbidity in cancer patients especially those in terminal stage. Despite the large amount of studies on depression in cancer patients, there are a lot of unanswered questions with respect to diagnosis, prevalence and treatment. Diagnosing depression in
Background: Hepatic dysfunction in the cancer unit has a significant impact on patient outcomes. The therapeutic application of anthracycline antibiotics are limited by side‑effects mainly myelosuppression, chronic cardiotoxicity, and hepatotoxicity. Aim: To assess the risk of Hepatotoxicity in breast cancer patients receiving ...
Alshemmari, Salem H; Elbasmi, Amani A; Alsirafy, Samy A
The place of death (PoD) has a significant effect on end-of-life care for patients dying of cancer. Little is known about the place of cancer deaths in our region. To identify the PoD of patients with cancer in Kuwait, we reviewed the death certificates submitted to the Kuwait Cancer Registry in 2009. Of 611 cancer deaths, 603 (98.7%) died in hospitals and only 6 (1%) patients died at home. More than half (57.3%) of inhospital deaths were in the Kuwait Cancer Control Center. Among those for whom the exact PoD within the hospital was identified (484 patients), 116 (24%) patients died in intensive care units and 12 (2.5%) patients died in emergency rooms. This almost exclusive inhospital death of patients with cancer in Kuwait is the highest ever reported. Research is needed to identify the reasons behind this pattern of PoD and to explore interventions promoting out-of-hospital death among terminally ill cancer patients in Kuwait. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Purpose: The aim of this study was to analyze the blood glucose (BG) variations in cancer patients during chemotherapy according to tumor types and chemotherapeutic regimens. Materials and Methods: Patients were examined from the Department of Medical Oncology of Cancer Hospital and Institute, Chinese Academy ...
Polk, Anne; Vaage-Nilsen, Merete Bech; Vistisen, Kirsten
To systematically review the incidence, manifestations and predisposing factors for cardiovascular toxicity in cancer patients treated with systemic 5-fluorouracil or capecitabine.......To systematically review the incidence, manifestations and predisposing factors for cardiovascular toxicity in cancer patients treated with systemic 5-fluorouracil or capecitabine....
Cree, Ian A; Deans, Zandra; Ligtenberg, Marjolijn J L; Normanno, Nicola; Edsjö, Anders; Rouleau, Etienne; Solé, Francesc; Thunnissen, Erik; Timens, Wim; Schuuring, Ed; Dequeker, Elisabeth; Murray, Samuel; Dietel, Manfred; Groenen, Patricia; Van Krieken, J Han
Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this paper is to provide minimum requirements for the management of molecular pathology laboratories. This general guidance should be augmented by the specific guidance available for different tumour types and tests. Preanalytical considerations are important, and careful consideration of the way in which specimens are obtained and reach the laboratory is necessary. Sample receipt and handling follow standard operating procedures, but some alterations may be necessary if molecular testing is to be performed, for instance to control tissue fixation. DNA and RNA extraction can be standardised and should be checked for quality and quantity of output on a regular basis. The choice of analytical method(s) depends on clinical requirements, desired turnaround time, and expertise available. Internal quality control, regular internal audit of the whole testing process, laboratory accreditation, and continual participation in external quality assessment schemes are prerequisites for delivery of a reliable service. A molecular pathology report should accurately convey the information the clinician needs to treat the patient with sufficient information to allow for correct interpretation of the result. Molecular pathology is developing rapidly, and further detailed evidence-based recommendations are required for many of the topics covered here. PMID:25012948
Maltoni, Marco; Setola, Elisabetta
Palliative sedation involves the use of sedative medication to relieve refractory symptoms in patients by reducing their level of consciousness. Although it is considered an acceptable clinical practice from most ethical points of view, palliative sedation is still a widely debated procedure and merits better understanding. The relevant medical literature pertaining to palliative sedation was analyzed and reviewed from various technical, relational, and bioethical perspectives. Proportionate palliative sedation is considered to be the most clinically appropriate modality for performing palliative sedation. However, guidelines must be followed to ensure that it is performed correctly. Benzodiazepines represent the first therapeutic option and careful monitoring of dosages is essential to avoid oversedation or undersedation. Proportionate palliative sedation is used to manage and relieve refractory symptoms in patients with cancer during their last days or hours of life. Evidence suggests that its use has no detrimental effect on survival. A different decision-making process is used to manage the withdrawal of hydration than the process used to determine whether proportionate palliative sedation is appropriate. Communication between patients, their relatives, and the health care staff is important during this medical intervention.
Petkovska, Sonja; Tolevska, Cveta; Kraleva, Slavica; Petreska, Elena
The purpose of this study is to present the level of conformity achieved by using 3D conformal radiotherapy for brain cancer patients. Conformity index is a helpful quantitative tool for assessing (evaluating) the quality of a treatment plan. Treatment plans made for ninety patients with brain tumor are worked on this paper. The patients are in supine position and immobilized with thermoplastic masks for the head. Computed tomography data sets with 5 mm scan thickness are used to create a 3D image. All structures of interest are contoured. In order to obtain an optimal dose distribution, treatment fields are fit around target volume with set-up margins of 7mm in each direction. The conformity index values are between 1.21 and 2.04. Value of 1.8 is exceeded in eighteen cases; nine of them are bigger than 1.9 and only three of them are above 2. The target volume for each of these extreme CI values is ideal covered (between 95% and 105% of the prescribed dose). The most acceptable conformity index value in this paper belongs to the plan with the lowest minimal dose (84.7%). It can be concluded that conformity index is necessary but not sufficient factor for assessing radiation treatment plan conformity. To be able to estimate the acceptability of some treatment plan in daily practice, additional information as minimal, maximal and mean dose into target volume, as well as health tissues coverage must be taken into account.(Author)
Full Text Available In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.
Stroud, D [Kaiser Permanente, Los Angeles Ca, CA (United States)
Purpose: Treatment of 131I thyroid cancer patients who also require regular hemodialysis (HD) treatments requires consideration of the administered activity and the HD schedule. In this work the red bone marrow is considered the dose limiting organ and the treatment plan optimized the HD schedule with the amount of radioactivity administered. Methods: The ‘Safe’ dose was considered to be 2 Gy (200 rad) to the red bone marrow.1 131Iodine doses of 50 mCi to 100 mCi were modeled and found to require a range of HD schedules. In order to achieve the safe dose to the red marrow, more aggressive HD schedules are required. 100 mCi required an aggressive HD treatment of every 24 hours for at least one week to achieve the ‘safe’ dose and an exposure appropriate for release from the hospital. A more normal schedule of HD beginning at 18 hours then every 48 hours allowed for up to 60 mCi administered dose allowed for a safe dose and expected release after less than one week.2In addition room was equipped with video cameras cameras for monitoring the patient and their vital signs from an adjacent room during HD. In this way the dialysis nurses were able to monitor the patient closely from an adjoining room. Results: Two HD patients were administered adjusted doses of about 50 mCi. The medical and nursing staff were exposed to no more than 4 mR for the entire treatment. The residual Iodine in the patient appeared to be normal after 4 to 6 days when the patient was released. Conclusion: With careful treatment planning 131Iodine treatments can be performed safely for patients needing HD and treatments appear to be as effective as those for patients with normal renal function.
Purpose: Treatment of 131I thyroid cancer patients who also require regular hemodialysis (HD) treatments requires consideration of the administered activity and the HD schedule. In this work the red bone marrow is considered the dose limiting organ and the treatment plan optimized the HD schedule with the amount of radioactivity administered. Methods: The ‘Safe’ dose was considered to be 2 Gy (200 rad) to the red bone marrow.1 131Iodine doses of 50 mCi to 100 mCi were modeled and found to require a range of HD schedules. In order to achieve the safe dose to the red marrow, more aggressive HD schedules are required. 100 mCi required an aggressive HD treatment of every 24 hours for at least one week to achieve the ‘safe’ dose and an exposure appropriate for release from the hospital. A more normal schedule of HD beginning at 18 hours then every 48 hours allowed for up to 60 mCi administered dose allowed for a safe dose and expected release after less than one week.2In addition room was equipped with video cameras cameras for monitoring the patient and their vital signs from an adjacent room during HD. In this way the dialysis nurses were able to monitor the patient closely from an adjoining room. Results: Two HD patients were administered adjusted doses of about 50 mCi. The medical and nursing staff were exposed to no more than 4 mR for the entire treatment. The residual Iodine in the patient appeared to be normal after 4 to 6 days when the patient was released. Conclusion: With careful treatment planning 131Iodine treatments can be performed safely for patients needing HD and treatments appear to be as effective as those for patients with normal renal function
Durfee, Sara M; Benson, Carol B; Arthaud, Dylan M; Alexander, Erik K; Frates, Mary C
To determine whether the sonographic appearance of thyroid cancer differs in patients with and without Hashimoto thyroiditis. Patients with histologically proven thyroid cancer who had thyroid peroxidase (TPO) antibodies measured and sonography performed preoperatively were included. We evaluated each nodule for size, echogenicity, composition, margins, halo, and vascularity and evaluated the background heterogeneity of the gland. There were 162 thyroid cancers in 145 patients. Forty-two patients (29.0%) had Hashimoto thyroiditis with positive TPO antibodies, and 103 patients (71.0%) had negative TPO antibodies. The background echogenicity was more often heterogeneous in TPO antibody-positive patients compared to those who had negative TPO antibodies (57.1% versus 26.2%; P= .0005). Comparing cancers in TPO antibody-positive to TPO antibody-negative patients, there was no significant difference in the size, echogenicity, composition, margins, halo presence, calcification presence and type, or vascularity of the cancerous nodule (P > .05). Among TPO antibody-positive patients, comparing thyroid cancerous nodules in patients with heterogeneous glands to those with homogeneous glands, there was no significant difference in any sonographic characteristic except the margin of the nodule, which was more often irregular or poorly defined in heterogeneous glands and more often smooth in homogeneous glands (Pthyroid cancer are similar in patients with and without Hashimoto thyroiditis. Among patients with Hashimoto thyroiditis and thyroid cancer, the sonographic appearance of the cancerous nodule is similar, except that cancerous nodule margins are more likely to be irregular or poorly defined when the gland is heterogeneous. © 2015 by the American Institute of Ultrasound in Medicine.
Goshayeshi, Ladan; Hoseini, Benyamin; Yousefli, Zahra; Khooie, Alireza; Etminani, Kobra; Esmaeilzadeh, Abbas; Golabpour, Amin
Gastric cancer is one of the most prevalent cancers in the world. Characterized by poor prognosis, it is a frequent cause of cancer in Iran. The aim of the study was to design a predictive model of survival time for patients suffering from gastric cancer. This was a historical cohort conducted between 2011 and 2016. Study population were 277 patients suffering from gastric cancer. Data were gathered from the Iranian Cancer Registry and the laboratory of Emam Reza Hospital in Mashhad, Iran. Patients or their relatives underwent interviews where it was needed. Missing values were imputed by data mining techniques. Fifteen factors were analyzed. Survival was addressed as a dependent variable. Then, the predictive model was designed by combining both genetic algorithm and logistic regression. Matlab 2014 software was used to combine them. Of the 277 patients, only survival of 80 patients was available whose data were used for designing the predictive model. Mean ?SD of missing values for each patient was 4.43?.41 combined predictive model achieved 72.57% accuracy. Sex, birth year, age at diagnosis time, age at diagnosis time of patients' family, family history of gastric cancer, and family history of other gastrointestinal cancers were six parameters associated with patient survival. The study revealed that imputing missing values by data mining techniques have a good accuracy. And it also revealed six parameters extracted by genetic algorithm effect on the survival of patients with gastric cancer. Our combined predictive model, with a good accuracy, is appropriate to forecast the survival of patients suffering from Gastric cancer. So, we suggest policy makers and specialists to apply it for prediction of patients' survival.
Liu, Xiangdong; Ji, Jianguang; Sundquist, Kristina; Sundquist, Jan; Hemminki, Kari
Cancer patients diagnosed with type 2 diabetes mellitus (T2DM) are at an increased risk of death due to cancer. However, whether T2DM comorbidity increases other causes of death in cancer patients is the novel theme of this study. Patients with T2DM were identified from the nationwide Swedish Hospital Discharge Register and linked with patients with cancer recorded from the Swedish Cancer Registry. Hazard ratios (HRs) were calculated for death due to all causes among cancer patients with and without T2DM; both underlying and multiple causes of death were examined using the Cox regression model. A total of 13 325 cancer patients were identified with comorbidity of T2DM. The total number of deaths of cancer patients was 276 021. Of these, 5900 occurred after T2DM diagnosis. For underlying causes of death, except for T2DM, the highest cause-specific HRs were found for complications of bacterial disease (HR, 3.93; 95% CI, 3.04-5.09), urinary system disease (HR, 3.39; 95% CI, 2.78-4.12), and myocardial infarction (HR, 2.93; 95% CI, 2.75-3.12). When risk of death was examined for both underlying and multiple causes of death, the highest HRs were found for hypertensive disease (HR, 3.42; 95% CI, 3.15-3.72), urinary system disease (HR, 3.39; 95% CI, 3.17-3.63), and arterial disease (HR, 3.26; 95% CI, 3.08-3.46). The diagnosis of T2DM in cancer patients is associated with an increased risk of death due to various causes, including myocardial infarction, other bacterial disease, urinary system disease, hypertensive disease, arterial disease, and so on, which may be related to both cancer and treatment. Clinicians that treat cancer patients with T2DM should pay more attention to comorbidities.
Liu, L.; Lemmens, V.E.; de Hingh, I.H.J.T.; de Vries, E.; Roukema, J.A.; van Leerdam, M.E.; Coebergh, J.W.; Soerjomataram, I.
Background: Compared with the general population, patients with a previous colorectal cancer are at higher risk for a second colorectal cancer, but detailed risk analysis by subsite is scarce. Objective: Our goal was to investigate the risk of a second cancer in relation to subsite as a basis for
Katz, Steven J; Hawley, Sarah T; Morrow, Monica; Griggs, Jennifer J; Jagsi, Reshma; Hamilton, Ann S; Graff, John J; Friese, Christopher R; Hofer, Timothy P
The Institute of Medicine has called for more coordinated cancer care models that correspond to initiatives led by cancer providers and professional organizations. These initiatives parallel those underway to integrate the management of patients with chronic conditions. We developed 5 breast cancer patient and practice management process measures based on the Chronic Care Model. We then performed a survey to evaluate patterns and correlates of these measures among attending surgeons of a population-based sample of patients diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles and Detroit (N = 312; response rate, 75.9%). Surgeon practice specialization varied markedly with about half of the surgeons devoting 15% or less of their total practice to breast cancer, whereas 16.2% of surgeons devoted 50% or more. There was also large variation in the extent of the use of patient and practice management processes with most surgeons reporting low use. Patient and practice management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status was weakly associated with patient and practice management processes. Low uptake of patient and practice management processes among surgeons who treat breast cancer patients may indicate that surgeons are not convinced that these processes matter, or that there are logistical and cost barriers to implementation. More research is needed to understand how large variations in patient and practice management processes might affect the quality of care for patients with breast cancer.
Justin Y Jeon
Full Text Available BACKGROUND: To evaluate the impact of diabetes on outcomes in colorectal cancer patients and to examine whether this association varies by the location of tumor (colon vs. rectum. PATIENTS AND METHODS: This study includes 4,131 stage I-III colorectal cancer patients, treated between 1995 and 2007 (12.5% diabetic, 53% colon, 47% rectal in South Korea. Cox proportional hazards modeling was used to determine the prognostic influence of DM on survival endpoints. RESULTS: Colorectal cancer patients with DM had significantly worse disease-free survival (DFS [hazard ratio (HR 1.17, 95% confidence interval (CI: 1.00-1.37] compared with patients without DM. When considering colon and rectal cancer independently, DM was significantly associated with worse overall survival (OS (HR: 1.46, 95% CI: 1.11-1.92, DFS (HR: 1.45, 95% CI: 1.15-1.84 and recurrence-free survival (RFS (HR: 1.32, 95% CI: 0.98-1.76 in colon cancer patients. No association for OS, DFS or RFS was observed in rectal cancer patients. There was significant interaction of location of tumor (colon vs. rectal cancer with DM on OS (P = 0.009 and DFS (P = 0.007. CONCLUSIONS: This study suggests that DM negatively impacts survival outcomes of patients with colon cancer but not rectal cancer.
Stratton, Kelly L; Alanee, Shaheen; Glogowski, Emily A; Schrader, Kasmintan A; Rau-Murthy, Rohini; Klein, Robert; Russo, Paul; Coleman, Jonathan; Offit, Kenneth
To analyze patients with kidney cancer referred for evaluation at a high-volume genetics service at a comprehensive cancer center and identify factors associated with positive tests for hereditary cancer syndromes. A retrospective review of patients referred to the Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center was performed, and patients with a personal history of kidney cancer were identified. Patient and disease characteristics were reviewed. In all, 4 variables including age at diagnosis of kidney tumor, presence of syndromic manifestations, family history of kidney cancer, and number of primary malignancies were evaluated for association with positive test results in 2 groups: patients tested for renal cell carcinoma syndromes and Lynch syndrome. Guidance for genetic testing strategy in patients with kidney cancer is provided. Between 1999 and 2012, 120 patients with a history of kidney cancer were evaluated by the Clinical Genetics Service. The mean age at kidney cancer diagnosis was 52 years (interquartile range: 42-63), with 57% being women. A family history of kidney cancer was reported by 39 patients (33%). Time between diagnosis of first cancer and genetic consultation was 5 years in the remaining 23%. Overall, 95 patients were tested for genetic abnormalities with 27 (28%) testing positive. Testing for renal cell carcinoma (RCC)-related syndromes was performed on 43 patients, with 13 testing positive (30%). Lynch syndrome testing was positive in 9 patients (32%) after 28 were tested. In RCC-associated syndromes, young age of diagnosis was associated with positive test results. Conversely, syndromic manifestations and increasing number of primary malignancies were associated with positive Lynch testing. The discovery of inherited kidney cancer syndromes has provided a unique opportunity to identify patients at increased risk for cancer. Factors associated with positive genetic testing are unique to different syndromes. These data
Dziewulska, Anna; Janiszewska-Olszowska, Joanna; Bachanek, Teresa; Grocholewicz, Katarzyna
To analyse the mineral content of saliva in patients with oral cancer in order to identify possible markers that might aid the diagnosis of oral cancer. The study group consisted of 34 patients, aged 35-72 years with a diagnosis of oral cancer, including seven women and 27 men, before the start of treatment. Samples of unstimulated saliva were collected in plastic containers. The concentrations of sodium and potassium were assessed using ion selective electrodes, and the concentrations of calcium, magnesium, iron and phosphorus were assessed using colorimetric methods. Statistically significant differences between the study and control groups were found only for the concentration of sodium--higher concentrations were found in the study group. When comparing different cancer localisations, the highest levels of salivary sodium were found in cases of cancer of the floor of the oral cavity, and the lowest levels in tongue or parotid gland cancer. The highest calcium levels were found in cancer of the floor of the oral cavity, and the lowest levels in tongue cancer. The highest levels of magnesium were found in cancer of the floor of the oral cavity, and the lowest in tongue cancer. As regards the different histological types, higher sodium and calcium levels were found in squamous cell carcinomas than in other types. Salivary mineral content in patients with oral squamous cell carcinoma is indicative of oral dehydration; however, we found no evidence of any salivary mineral markers that would be useful for the diagnosis of oral cancer.
Takamura, S; Sakuyama, T; Nakamura, Y; Takahashi, N; Hattori, M
In the last 6 years, we have experienced 20 cancer patients who received home parenteral nutrition for terminal stage. The patients had 13 gastric cancers, 3 esophageal cancers and 5 others. The prognosis of upper G-I cancer is known to be poorer than that of colon cancer. The home care of our cases, the gastric cancer lasted 25 days on average, which was shorter than others. So the home care for patients in the terminal stage of gastric cancer is very short. Therefore we decide the home care for the terminal stage of gastric cancer as soon as possible. We conducted a questionnaire survey of our cases and family. We finally found that the most important thing is the safety of patient for the maintenance of home care. Our home care system is made up of a 3-way relationship among the patient, support system and doctor. The doctor is on call for the problems of the patient for 24 hours. Therefore, we believe that this system is comfortable for both the patient and family.
Fallahzadeh, Ramin; Ghasemzadeh, Hassan; Shahrokni, Armin
The purpose of this review is to explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings. With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic healthcare. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems. While some studies reported positive outcomes using remote assessment technologies, such as web/smart phone-based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer care is warranted.
A. L. Akopov
Full Text Available Current views on mechanisms of therapeutic effect of photodynamic therapy for treating of cancer patients are represented. The history of formation and development of the method is described. The main requirements for agents used as photosensitizers are listed. Detailed review of main photosensitizers used in clinical practice in Russia and in foreign countries with their chemical structure, main spectral characteristics was performed. Methods of its application, therapeutic dose ranges, indications, specifi c pharmacokinetic properties and side-effects are briefl y outlined. Advantages and disadvantages of the most popular modern photosensitizers, main mechanisms of entry of photosensitizers of different chemical structure into cancer cells are observed. Three main possible component of anti-tumor effect: direct damage of cancer cells, impairment of vascular stroma of tumor and elimination of tumor due to immune cells are shown and closely discussed. Necrosis and apotosis of neovascular net which are main development trends of anti-tumor action for photodynamic therapy are noticed.
In 2008, the International Agency for Research on Cancer (IARC) released its World Cancer Report, which indicated that cancer accounts for approximately 12% of all-cause mortality worldwide. IARC estimated that globally 7.6 million people died from cancer and that 12.4 million new cases were diagnosed in 2008. The report went on to project that, due to increases in life expectancy, improvements in clinical diagnostics, and shifting trends in health behaviors (e.g. increases in smoking and sedentary lifestyles), in the absence of significant efforts to improve global cancer control, cancer mortality could increase to 12.9 million and cancer incidence to 20 million by the year 2030. Looking deeper into the data, it becomes clear that cancer-related stigma and myths about cancer are important problems that must be addressed, although different from a country to another. Stigmas about cancer present significant challenges to cancer control: stigma can have a silencing effect, whereby efforts to increase cancer awareness are negatively affected. The social, emotional, and financial devastation that all too often accompanies a diagnosis of cancer is, in large part, due to the cultural myths and taboos surrounding the disease. Combating stigma, myths, taboos, and overcoming silence will play important roles in changing this provisional trajectory. There are several reasons that cancer is stigmatized. Many people in our area perceived cancer to be a fatal disease. Cancer symptoms or body parts affected by the disease can cultivate stigma. Fears about treatment can also fuel stigma. There was evidence of myths associated with cancer, such as the belief that cancer is contagious, or cancer may be seen as a punishment. After reviewing these different examples of cultural myths and taboos met in cancer care, we can report these lessons learned: 1. Around the world, cancer continues to carry a significant amount of stigma, myths, and taboos; however, there are opportunities to
Background: The development in cancer care has shifted towards shorter hospital stays and more outpatient treatment. Today, cancer care and treatment predominantly takes place in outpatient settings where encounters between patients and health care professionals are often brief. This development...... will probably continue internationally as the global cancer burden seems to be growing significantly. Furthermore, the number of patients who require ambulatory treatments such as chemotherapy is increasing. Research has shown there is a possible risk of overlooking cancer patients´ needs when the time allotted...
Full Text Available Background: Symptomatic bacteraemia, is a frequent condition among cancer patients with a significant morbidity and mortality all over the world. Objectives: The aim of this study was to determine the burden of enteric pathogens causing bacteremia among cancer patients. Patients and Methods: Ten ml blood samples were withdrawn from the cancer patients under aseptic conditions. The blood specimens were added to the blood culture bottles and incubated at 37°C. The bacterial isolates from these samples were identified by routine biochemical reactions. Results: During the study period, 68 blood samples from cancer patients were analyzed for bacteremia. Of these patients, six were female (08/82% and 62 were male (91.18%; with age ranging from under 40 years to 85 years old (mean, 63 years. Gastro-intestinal cancer and cancers of head and neck were the most frequent cancer types in the studied group, accounting for 51 (75% and 15 (22.1% cases, respectively. The mean weight of patients was 69.18 Kg (range: 49-100 Kg. Similarly, the mean length of hospital stay was 8 days (range: 4-12 days. Positive blood cultures were detected in only 12 (17.65% and 11 (91.7% blood specimens from the Cancer Institute, Tehran, compared with one (08.33% from Shahid Kamali hospital, Karaj. From these patients, 15 bacteria were isolated; E. coli alone outnumbered other species and accounted for 33.33% of the episodes of bacteremia. Conclusions: In conclusion, our investigation revealed that cancers of GI tract are the most common cancer types causing bacteremia and also we identified that most common bacteria causing bacteremia in Cancer Institute, Tehran and Shahid Kamali Hospital, Karaj, are E. coli and S. aureus
Shimizu, Wakako; Ogino, Takashi; Ebihara, Satoshi; Ikeda, Hiroshi.
Fifty-nine cases of laryngeal cancer treated by radiotherapy at the National Cancer Center Hospital between 1962 and 1990 were analyzed retrospectively. All the patients were less than 50 years old. The median total dose of the radiation delivered to the primary tumor site was 70 Gy. The overall 5-yr survival rate and 5-yr local control rate were 88% and 72%, respectively. Five (8.5%) of the 59 patients developed late recurrence more than five yr after initial treatment, but subsequent salvage operations were successful for disease control; three patients had T1 glottic cancer, one had T2-3 glottic cancer and one had T3N1 supraglottic cancer. Since the local control rate and the 5-yr survival rate after radiotherapy are satisfactory, radiotherapy, which allows both functional and esthetic conservation, has an important role in the treatment of laryngeal cancer in adults under 50 yr of age. (author)
Feys, Lynn; Descamps, Benedicte; Vanhove, Christian; Vermeulen, Stefan; Vandesompele, J O; Vanderheyden, Katrien; Messens, Kathy; Bracke, Marc; De Wever, Olivier
Bioluminescent cancer models are widely used but detailed quantification of the luciferase signal and functional comparison with a non-transfected control cell line are generally lacking. In the present study, we provide quantitative and functional tests for luciferase-transfected cells. We quantified the luciferase expression in BLM and HCT8/E11 transfected cancer cells, and examined the effect of long-term luciferin exposure. The present study also investigated functional differences between parental and transfected cancer cells. Our results showed that quantification of different single-cell-derived populations are superior with droplet digital polymerase chain reaction. Quantification of luciferase protein level and luciferase bioluminescent activity is only useful when there is a significant difference in copy number. Continuous exposure of cell cultures to luciferin leads to inhibitory effects on mitochondrial activity, cell growth and bioluminescence. These inhibitory effects correlate with luciferase copy number. Cell culture and mouse xenograft assays showed no significant functional differences between luciferase-transfected and parental cells. Luciferase-transfected cells should be validated by quantitative and functional assays before starting large-scale experiments. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
Mahmood, Kamran; Wahidi, Momen M
Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully. A multidisciplinary approach to tracheostomy care leads to improved outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
This article provides a summary of currently available information from a broad range of disciplines aimed at guiding the physician caring for the pregnant patient who requires nonobstetric surgery. An understanding of the anatomic and physiologic alterations that occur during pregnancy will allow such procedures to be accomplished with morbidity and mortality approaching those of nonpregnant surgical patients. The presence of the fetus does impose some restraint; however, this should rarely impair appropriate diagnosis and treatment of maternal disease. This obtains from the broad range of diagnostic and therapeutic alternatives available, and from the fact that what is beneficial for maternal health is generally best for the fetus. 64 references
Eliott, Jaklin A; Olver, Ian
Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. © 2010 Blackwell Publishing Ltd.
Wagholikar, Amol; Fung, Maggie; Nelson, Colleen
To understand the journey of advanced prostate cancer patients for supporting development of an innovative patient journey browser. Prostate cancer is one of the common cancers in Australia. Due to the chronic nature of the disease, it is important to have effective disease management strategy and care model. Multi-disciplinary care is a well-proven approach for chronic disease management. The Multi-disciplinary team (MDT) can function more effectively if all the required information is available for the clinical decision support. The development of innovative technology relies on an accurate understanding of the advanced prostate cancer patient's journey over a prolonged period. This need arises from the fact that advanced prostate cancer patients may follow various treatment paths and change their care providers. As a result of this, it is difficult to understand the actual sources of patient's clinical records and their treatment patterns. The aim of the research is to understand variable sources of clinical records, treatment patterns, alternative therapies, over the counter (OTC) medications of advanced prostate cancer patients. This study provides better and holistic understanding of advanced prostate cancer journey. The study was conducted through an on-line survey developed to seek and analyse the responses from the participants. The on-line questionnaire was carefully developed through consultations with the clinical researchers at the Australian Prostate Cancer Research Centre-Queensland, prostate cancer support group representatives and health informaticians at the Australian E-Health Research Centre. The non-identifying questionnaire was distributed to the patients through prostate cancer support groups in Queensland, Australia. The pilot study was carried out between August 2010 and December 2010. The research made important observations about the advanced prostate cancer journey. It showed that General Practitioner (GP) was the common source of
Tan, Hung-Jui; Chamie, Karim; Daskivich, Timothy J; Litwin, Mark S; Hu, Jim C
Beyond age and comorbidity, functionality can shape the long-term survival potential of patients with cancer. Accordingly, herein the authors compared mortality and receipt of cancer-directed surgery according to patient function among older adults with kidney cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 through 2009, the authors studied 28,326 elderly subjects with primary kidney cancer. Patient function was quantified using function-related indicators, claims indicative of dysfunction and disability. Adjusting for patient and cancer characteristics, competing risk regression was used to assess the relationship between function-related indicator count and cause-specific mortality and then generalized estimating equations were used to quantify the probability of surgery. A total of 13,619 adult patients (48.1%) with at least 1 function-related indicator were identified. A higher indicator category was associated with older age, greater comorbidity, female sex, unmarried status, lower socioeconomic status, and higher stage of disease (Pkidney cancer mortality varied minimally with patient function. Patients with ≥ 2 indicators received cancer-directed surgery less often than those without disability (odds ratio, 0.61; 95% CI, 0.56-0.66), although treatment probabilities remained high for patients with locoregional disease and low for those with metastatic cancer. Among older adults with kidney cancer, functional health stands as a significant predictor of long-term survival. However, receipt of cancer-directed surgery appears largely determined by cancer stage. Patient function should be considered more heavily when determining treatment for older adults with kidney cancer. Cancer 2016;122:3776-3784. © 2016 American Cancer Society. © 2016 American Cancer Society.
Pedersen, Allison E; Hack, Thomas F; McClement, Susan E; Taylor-Brown, Jill
To delineate the role of the oncology patient navigator, drawing from the experiences and descriptions of younger women with breast cancer. Interpretive, descriptive, qualitative research design. Participants' homes, researcher's home, and via telephone, all in Winnipeg, Manitoba, Canada. 12 women aged 50 years or younger who were diagnosed with breast cancer within the last three years. Face-to-face semistructured interviews explored patient experiences with the cancer care system, including problems encountered, unmet needs, and opinions about the functions of the patient navigator role. The audio-recorded interviews were transcribed and data were broken down and inductively coded into four categories. Constant comparative techniques also were used during analysis. The role of the oncology patient navigator included two facets: "Processual facets," with the subthemes assigned to me at diagnosis, managing the connection, mapping the process, practical support, and quarterbacking my entire journey; and "Personal qualities: The essentials," with the subthemes empathetic care tenor, knowing the cancer system, and understanding the medical side of breast cancer. Despite the tremendous effort directed toward enhancing care for younger women undergoing treatment for breast cancer, gaps continue to exist. Younger women with breast cancer require a care approach providing ongoing dialogue, teaching, and emotional support from the point of diagnosis through treatment, including transitions of care within the oncology setting and back to their primary care practitioner. Oncology nurse navigators are well positioned to provide patients with anticipatory guidance from diagnosis to the end of treatment.
Lawrenz, B; Neunhoeffer, E; Henes, M; Lessmann-Bechle, S; Krämer, B; Fehm, Tanja
The increase of breast cancer in young women under 40 years and the increasing age of women at the time of the birth of their first child underlines the importance to implement counselling for fertility-preserving strategies in the management of breast cancer care. We present the fertility-preserving procedures performed after routine counselling for primary breast cancer patients in a large certified breast cancer centre. Since November 2006, patients aged below 40 years with histologically confirmed breast cancer are routinely counselled on fertility-preserving possibilities before breast surgery and chemotherapy in the fertility centre of the University Women's Hospital in Tuebingen. The recommendations are based on the treatment recommendations of the network FertiPROTEKT. During the last 40 months, 56 primary breast cancer patients were counselled. Forty-one of these patients were hormone receptor positive. Thirty-four patients (63%) underwent fertility-preserving strategies. The majority of the patients (n = 22) decided on ovarian tissue cryopreservation. GnRH protection was performed in 14 patients. In 12 patients an ovarian stimulation protocol was initiated to cryopreserve fertilized or unfertilized oocytes. A combination of different fertility-preserving methods was performed in 12 patients. The preservation of ovarian function and fertility are of great importance to young breast cancer patients. Counselling on fertility-preserving strategies is therefore critical in these patients and should be routinely performed.
The use of alternative and complementary medicine (CAM) in cancer patients is widespread and it is not surprising as the results gained by conventional treatments are not sufficient. However, the results from the studies with CAM are not always sufficient according to their testing in appropriate clinical studies. Another problem that is present in the use of CAM is the possibility of drug-drug interactions between conventional therapies and CAM. Thus, it is of utmost importance that the oncologist possess a good knowledge of available CAM and provide a sufficient time for discussion with the patient and his/her family about possible alternative treatments and any downside risks. The cornerstone for pertinent discussion is sufficient knowledge on the part of the oncologist about those alternative treatments that are usually presented in the media with incomplete information about their relevant clinical tests and side effects. The following article presents a review of the current alternative treatment methods with a focus on the alternative drugs that have already been clinically tested, and secondarily on the alternative drugs that have been used even without sufficient testing in clinical trials. (author)
Beckman, Emily S; Helft, Paul R; Torke, Alexia M
Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university-based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well-being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients' hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients' hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients' goals.
Breast Cancer; Colorectal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Head and Neck Cancer; Liver Cancer; Lung Cancer; Metastatic Cancer; Ovarian Cancer; Pancreatic Cancer; Testicular Germ Cell Tumor
Manenschijn, L; Quinkler, M; van Rossum, E F C
The only approved drug for the treatment of adrenocortical cancer (ACC) is mitotane. Mitotane is adrenolytic and therefore, hydrocortisone replacement therapy is necessary. Since mitotane increases cortisol binding globulin (CBG) and induces CYP3A4 activity, high doses of hydrocortisone are thought to be required. Evaluation of hydrocortisone therapy in mitotane-treated patients has been difficult since there is no good marker to evaluate hydrocortisone therapy. Measurement of cortisol in scalp hair is a novel method that offers the opportunity to measure long-term cortisol levels. Our aim was to evaluate whether hair cortisol measurements could be useful in evaluating recent hydrocortisone treatment in mitotane-treated ACC patients. Hair cortisol levels were measured in 15 mitotane-treated ACC patients on hydrocortisone substitution and 96 healthy individuals. Cortisol levels were measured in 3 cm hair segments, corresponding to a period of 3 months. Hair cortisol levels were higher in ACC patients compared to healthy individuals (pcortisol levels above the reference range. None of the patients had hair cortisol levels below normal. In contrast to hydrocortisone doses (β=0.03, p=0.93), hair cortisol levels were associated with BMI (β=0.53, p=0.042). There was no correlation between hair cortisol levels and hydrocortisone doses (β=0.41, p=0.13). Almost half of the ACC patients had high hair cortisol levels, suggesting long-term over-substitution of hydrocortisone in some of the patients, whereas none of the patients was under-substituted. Hair cortisol measurements might be useful in long-term monitoring hydrocortisone treatment in mitotane-treated ACC patients. © Georg Thieme Verlag KG Stuttgart · New York.
Martell, K.; Fairchild, A.; LeGerrier, B.; Sinha, R.; Baker, S.; Liu, H.; Ghose, A.; Olivotto, I.A.; Kerba, M.
Background A comprehensive assessment of cannabis use by patients with cancer has not previously been reported. In this study, we aimed to characterize patient perspectives about cannabis and its use. Methods An anonymous survey about cannabis use was offered to patients 18 years of age and older attending 2 comprehensive and 2 community cancer centres, comprising an entire provincial health care jurisdiction in Canada (ethics id: hreba-17011). Results Of 3138 surveys distributed, 2040 surveys were returned (65%), with 1987 being sufficiently complete for analysis (response rate: 63%). Of the respondents, 812 (41%) were less than 60 years of age; 45% identified as male, and 55% as female; and 44% had completed college or higher education. Of respondents overall, 43% reported any lifetime cannabis use. That finding was independent of age, sex, education level, and cancer histology. Cannabis was acquired through friends (80%), regulated medical dispensaries (10%), and other means (6%). Of patients with any use, 81% had used dried leaves. Of the 356 patients who reported cannabis use within the 6 months preceding the survey (18% of respondents with sufficiently complete surveys), 36% were new users. Their reasons for use included cancer-related pain (46%), nausea (34%), other cancer symptoms (31%), and non-cancer-related reasons (56%). Conclusions The survey demonstrated that prior cannabis use was widespread among patients with cancer (43%). One in eight respondents identified at least 1 cancer-related symptom for which they were using cannabis.
Krishnasamy, Karthikayini; Li Yoong, Tang; Mei Chan, Chong; Peng Choong, Lau; Chinna, Karuthan
Malnutrition is common among patients with cancer, but little attention is given to its risks and consequences. The aim of this study is to assess the nutritional status and identify the factors associated with malnutrition among newly diagnosed patients with cancer. Patients admitted with newly diagnosed cancer at a teaching hospital in Malaysia were recruited from January to April 2015. Nutritional status was assessed before treatment initiation, and patients were classified into three categories. A total of 132 pretreatment patients were recruited into the study. About half were severely malnourished. Patients with stage III cancer had the highest prevalence of severe malnourishment. Clinical parameters and disease characteristics were significantly associated with nutritional status. Demographic variables were also statistically significantly associated with severe nutritional status.
Lindahl-Jacobsen, Line; Hansen, Dorte Gilså; Wæhrens, Eva Ejlersen
and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. METHODS: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living...... Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). RESULTS: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results......BACKGROUND: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify...
Aiello-Laws, Lisa B
The Joint Commission publishes its annual National Patient Safety Goals to guide accredited organizations in addressing high-risk, low-volume concerns related to patient safety. The 2010 list includes a goal to identify patients at risk for suicide, but do oncology nurses need to be concerned about the risk of suicide in patients with cancer?
The central aim of this thesis was to unravel the relationship between patient characteristics, communication between patient and clinician, and subsequent patient information recall in the context of medical consultations with older cancer patients. Chapter 2 reviewed the literature to explore age
Mohammadzadeh, Zeinab; Davoodi, Somayeh; Ghazisaeidi, Marjan
Online social network technologies have become important to health and apply in most health care areas. Particularly in cancer care, because it is a disease which involves many social aspects, online social networks can be very useful. Use of online social networks provides a suitable platform for cancer patients and families to present and share information about their medical conditions, address their educational needs, support decision making, and help to coping with their disease and improve their own outcomes. Like any other new technologies, online social networks, along with many benefits, have some negative effects such as violation of privacy and publication of incorrect information. However, if these effects are managed properly, they can empower patients to manage cancer through changing behavioral patterns and enhancing the quality of cancer patients lives This paper explains some application of online social networks in the cancer patient care process. It also covers advantages and disadvantages of related technologies.
Deane, K; Fitch, M; Carman, M
Art therapy is a healing art intended to integrate physical, emotional, and spiritual care by facilitating creative ways for patients to respond to their cancer experience. A new art therapy program was designed to provide cancer patients with opportunities to learn about the McMichael Canadian Art Collection and to explore personal feelings about their cancer experience through combined gallery and studio components. The role of the facilitator was to assist in the interpretation of a participant's drawing in order to reveal meaning in the art. This paper presents patients' perspectives about the new art therapy program. Content analysis of participant feedback provided information about the structure, process, and outcomes of the program. Evaluation of the art therapy/museum education program demonstrated many benefits for cancer patients including support, psychological strength, and new insights about their cancer experience.
Nawa, Toru; Kato, Jun; Kawamoto, Hirofumi; Okada, Hiroyuki; Yamamoto, Hiroshi; Kohno, Hiroyuki; Endo, Hisayuki; Shiratori, Yasushi
Recently, the clinical and biological differences between right- and left-sided colon cancers have been widely debated. However, close analyses of these clinical differences, based on large-scale studies, have been scarcely reported. A total of 3552 consecutive Japanese colorectal cancer cases were examined and the clinical differences between right- and left-sided colon cancer cases were investigated. The proportion of right-sided colon cancer was relatively high in patients aged less than 40 years (33%) and more than 80 years (43%). The proportion of right-sided colon cancer in patients aged 40-59 years was relatively low (male 22% and female 29%). In male patients the proportion increased in the 70-79 years age group (30%), while in female patients the proportion increased in the 60-69 years age group (39%). Right-sided colon cancer was more likely to be detected at an advanced stage (T1 stage; left 22%, right 15%) (P cancer was dominant in the left colon (left 59%; right 40%) (P cancer in the right colon was significantly higher than that in the left colon (left 25%; right 44%) (P colon cancer was observed and the difference between male and female patients was highlighted. Other clinical features also differed between right- and left-sided colon cancer, suggesting that different mechanisms may be at work during right and left colon carcinogenesis.
Valerie A. Allen
Full Text Available Background. Diarrhea is a common problem in ovarian cancer patients undergoing chemotherapy and Clostridium difficile infection has been identified as a cause. The proper diagnosis and treatment of diarrhea are critical to patient care, especially to prevent the serious complications from a severe Clostridium difficile infection (CDI. Case. We present a heavily pretreated ovarian cancer patient who developed recurrent pseudomembranous colitis while receiving carboplatin chemotherapy. Despite treatment with oral metronidazole for fourteen days, the patient’s diarrhea relapsed and colonoscopy revealed extensive pseudomembranous colitis. The infection eventually resolved with the combination of oral vancomycin and metronidazole. Conclusions. Diarrhea is a common problem in patients undergoing chemotherapy for ovarian cancer. Management requires obtaining the proper diagnosis. Clostridium difficile associated pseudomembranous colitis must be part of the differential diagnosis. Treatment must be sufficient to prevent relapses of the Clostridium difficile infection to prevent serious consequences in an already vulnerable patient population.
Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per
OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information...... on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care...... for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required....
Ju, Na Rae; Jeffe, Donna B; Keune, Jason; Aft, Rebecca
Breast cancer patients whose tumors achieve a pathological complete response (pCR) with neoadjuvant chemotherapy have a prognosis which is better than that predicted for the stage of their disease. However, within this subgroup of patients, recurrences have been observed. We sought to examine factors associated with recurrence in a population of breast cancer patients who achieved a pCR with neoadjuvant chemotherapy. A retrospective chart review was conducted of all patients with unilateral breast cancer treated with neoadjuvant chemotherapy from January 1, 2000 to December 31, 2010 at one comprehensive cancer center. A pCR was defined as no residual invasive cancer in the breast in the surgical specimen following neoadjuvant therapy. Recurrence was defined as visceral or bony reappearance of cancer after completion of all therapy. Of 818 patients who completed neoadjuvant chemotherapy, 144 (17.6 %) had pCR; six with bilateral breast cancer were excluded from further analysis. The mean time to follow-up was 47.2 months. Among the 138 patients with unilateral breast cancer, there were 14 recurrences (10.1 %). Using a binary multiple logistic regression model, examining types of chemotherapy and surgery, race, lymph node assessment, and lymph node status, breast cancer side, triple-negative status, and radiation receipt, only African-American patients (OR: 5.827, 95 % CI: 1.280-26.525; p = 0.023) were more likely to develop distant recurrence. The mean time to recurrence was 31.9 months. In our study, race was the only independent predictor of recurrence after achieving pCR with neoadjuvant chemotherapy. The reasons for this observation require further study.
Ramsey, Scott D; Bansal, Aasthaa; Fedorenko, Catherine R; Blough, David K; Overstreet, Karen A; Shankaran, Veena; Newcomb, Polly
Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among patients with cancer is not known. We linked Western Washington SEER Cancer Registry records with federal bankruptcy records for the region. By using propensity score matching to account for differences in several demographic and clinical factors between patients who did and did not file for bankruptcy, we then fit Cox proportional hazards models to examine the relationship between bankruptcy filing and survival. Between 1995 and 2009, 231,596 persons were diagnosed with cancer. Patients who filed for bankruptcy (n = 4,728) were more likely to be younger, female, and nonwhite, to have local- or regional- (v distant-) stage disease at diagnosis, and have received treatment. After propensity score matching, 3,841 patients remained in each group (bankruptcy v no bankruptcy). In the matched sample, mean age was 53.0 years, 54% were men, mean income was $49,000, and majorities were white (86%), married (60%), and urban (91%) and had local- or regional-stage disease at diagnosis (84%). Both groups received similar initial treatments. The adjusted hazard ratio for mortality among patients with cancer who filed for bankruptcy versus those who did not was 1.79 (95% CI, 1.64 to 1.96). Hazard ratios varied by cancer type: colorectal, prostate, and thyroid cancers had the highest hazard ratios. Excluding patients with distant-stage disease from the models did not have an effect on results. Severe financial distress requiring bankruptcy protection after cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate this risk. © 2016 by American Society of Clinical Oncology.
Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD was 57.7 (±12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension
Dobrila Dintinjana, Renata; Guina, Tina; Krznarić, Željko; Radić, Mladen; Dintinjana, Marijan
Nutritional support, addressing the specific needs of this patient group, is required to help improve prognosis, and reduce the consequences of cancer-associated nutritional decline. Early intervention with nutritional supplementation has been shown to halt malnutrition, and may improve outcome in some patients. In our study we tried to assess the influence of nutritional support (counseling, oral liquids, megestrol acetate) on nutritional status and symptoms prevalence in patients ...
Vries, Y.C. de; Berg, M.M.; Vries, J.H.M. de; Boesveldt, S.; Kruif, J.; Buist, N.; Haringhuizen, A.; Los, M.; Sommeijer, D.W.; Timmer-Bonte, J.H.N.; Laarhoven, H.W. van; Visser, M.; Kampman, E.; Winkels, R.M.
PURPOSE: Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect dietary habits. This study assessed the intake of energy, macronutrients and food groups before and during chemotherapy in breast cancer patients
Vries, de Y.C.; Berg, van den M.M.G.A.; Vries, de J.H.M.; Boesveldt, S.; Kruif, de J.Th.C.M.; Buist, N.; Haringhuizen, A.; Los, M.; Sommeijer, D.W.; Timmer-Bonte, J.H.N.; Laarhoven, van H.W.M.; Visser, M.; Kampman, E.; Winkels, R.M.
Purpose: Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect dietary habits. This study assessed the intake of energy, macronutrients and food groups before and during chemotherapy in breast cancer patients
de Vries, Y. C.; van den Berg, M. M. G. A.; de Vries, J. H. M.; Boesveldt, S.; de Kruif, J. Th C. M.; Buist, N.; Haringhuizen, A.; Los, M.; Sommeijer, D. W.; Timmer-Bonte, J. H. N.; van Laarhoven, H. W. M.; Visser, M.; Kampman, E.; Winkels, R. M.
Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect dietary habits. This study assessed the intake of energy, macronutrients and food groups before and during chemotherapy in breast cancer patients compared
de Vries, Y. C.; van den Berg, M. M.G.A.; de Vries, J. H.M.; Boesveldt, S.; de Kruif, J. Th C.M.; Buist, N.; Haringhuizen, A.; Los, M.; Sommeijer, D. W.; Timmer-Bonte, J. H.N.; van Laarhoven, H. W.M.; Visser, M.; Kampman, E.; Winkels, R. M.
PURPOSE: Breast cancer patients receiving chemotherapy often experience symptoms such as nausea, vomiting and loss of appetite that potentially affect dietary habits. This study assessed the intake of energy, macronutrients and food groups before and during chemotherapy in breast cancer patients
Vos, Martina S.; Putter, Hein; Leurs, Amber; Rooijmans, Harry G. M.; de Haes, Hanneke C. J. M.; van Houwelingen, Hans C.
Based on Weissman and Hackett's comprehensive definition of denial, a semi-structured interview was developed to measure denial in cancer patients. The denial in cancer interview (DCI) covers both the patients' recount of their illness experience and the expert's impression of the level of denial in
Cancer and AIDS are both pandemics: they have an emotional and social impact that goes far beyond the physical disruption they cause. These are usually perceived and addressed as independent disease entities. When these coexist in one patient, however, the appropriate management of the cancer needs to be modified from the standard clinical protocols. New protocols appearing in the radiotherapy literature have been investigative rather than definitive and, with few exceptions, analyse the results of small series of patients. The IAEA has extensive projects in radiation oncology in developing countries. In Africa, there is concern that AIDS related cancers utilise an increasing amount of scarce resources, that they frequently require equipment for the management of superficial tumours, and that inadequate training is available in the management of these cancers. This report developed from the need to address these concerns. An Advisory Group Meeting (AGM) on the Relationship between Human Immunodeficiency Virus (HIV) and Cancer Management Protocols for Developing Countries was convened in October 1999. A reading of this report will show that considerable amount of further investigation is required to respond authoritatively to many of the management decisions that need be made. It is also evident that the greatest number of patients requiring optimal management protocols live in sub-Saharan Africa - a region where research resources are at a minimum. The IAEA has made available limited funding for a research project in determining the intermediate term effects of radiation therapy on the immune system in AIDS related cervical cancer.
Cancer and AIDS are both pandemics: they have an emotional and social impact that goes far beyond the physical disruption they cause. These are usually perceived and addressed as independent disease entities. When these coexist in one patient, however, the appropriate management of the cancer needs to be modified from the standard clinical protocols. New protocols appearing in the radiotherapy literature have been investigative rather than definitive and, with few exceptions, analyse the results of small series of patients. The IAEA has extensive projects in radiation oncology in developing countries. In Africa, there is concern that AIDS related cancers utilise an increasing amount of scarce resources, that they frequently require equipment for the management of superficial tumours, and that inadequate training is available in the management of these cancers. This report developed from the need to address these concerns. An Advisory Group Meeting (AGM) on the Relationship between Human Immunodeficiency Virus (HIV) and Cancer Management Protocols for Developing Countries was convened in October 1999. A reading of this report will show that considerable amount of further investigation is required to respond authoritatively to many of the management decisions that need be made. It is also evident that the greatest number of patients requiring optimal management protocols live in sub-Saharan Africa - a region where research resources are at a minimum. The IAEA has made available limited funding for a research project in determining the intermediate term effects of radiation therapy on the immune system in AIDS related cervical cancer
Strashinin, A.I.; Gerasimyak, V.G.; Vladimirova, V.A.; Ivanova, L.V.
The ways of medical and social-occupational rehabilitation after a course of radiotherapy in patients with respiratory system cancer have been determined. Medical rehabilitation in patients with lung cancer comprises expedient planning of radiotherapy by means of systematic medicamental treatment. It is shown that it is necessary to place the patients in special rehabilitation departments after radiotherapy of carry out the treatment of pneumonities
Schmidt, Stefanie, 1979-
The overall objective of this thesis was to describe the evolution of Health-Related Quality of Life in Spanish patients with urologic tumours; and to the examine clinical and treatment-related factors associated with changes in Health-Related Quality of Life during the first year of treatment. The EMPARO project is an observational, multicenter, prospective study on patients diagnosed with bladder cancer (n=326) and prostate cancer (n=472). Consecutive patients were enrolled in 7 Spanish hos...
Yamashita, Keishi; Muto, Manabu; Ohtsu, Atsushi; Mera, Kiyomi; Doi, Toshihiko; Sano, Yasushi; Yoshida, Shigeaki
We reviewed our clinical experiences of chemoradiotherapy (CRT) for esophageal cancer (EC) in 44 patients with multiple primary malignant neoplasms. Among them, 34 were accompanied with synchronous tumors, 8 were accompanied with antecedent tumors and 8 with subsequent tumors. The sites of primary malignant neoplasms were as follows; stomach 24 (43.6%), head and neck 17 (30.9%), colon and rectum 4 (7.3%). Among the 19 patients with synchronous cancer in the stomach, 6 patients underwent gastrectomy or endoscopic mucosal resection before CRT, and the others received definitive CRT as initial treatment. While 5 patients were alive without recurrence of EC and gastric cancer, more than half of the patients died of EC. Among 11 patients with head and neck cancer (HNC), 9 patients underwent surgery for HNC before CRT, because the clinical stages of the HNC was more progressive than that of EC. Only 3 patients achieved complete cure of both EC and HNC. The number of patients who developed subsequent tumors after CRT for EC was too small for us to draw definitive conclusions from our discussion, so further long-term follow-up and analysis based on large-scale surveys are required. Although CRT has become one of the standard treatments for EC, there is no treatment strategy for patients with both EC and other malignant primary neoplasms. Our results suggest that we should consider the curability of EC by CRT when we treat such patients. (author)
Mahesh, P A; Archana, S; Jayaraj, B S; Patil, Shekar; Chaya, S K; Shashidhar, H P; Sunitha, B S; Prabhakar, A K
Age adjusted incidence rate of lung cancer in India ranges from 7.4 to 13.1 per 100,000 among males and 3.9 to 5.8 per 100,000 among females. The factors affecting survival in lung cancer patients in India are not fully understood. The current study was undertaken to evaluate the factors affecting survival in patients diagnosed with lung cancer attending a tertiary care cancer institute in Bangalore, Karnataka, India. Consecutive patients with primary lung cancer attending Bangalore Institute of Oncology, a tertiary care centre at Bangalore, between 2006 and 2009 were included. Demographic, clinical, radiological data were collected retrospectively from the medical records. A total of 170 consecutive subjects (128 males, 42 females) diagnosed to have lung cancer; 151 non-small cell lung cancer (NSCLC) and 19 small cell lung cancer (SCLC) were included. A higher proportion of never-smokers (54.1%) were observed, mostly presenting below the age of 60 yr. Most subjects were in stage IV and III at the time of diagnosis. More than 50 per cent of patients presented with late stage lung cancer even though the duration of symptoms is less than 2 months. The 30-month overall survival rates for smokers and never-smokers were 32 and 49 per cent, respectively. No significant differences were observed in 30 month survival based on age at presentation, gender and type of lung cancer. Cox proportional hazards model identified never-smokers and duration of symptoms less than 1 month as factors adversely affecting survival. Our results showed that lung cancer in Indians involved younger subjects and associated with poorer survival as compared to other ethnic population. Studies on large sample need to be done to evaluate risk factors in lung cancer patients.
Kast, Karin; Schoffer, Olaf; Link, Theresa; Forberger, Almuth; Petzold, Andrea; Niedostatek, Antje; Werner, Carmen; Klug, Stefanie J; Werner, Andreas; Gatzweiler, Axel; Richter, Barbara; Baretton, Gustavo; Wimberger, Pauline
Prognosis of Her2-positive breast cancer has changed since the introduction of trastuzumab for treatment in metastatic and early breast cancer. It was described to be even better compared to prognosis of Her2-negative metastatic breast cancer. The purpose of this study was to evaluate the effect of trastuzumab in our cohort. Besides the effect of adjuvant pretreatment with trastuzumab on survival of patients with metastatic Her2-positive breast cancer was analyzed. All patients with primary breast cancer of the Regional Breast Cancer Center Dresden diagnosed during the years 2001-2013 were analyzed for treatment with or without trastuzumab in the adjuvant and in the metastatic treatment setting using Kaplan-Meier survival estimation and Cox regression. Age and tumor stage at time of first diagnosis of breast cancer as well as hormone receptor status, grading, time, and site of metastasis at first diagnosis of distant metastatic disease were analyzed. Of 4.481 female patients with primary breast cancer, 643 presented with metastatic disease. Her2-positive status was documented in 465 patients, including 116 patients with primary or secondary metastases. Median survival of patients with Her2-positive primary metastatic disease was 3.0 years (95% CI 2.3-4.0). After adjustment for other factors, survival was better in patients with Her2-positive breast cancer with trastuzumab therapy compared to Her2-negative metastatic disease (HR 2.10; 95% CI 1.58-2.79). Analysis of influence of adjuvant therapy with and without trastuzumab by Kaplan-Meier showed a trend for better survival in not pretreated patients. Median survival was highest in hormone receptor-positive Her2-positive (triple-positive) primary metastatic breast cancer patients with 3.3 years (95% CI 2.3-4.6). Prognosis of patients with Her2-positive metastatic breast cancer after trastuzumab treatment is more favorable than for Her2-negative breast cancer. The role of adjuvant chemotherapy with or without
Iqbal, M.; Syed, G.M.S.; Siddiqui, K.S.
To study the frequencies of metal disorders among adult cancer patients in relation to their age, gender, marital status and type of malignancy. Socio-demographic characteristics and cancer diagnoses were recorded on a data capture form. diagnoses of metal disorders were made on the basis of diagnostic and statistical manual (DSM-IV) fourth edition. Shuakat Khanum Memorial Hospital and Research Centre. Two hundred and twenty newly diagnosed cancer patients were interviewed by a clinical psychologist before commencing any cancer treatment. Diagnosis of any metal disorder was transcribed using DSM-IV criteria and data thus collected were analyzed using SPSS for Windows. Observed frequencies of various metal disorders were compared with respect to patient's age, gender, martial status and type of cancer. Sixty five percent patients presented with various mental disorder. Adjusting disorders and mood disorders accounted for 34% each, while anxiety disorder was seen in 30% and remaining had delirium and somatoform disorders. Mental disorders were more common in males, and in younger age group. The oncologist and physicians treating cancer patients should carefully evaluate their patients for symptom of associated mental disorder and provide the required clinical support. (author)
Chiang, Ting-Yu; Wang, Chao-Hui; Lin, Yu-Fen; Chou, Shu-Lan; Wang, Ching-Ting; Juang, Hsiao-Ting; Lin, Yung-Chang; Lin, Mei-Hsiang
Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (prefuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.
Abbey P Theiss
Full Text Available Phosphorylated signaling molecules are biomarkers of cancer pathophysiology and resistance to therapy, but because phosphoprotein analytes are often labile, poorly controlled clinical laboratory practices could prevent translation of research findings in this area from the bench to the bedside. We therefore compared multiple biomarker and phosphoprotein immunohistochemistry (IHC results in 23 clinical colorectal carcinoma samples after either a novel, rapid tissue fixation protocol or a standard tissue fixation protocol employed by clinical laboratories, and we also investigated the effect of a defined post-operative "cold" ischemia period on these IHC results. We found that a one-hour cold ischemia interval, allowed by ASCO/CAP guidelines for certain cancer biomarker assays, is highly deleterious to certain phosphoprotein analytes, specifically the phosphorylated epidermal growth factor receptor (pEGFR, but shorter ischemic intervals (less than 17 minutes facilitate preservation of phosphoproteins. Second, we found that a rapid 4-hour, two temperature, formalin fixation yielded superior staining in several cases with select markers (pEGFR, pBAD, pAKT compared to a standard overnight room temperature fixation protocol, despite taking less time. These findings indicate that the future research and clinical utilities of phosphoprotein IHC for assessing colorectal carcinoma pathophysiology absolutely depend upon attention to preanalytical factors and rigorously controlled tissue fixation protocols.
Objective To analyze the characteristics of patients who needed a blood transfusion due to epistaxis-caused anemia and to define potential risk factors. Design Retrospective cohort study. Setting A total cohort of 591 epistaxis patients, prospectively included between March 2007 and April 2008 at the ENT department of the University Hospital of Zurich, was evaluated concerning the need for blood transfusions. Methods The clinical charts and medical histories of these patients were evaluated. Main outcome measures Common parameters that increase the risk for severe anemia due to epistaxis. Results Twenty-two patients required blood transfusions due to their medical condition. 22.7% suffered from traumatic nosebleeds. Another 27.3% had a known medical condition with an increased bleeding tendency. These proportions were significantly higher than in the group of patients without need of blood transfusion. The odds ratio for receiving a blood transfusion was 14.0 in patients with hematologic disorders, 4.3 in traumatic epistaxis and 7.7 in posterior bleeders. The transfusion-dependent epistaxis patients suffered significantly more often from severe posterior nosebleeds with the need for a surgical therapeutic approach. Conclusions Patients with severe nosebleeds either from the posterior part of the nose or with known hematologic disorders or traumatic epistaxis should be closely monitored by blood parameter analyses to evaluate the indication for hemotransfusion. The acronym THREAT (Trauma, Hematologic disorder, and REAr origin of bleeding → Transfusion) helps to remember and identify the factors associated with an increased risk of receiving blood transfusion. PMID:23663751
Stephenson, N L; Weinrich, S P; Tavakoli, A S
To test the effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Quasi-experimental, pre/post, crossover. A medical/oncology unit in a 314-bed hospital in the southeastern United States. Twenty-three inpatients with breast or lung cancer. The majority of the sample were female, Caucasian, and 65 years or older; had 12 or fewer years of education and an annual income of $20,000 or more; and were receiving regularly scheduled opioids and adjuvant medications on the control and intervention day. Procedures included an intervention condition (foot reflexology to both feet for 30 minutes total by a certified reflexologist) and a control condition for each patient (with at least a two-day break). No changes were made in patients' regular schedule or medications. Anxiety and pain. Following the foot reflexology intervention, patients with breast and lung cancer experienced a significant decrease in anxiety. One of three pain measures showed that patients with breast cancer experienced a significant decrease in pain. The significant decrease in anxiety observed in this sample of patients with breast and lung cancer following foot reflexology suggests that this may be a self-care approach to decrease anxiety in this patient population. Professionals and lay people can be taught reflexology. Foot reflexology is an avenue for human touch, can be performed anywhere, requires no special equipment, is noninvasive, and does not interfere with patients' privacy.
Salas, Sebastien; Mercier, Sophie; Moheng, Benjamin; Olivet, Sandrine; Garcia, Marie-Eve; Hamon, Sophie; Sibertin-Blanc, Camille; Duffaud, Florence; Auquier, Pascal; Baumstarck, Karine
The aims of this study were to report nutritional status in a large panel of patients with cancer requiring exclusive chemotherapy and to study the influence of nutritional status on their quality of life (QoL). This work was a longitudinal cohort study performed at a French university teaching hospital. Eligible patients were individuals with a cancer needing treatment based on exclusive chemotherapy. Three work-ups were performed: i) before the administration of the first course of chemotherapy: T1, ii) before the administration of the second (for patients with 3 planned courses) or third (patients with 6 planned courses) course: T2, and iii) before the administration of the last planned course: T3. The following data were collected: general health (performance status) and nutritional status (weight, anorexia grading, albuminemia, pre-albuminemia, and C-reactive protein) and QoL. The nutritional status of patients with cancer was preserved. Functional impairment, the presence of anorexia, the palliative nature of the chemotherapy, and an elevated C-reactive protein dosage were independent predictive factors of a lower QoL among patients assessed at the end of chemotherapy. Although larger studies should corroborate these findings, clinicians may include this information in the management of patients with cancer requiring exclusive chemotherapy to identify the most vulnerable patients. Current controlled trials NCT01687335 (registration date: October 6, 2011).
Campos, Fábio Guilherme C M DE; Figueiredo, Marleny Novaes; Monteiro, Mariane; Nahas, Sérgio Carlos; Cecconello, Ivan
Sporadic colorectal cancer (CRC) is traditionally diagnosed after de sixth decade of life, although a small percentage of cases are diagnosed in patients under 40 years of age, and incidence is increasing. There exists a great volume of controversy regarding clinical outcome of young patients diagnosed with colorectal cancer (CRC) when compared to elder counterparts. Our aims were to evaluate the rate of CRC in young patients, to review the pertaining literature and to discuss outcomes and clinical prognosis. A retrospective review involving patients with CRC was undertaken, focusing on age at diagnosis. The information extracted from this literature review showed a trend towards a decreased incidence in older people with an opposite effect among adolescents and young adults. Moreover, biological aggressiveness in young adults diagnosed with CRC has not been fully recognized, although it is usually diagnosed later and in association with adverse histological features. Besides that, these features don't affect outcome. These apparent increase in CRC incidence among young patients during the last decades raises the need for a greater suspicious when evaluating common symptoms in this group. Thus, educational programs should widespread information for both population and physicians to improve prevention and early diagnosis results. RESUMO O câncer colorretal (CCR) esporádico é tradicionalmente diagnosticado após a sexta década de vida, embora uma pequena porcentagem de casos seja diagnosticada em doentes abaixo dos 40 anos de idade, e a incidência está aumentando. Existe uma grande controvérsia a respeito da evolução clínica de doentes jovens portadores de CCR em comparação aos mais idosos. Os objetivos deste estudo foram avaliar a prevalência de CCR em doentes jovens, rever a literatura pertinente e discutir suas características mais importantes nesta faixa etária. Para tanto realizou-se revisão da literatura envolvendo doentes com CCR com foco na
Zargar, Homayoun; Krishnan, Jayram; Autorino, Riccardo; Akca, Oktay; Brandao, Luis Felipe; Laydner, Humberto; Samarasekera, Dinesh; Ko, Oliver; Haber, Georges-Pascal; Kaouk, Jihad H; Stein, Robert J
Robotic technology is increasingly adopted in urologic surgery and a variety of techniques has been described for minimally invasive treatment of upper tract urothelial cancer (UTUC). To describe a simplified surgical technique of robot-assisted nephroureterectomy (RANU) and to report our single-center surgical outcomes. Patients with history of UTUC treated with this modality between April 2010 and August 2013 were included in the analysis. Institutional review board approval was obtained. Informed consent was signed by all patients. A simplified single-step RANU not requiring repositioning or robot redocking. Lymph node dissection was performed selectively. Descriptive analysis of patients' characteristics, perioperative outcomes, histopathology, and short-term follow-up data was performed. The analysis included 31 patients (mean age: 72.4±10.6 yr; mean body mass index: 26.6±5.1kg/m(2)). Twenty-six of 30 tumors (86%) were high grade. Mean tumor size was 3.1±1.8cm. Of the 31 patients, 13 (42%) had pT3 stage disease. One periureteric positive margin was noted in a patient with bulky T3 disease. The mean number of lymph nodes removed was 9.4 (standard deviation: 5.6; range: 3-21). Two of 14 patients (14%) had positive lymph nodes on final histology. No patients required a blood transfusion. Six patients experienced complications postoperatively, with only one being a high grade (Clavien 3b) complication. Median hospital stay was 5 d. Within the follow-up period, seven patients experienced bladder recurrences and four patients developed metastatic disease. Our RANU technique eliminates the need for patient repositioning or robot redocking. This technique can be safely reproduced, with surgical outcomes comparable to other established techniques. We describe a surgical technique using the da Vinci robot for a minimally invasive treatment of patients presenting with upper tract urothelial cancer. This technique can be safely implemented with good surgical outcomes
Sudo, H.; Sagara, M.; Ban, S.; Noda, S.; Iwakawa, M.; Harada, Y.; Imai, T.; Cologne, J.B.
Full text: Cytokinesis-blocked micronucleus (CBMN) assay has been extensively used to evaluate the radiation sensitivity of human individuals. Using the CBMN assay, Scott et al (1998, 1999) demonstrated that a fraction of radiosensitive individuals in breast cancer case population was larger than in normal individual population. However, Vral et al were very skeptical about the Scott et al's findings (2002). Under the approval from the ethical committee of NIRS, peripheral blood was obtained from 46 normal healthy females, 131 breast cancer patients, 32 cervical cancer patients and 7 female head and neck cancer patients. Radiosensitivity of T-lymphocytes was assessed by using a CBMN assay. The frequencies of MN per binucleated cell in healthy donors were 0.031(±0.010) and 0.151(±0.066) for cells treated before and after X-ray-irradiation (2Gy), respectively. Spontaneous MN frequencies in cancer patients were significantly higher than healthy donors (p < 0.001). Radiation sensitivities of breast- and head and neck-cancer patients were significantly higher than normal individuals (p < 0.001). Cervical cancer patients were more resistant to irradiation than healthy donors, though the number of cases for statistical analysis was small. (p < 0.001). We are considering that the HPV infection affected the radiosensitivity of cervical cancer cases. Because it is widely believed that one key mechanism which leads to spontaneous micronucleus formation involves an imbalance of chromosomal segregation and a chromosomal instability in patients' lymphocytes might be greater than that in normal individuals' lymphocytes. Recently, Kuschel et al (2002) demonstrated that ratios in two SNPs on XRCC3 were significantly different between cancer patients and healthy females. Then, we can suppose that the radiation-related genes with low penetrance may be involved in tumorigenesis of mammary- and head and neck-cells, and also, in patients' radiation susceptibility
Castleton, Kimra; Fong, Thomas; Wang-Gillam, Andrea; Waqar, Muhammad A; Jeffe, Donna B; Kehlenbrink, Lisa; Gao, Feng; Govindan, Ramaswamy
Recently published articles have established that a substantial number of cancer patients utilize the Internet to gather information about their respective diagnoses. The challenges for medical providers include understanding the prevalence and characteristics of patients using the Internet, reasons for Internet use, and the effectiveness of currently available websites in providing useful health-related information to patients. Adults with cancer were asked to complete a self-administered, anonymous, 21-item questionnaire upon registration at the Alvin J. Siteman Cancer Center at the Washington University School of Medicine. There were 500 respondents (mean age 58 years (range 18-90), 83% Caucasian and 15% African-American). Three hundred ninety-eight participants (80%) reported access to the Internet, and 315 (63%) reported searching for information about cancer on the Internet. Patients accessing the Internet for cancer information were younger than those who did not (median age 56 vs. 63 years; p Internet usage for cancer information also differed by race (p Internet for cancer information, 13.3% of patients had their decisions towards treatments affected or changed, and 11.4% of patients had their choice in physicians affected or changed because of Internet use; 23.5% of patients sought information on clinical trials, and 9.5% of patients were influenced or changed their decision regarding clinical trial enrollment due to Internet information. Approximately two thirds of patients with cancer used the Internet to obtain information about their disease. Factors affecting Internet use for cancer information included age, race, and education. Clinical decisions can be affected by Internet use.
Full Text Available Health-related quality of life is now considered an important endpoint in cancer clinical trials. It has been shown that assessing quality of life in cancer patients could contribute to improved treatment and could even serve as a prognostic factor along with medical parameters. This paper presents a review of quality of life outcomes in patients with breast cancer according to previous descriptive findings. This is a bibliographic review of the literature covering publications that appeared in English language biomedical journals between 1987 and 2008. The search strategy included a combination of the key words quality of life and breast cancer in the titles of published articles. The major findings are summarized and presented under different headings: evaluation of health-related quality of life i at the time of diagnosis, ii during treatment, and iii after the completion of treatment. Breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that have a negative effect on their quality of life. Also adjuvant hormonal therapies were found to have a similar negative impact on quality of life. Psychological distress-anxiety and depression were found to be common among breast cancer patients. Symptoms-pain, fatigue, and insomnia were among the most common symptoms reported. There was quite an extensive body of literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care.
Mariette, Christophe; De Botton, Marie-Laure; Piessen, Guillaume
Cancers of the esophagus and stomach have a major impact on patients' nutritional status by virtue of these organs' inherent digestive functions. Many patients with these cancers will require surgical intervention, which imposes further metabolic demands and compounds preexisting nutritional disorders. Patients with esophagogastric cancer are likely to have lost weight by the time the diagnosis is made. This fact alone is of clinical importance, because it is well known that patients who have lost weight will have higher operative mortality and morbidity rates than patients who maintain their weight. Initial assessment of patients with esophagogastric cancer should include a routine evaluation of nutritional status. This will allow the identification of patients who are at risk of complications, particularly in the postoperative setting. These patients should be targeted for specific nutritional support.
Bah, Ismaël; Goudie, Eric; Khereba, Mohamed; Ferraro, Pasquale; Duranceau, André; Martin, Jocelyne; Thiffault, Vicky; Liberman, Moishe
Preoperative evaluation of patients with suspected or confirmed lung cancer consists of clinical and radiological staging. Malignant pleural effusion is a poor prognosticator in non-small-cell lung cancer. Pleural ultrasound (PU) allows for the assessment of pleural effusion, providing real-time guidance for its aspiration and cytological analysis. Pleural Ultrasonography in Lung Cancer (PULC) as an adjunct to physical examination has the potential to improve preoperative staging of non-small-cell lung cancer during first surgical encounter by allowing the evaluation of previously unassessed pleural effusion. This study consisted of a prospective trial of surgeon-performed PU in the preoperative evaluation of lung cancer patients. All patients evaluated in the thoracic surgery clinic with the new or presumed diagnosis of lung cancer were eligible. A portable ultrasound machine was used to evaluate pleural fluid in the bilateral costophrenic sulci with pleural fluid aspiration for cytological analysis. Forty-five patients were prospectively enrolled over a 3-month period. Thirteen patients had ultrasound evidence of a pleural effusion, of which 3 were significant enough for aspiration. Cytological analysis of these effusions yielded malignant cells in 1 patient. Positive PULC evaluation led to a change in clinical staging (M0 to M1a) in 10 patients and a change in pathological staging (pleural fluid cytology positive) in 1 patient. The time required for PULC examination was 15 ± 7 min. There were no complications related to the procedures. Preoperative pleural ultrasonography is a rapid and effective way to improve precision of staging in patients with lung cancer. More precise staging may allow for more appropriate testing, patient prognostication and operative planning.
Full Text Available Summary: Background: Demoralization is distinctive psychological distress that involves hopelessness, helplessness, loss of purpose and meaning, and existential distress. Cancer patients' demoralization has been well documented, but little is known regarding older cancer patients and the related factors. Therefore, this study evaluated demoralization syndrome in older cancer patients. Methods: Cancer patients over 61 years old (n = 113, female 59.3%, mean age 65.7 years, range 61–80 diagnosed with heterogeneous types of cancer were recruited. They completed questionnaires in a hospital's inpatient and outpatient units. Their demoralization was measured using the Demoralization Scale-Mandarin Version (DS-MV. The Patient Health Questionnaire-9 (PHQ-9, Distress Thermometer (DT, Beck Scale for Suicide Ideation (BSS, and Posttraumatic Growth Inventory (PTGI were used to measure other psychological statuses and the association with demoralization. Results: The mean DS-MV score was 28.1 (SD = 16.3. In this sample, 57.7% had moderate to high demoralization (18.6% had moderate demoralization, and 38.1% had high demoralization. Twenty-three percent reported a DT score of five and above, 5.5% reported a PHQ-9 score of 10 and above, and 23.9% reported a BSS score greater than zero. Demoralization was associated with suicide ideation, depression, distress, lower education, and the cancer site. Demoralization was not associated with posttraumatic growth, gender, work status, or religion. Conclusion: More than half of older cancer patients have moderate to high demoralization and it is associated with depression, suicide ideation, and distress. Screening and interventions that are better tailored to older cancer patients could improve the quality of care in cancer treatment. Keywords: aged, cancer, depression, hospice care/psychology, morale
Malhotra, Jyoti; Rotter, David; Tsui, Jennifer; Llanos, Adana A M; Balasubramanian, Bijal A; Demissie, Kitaw
Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive. Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest. Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs. Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study. Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26
Full Text Available Abstract Background Gastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affect their psychological distress. Methods This was a cross sectional study of anxiety and depression in patients with gastrointestinal cancer attending to the Tehran Cancer Institute. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS. This is a widely used valid questionnaire to measure psychological distress in cancer patients. Demographic and clinical data also were collected to examine anxiety and depression in sub-group of patients especially in those who knew their cancer diagnosis and those who did not. Results In all 142 patients were studied. The mean age of patients was 54.1 (SD = 14.8, 56% were male, 52% did not know their cancer diagnosis, and their diagnosis was related to esophagus (29%, stomach (30%, small intestine (3%, colon (22% and rectum (16%. The mean anxiety score was 7.6 (SD = 4.5 and for the depression this was 8.4 (SD = 3.8. Overall 47.2% and 57% of patients scored high on both anxiety and depression. There were no significant differences between gender, educational level, marital status, cancer site and anxiety and depression scores whereas those who knew their diagnosis showed a significant higher degree of psychological distress [mean (SD anxiety score: knew diagnosis 9.1 (4.2 vs. 6.3 (4.4 did not know diagnosis, P Conclusion Psychological distress was higher in those who knew their cancer diagnosis. It seems that the cultural issues and the way we provide information for cancer patients play important role in their improved or decreased psychological well-being.
Miyamoto, David T.; Mamon, Harvey J.; Ryan, David P.
Purpose: To review the outcomes and tolerability of full-dose chemoradiation in elderly patients aged 75 years or older with localized pancreatic cancer. Methods and Materials: We retrospectively reviewed patients aged 75 years or older with nonmetastatic pancreatic cancer treated with chemoradiation therapy at two institutions from 2002 to 2007. Patients were analyzed for treatment toxicity, local recurrences, distant metastases, and survival. Results: A total of 42 patients with a median age of 78 years (range, 75-90 years) who received chemoradiation therapy for pancreatic cancer were identified. Of the patients, 24 had locally advanced disease treated with definitive chemoradiation, and 18 had disease treated with surgery and chemoradiation. Before chemoradiotherapy, the mean Eastern Cooperative Oncology Group performance status was 1.0 ± 0.8, and the mean 6-month weight loss was 5.3 ± 3.8 kg. The mean radiation dose delivered was 48.1 ± 9.2 Gy. All patients received fluoropyrimidine-based chemotherapy concurrently with radiotherapy. In all, 8 patients (19%) were hospitalized, 7 (17%) had an emergency room visit, 15 (36%) required a radiation treatment break, 3 (7%) required a chemotherapy break, 9 (21%) did not complete therapy, and 22 (49%) had at least one of these adverse events. The most common toxicities were nausea, pain, and failure to thrive. Median overall survival was 8.6 months (95% confidence interval, 7.2-13.1) in patients who received definitive chemoradiation therapy and 20.6 months (95% confidence interval, 9.5-∞) in patients who underwent resection and chemoradiation therapy. Conclusions: In this dataset of very elderly patients with pancreatic cancer and good Eastern Cooperative Oncology Group performance status, outcomes after chemoradiotherapy were similar to those among historic controls for patients with locally advanced and resected pancreatic cancer, although many patients experienced substantial treatment-related toxicity.
Shimizutani, Kiminari; Koseki, Yonoshin; Ikeda, Hiroshi
From January 1980 through April 1990, a total of 317 patients with an oral cancer were treated with radiation therapy at Department of Radiology, Osaka University Hospital. Twenty-seven (8.5%) of these 317 patients had other primary cancers. For statistical purposes, the expected number of other primary cancers was estimated by multiplying the age-sex specific incidence rates among Osaka residents with the Person-year at risk figures, based on the Osaka Prefectural Cancer Registry. The observed/expected [0/E] ratios were 16.00 (p<0.01) for the esophagus and 28.42 (p<0.01) for the oropharynx. The present study suggested the necessity of following up oral cancer patients, especially those who have had carcinoma of the mouth floor, in order to enable the early diagnosis of upper digestive tract cancer. (author)
Omland, Silje Haukali; Ahlström, Magnus Glinvad; Gerstoft, Jan
BACKGROUND: The risk of skin cancer in HIV-infected patients has not been extensively studied. OBJECTIVE: To determine the risk of skin cancer in HIV-infected patients and compare it with the risk in the background population. METHODS: In a matched, nationwide population-based cohort study we...... compared the risk of skin cancer in 4280 HIV-infected patients from the Danish HIV cohort study with a background population cohort, according to the level of immunosuppression and route of transmission. Primary outcomes were time to first basal cell carcinoma (BCC), squamous cell carcinoma (SCC...
Lund, M; Diaz, L J; Gørtz, S
BACKGROUND AND PURPOSE: Myotonic dystrophies (DM) are autosomal dominantly inherited neuromuscular disorders caused by unstable nucleotide repeat expansions. DM and cancer have been associated, but the pathogenesis behind the association remains unclear. It could relate to derived effects of the DM...... genotype in which case non-DM relatives of DM patients would not be expected to be at increased risk of cancer. To elucidate this, a population-based cohort study investigating risk of cancer in relatives of DM patients was conducted. METHODS: DM was identified using the National Danish Patient Registry...
Eric S. Zhou
Full Text Available Insomnia disorder is common in patients undergoing cancer treatment. There is compelling evidence demonstrating that cognitive-behavioral therapy for insomnia (CBT-I should be the initial treatment, but there has been insufficient research has been conducted among cancer patients. This population presents with unique physical and psychosocial health issues that may interfere with standard CBT-I and addressing these issues can play a role in improving treatment adherence and efficacy. We explore potential adaptations that can be made to standard CBT-I for cancer patients. Further research for this growing population is essential.
Ohkawa, Sakae; Kaizu, Yukiko; Odamaki, Mari; Ikegaya, Naoki; Hibi, Ikuo; Miyaji, Kunihiko; Kumagai, Hiromichi
There is controversy about whether the dietary protein requirement of 1.2 g/kg/d for hemodialysis (HD) patients, in the nutritional guidelines recommended by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), is reasonable. A cross-sectional study was conducted in 129 stable HD patients without diabetes (84 men, 45 women) to investigate the association between the protein equivalent of nitrogen appearance normalized by ideal body weight (nPNAibw), an index of protein intake, and skeletal muscle mass or other metabolic consequences. Patients were divided into 5 groups according to nPNAibw index. Midthigh muscle area (TMA), midthigh subcutaneous fat area (TSFA), abdominal muscle area (AMA), abdominal subcutaneous fat area (ASFA), and visceral fat area (AVFA) were measured using computed tomography, and various nutritional parameters were compared among these groups. TMA and AMA values increased with increasing dietary protein intake from less than 0.7 g/kg/d to 0.9-1.1 g/kg/d and showed a plateau at greater than 0.9 to 1.1 g/kg/d of dietary protein intake. Conversely, fat mass, including TSFA, ASFA, and AVFA, and serum potassium concentration increased with graded protein intake, and no plateau was formed. Patients with nPNAibw greater than 1.3 g/kg/d satisfied the criterion of visceral obesity. Although serum prealbumin levels showed a trend similar to that of muscle mass, there was no significant difference in serum albumin levels among the study groups. Optimal dietary protein requirement for patients undergoing maintenance HD in a stable condition appears to be less than the level recommended by the NKF-KDOQI nutritional guidelines.
Mazor, Kathleen M; Beard, Reneé L; Alexander, Gwen L; Arora, Neeraj K; Firneno, Cassandra; Gaglio, Bridget; Greene, Sarah M; Lemay, Celeste A; Robinson, Brandi E; Roblin, Douglas W; Walsh, Kathleen; Street, Richard L; Gallagher, Thomas H
To explore patients' and family members' views on communication during cancer care and to identify those aspects of clinician-patient communication which were most important to patients and family members. We conducted a secondary data analysis of qualitative data from 137 patients with cancer and family members of patients with cancer. We used a modified version of the constant comparative method and coding paradigm of grounded theory. Patients want sensitive, caring clinicians who provide information that they need, when they need it, in a way that they can understand; who listen and respond to questions and concerns, and who attempt to understand the patient's experience. Effective information exchange and a positive interpersonal relationship with the clinician were of fundamental importance to patients and family members. These were interrelated; for instance, failure to provide information a patient needed could damage the relationship, whereas excellent listening could foster the relationship. Information exchange and relationship were also integral to decision-making, managing uncertainty, responding to emotions, and self-management. Clinicians who were responsive to patients' needs beyond the immediate medical encounter were valued. The complexity of cancer care today suggests that efforts to improve communication must be multilevel, acknowledging and addressing patient, clinician, organizational and policy barriers, and facilitators. Measurement tools are needed to assess cancer patients' and family members' experiences with communication over the course of cancer care to provide meaningful, actionable feedback to those seeking to optimize their effectiveness in communicating with patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.
Farpour, Hamid Reza; Habibi, Leila; Owji, Seyed Hossein
Objective: The focus of attention was the prevalence of depression among cancer patients using social networks. An attempt was made to determine if social media could help cancer patients overcome their stress and depression, causes of serious emotional and mental problems for them and their families. Methods: To ascertain the prevalence of depression among cancer patients with reference to use of social networks, 316 cancer patients in the Association of Cancer Patients and cancer-related ce...
Vinoda Thulaseedharan, Jissa; Malila, Nea; Swaminathan, Rajaraman; Esmy Pulikottil, Okuru; Hakama, Matti; Muwonge, Richard; Sankaranarayanan, Rengaswamy
Background: Patients’ survival after diagnosis of cervical cancer is indirectly influenced by socio-economic factors. We evaluated this survival and its socio-economic determinants in a rural population in south India. Methods: We assessed 165 women diagnosed with cervical cancer from the routine care control arm of a randomized screening trial conducted in rural south India. Kaplan-Meier curves were plotted to illustrate the observed survival of cancer patients. The effect of socio-econom...
Verdoodt, Freija; Hansen, Merete Kjaer; Kjaer, Susanne K.
-cause or ovarian cancer-specific mortality. Among 4,419 patients with epithelial ovarian cancer, post-diagnostic statin use was not statistically significantly associated with all-cause (HR: 0.90, 95% CI: 0.78–1.04) or ovarian cancer-specific mortality (HR: 0.90, 95% CI: 0.76–1.08). There was little evidence...
M.Tech. In spite of the improvement in the delivery of anti-cancer treatments over the past decade, side effects from these treatments remain inevitable. A common, distressing side effect that all cancer patients experience is fatigue. However, cancer related fatigue (CRF) remains one that is under-reported and under-treated. CRF is a topic that has received very limited attention in the South African context. Regardless of the amount of literature available on CRF, many questions continue...
Maleux, Geert; Marchal, Pieter; Heye, Sam; Vaninbroukx, Johan; Palmers, Marleen; Verhamme, Peter; Verhaeghe, Raymond
To assess the safety, feasibility and efficacy of catheter-directed thrombolysis for thoracic central venous thrombosis in both cancer and non-cancer patients. A retrospective case series of 68 patients, including 35 with active cancer and 33 without cancer, was analysed. They all received catheter-directed thrombolysis with alteplase or urokinase for symptomatic acute major thoracic vein thrombosis. Substantial clot lysis was obtained in 62 out of 68 patients (91%), the results being 88.6 and 93.8% for cancer and non-cancer patients respectively (P = 0.68). The mean infusion time in patients with and without cancer was 2.11 and 1.84 days respectively (P = 0.3259). Procedure-related complications occurred in two cancer patients (8.6%) and in seven non-cancer patients (21%) (P = 0.18). One cancer patient developed a fatal intracranial bleeding. Additional intervention after successful lysis was performed in cancer (n = 18; 51%) as well as in non-cancer patients (n = 29; 88%). Catheter-directed thrombolysis is a feasible and highly effective interventional procedure with an acceptable safety profile in selected patients with and without cancer for the treatment of symptomatic thoracic central venous thrombosis. In most cases, additional endovascular or surgical procedures are required to restore and maintain vessel patency after successful thrombolysis. (orig.)
Full Text Available It has been suggested that physical activity in breast cancer patients can not only improve quality of life. Influences on physical and psychological levels have been evaluated, but effects on the immune system of breast cancer patients are hardly known. A PubMed search identified relevant trials and meta-analyses from 1970 to 2013. This review summarizes the results of international studies and the current discussion of effects of physical activity on the immune system of breast cancer patients. Highlighted are effects of physical activity on the immune system. Seven original articles and 14 reviews included in this review. Two original and the review articles includes other tumor entities besides breast cancer.Evaluated methods such as dose-response relationships for exercise in oncology, hardly exist. Increased immunological anti-cancer activity due to physical activity is probably mediated via an increase in number and cytotoxicity of monocytes and natural killer cells and cytokines.
Gondos, Adam; Jansen, Lina; Heil, Joerg
Background We examined time trends in axilla management among patients with early breast cancer in European clinical settings. Material and methods EUROCANPlatform partners, including population-based and cancer center-specific registries, provided routinely available clinical cancer registry data...... for a comparative study of axillary management trends among patients with first non-metastatic breast cancer who were not selected for neoadjuvant therapy during the last decade. We used an additional short questionnaire to compare clinical care patterns in 2014. Results Patients treated in cancer centers were...... younger than population-based registry populations. Tumor size and lymph node status distributions varied little between settings or over time. In 2003, sentinel lymph node biopsy (SLNB) use varied between 26% and 81% for pT1 tumors, and between 2% and 68% for pT2 tumors. By 2010, SLNB use increased to 79...
Full Text Available Abstract Background Estimated conditional survival for cancer patients diagnosed at different ages and disease stage provides important information for cancer patients and clinicians in planning follow-up, surveillance and ongoing management. Methods Using population-based cancer registry data for New South Wales Australia, we estimated conditional 5-year relative survival for 11 major cancers diagnosed 1972–2006 by time since diagnosis and age and stage at diagnosis. Results 193,182 cases were included, with the most common cancers being prostate (39,851, female breast (36,585 and colorectal (35,455. Five-year relative survival tended to increase with increasing years already survived and improvement was greatest for cancers with poor prognosis at diagnosis (lung or pancreas and for those with advanced stage or older age at diagnosis. After surviving 10 years, conditional 5-year survival was over 95% for 6 localised, 6 regional, 3 distant and 3 unknown stage cancers. For the remaining patient groups, conditional 5-year survival ranged from 74% (for distant stage bladder cancer to 94% (for 4 cancers at different stages, indicating that they continue to have excess mortality 10–15 years after diagnosis. Conclusion These data provide important information for cancer patients, based on age and stage at diagnosis, as they continue on their cancer journey. This information may also be used by clinicians as a tool to make more evidence-based decisions regarding follow-up, surveillance, or ongoing management according to patients' changing survival expectations over time.
Zhou, Y; Mendonca, S C; Abel, G A; Hamilton, W; Walter, F M; Johnson, S; Shelton, J; Elliss-Brookes, L; McPhail, S; Lyratzopoulos, G
Background: In England, ‘fast-track’ (also known as ‘two-week wait’) general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. Methods: We examined data from 669 220 patients with 35 cancers diagnosed in 2006–2010 following either fast-track or ‘routine’ primary-to-secondary care referrals using ‘Routes to Diagnosis’ data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. Results: There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. Conclusions: Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for ‘alarm’ symptoms are needed to improve diagnostic timeliness. PMID:29182609
Zhou, Y; Mendonca, S C; Abel, G A; Hamilton, W; Walter, F M; Johnson, S; Shelton, J; Elliss-Brookes, L; McPhail, S; Lyratzopoulos, G
In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. We examined data from 669 220 patients with 35 cancers diagnosed in 2006-2010 following either fast-track or 'routine' primary-to-secondary care referrals using 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for 'alarm' symptoms are needed to improve diagnostic timeliness.
Full Text Available Detection of cancer is often equal to facing with a crisis by the patients. Traditionally it is believed that cancer diagnosis should not be told to the patients. The aim of this study was to compare the attitudes towards the disclosure of cancer diagnosis in patients with cancer and control group included healthy people. This crosssectional study was carried out in 2015 with a total of 531 people. We used three questionnaires to collect data. The first one was EORTC QLQ-C30 to assess quality of life of patients with cancer. The second one included items to assess the patients' willingness for detection of the cancer diagnosis. Finally, the third one was the DUREL to evaluate religiosity. Five hundred and thirty one subjects including 216 patients with cancer and 315 healthy people were studied. Mean age of participants was 44 ± 15.7, 50.5% were female. Overall, 63% of patien ts with cancer were informed of their disease status and 37% uninformed. A significant association was seen between the awareness of cancer with physical and social functioning of quality of life. There was a positive significant association between the tendency for being informed of the diagnosis and non-organizational religious activity in participants without cancer. Global health status and all dimensions of religious were correlated in patients significantly. We found the majority of subjects tend to be aware of the disclosure of diagnosis. The physical and social functioning of quality of life were better in uninformed patients than informed patients.
Arab, Claudia; Vanderlei, Luiz Carlos Marques; da Silva Paiva, Laércio; Fulghum, Kyle Levi; Fristachi, Carlos Elias; Nazario, Afonso Celso Pinto; Elias, Simone; Gebrim, Luiz Henrique; Ferreira Filho, Celso; Gidron, Yori; Ferreira, Celso
To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.
In this article, we make the etiologic diagnosis for a sick patient named Healthcare: the cancer of greed. When we explore the two forms of this cancer--corporate and bureaucratic--we find the latter is the greater danger to We the Patients. The "treatments" applied to patient Healthcare by the Congressional "doctors" have consistently made the patient worse, not better. At the core of healthcare's woes is the government's diversion of money from healthcare services to healthcare bureaucracy. As this is the root cause, it is what we must address in order to cure, not sedate or palliate, patient Healthcare.
We examined the outcomes of the first 500 patients referred to a dedicated Rapid Access Lung Cancer Clinic. A total of 206 patients (41.2%) were diagnosed with a thoracic malignancy; 179 had primary lung cancer and 27 had secondary or other thoracic cancers. Pulmonary nodules requiring ongoing surveillance were found in a further 79 patients (15.8%). Of those patients found to have primary lung cancer, 24 (13.4%) had Small Cell and 145 (81%) had Non Small Cell Lung Cancer. In patients with Non small cell tumours, 26 (21.1%) were stage 1, 14 (11.4%) stage II, 37 (30.1%) stage III and 46 (37.4%) stage IV at diagnosis. For the 129 patients (72%) in whom the thoracic MDT recommended active treatment, primary therapy was surgical resection in 44 (24.6%), combined chemoradiation in 31 patients (17.3%), chemotherapy alone in 39 (21.8%) and radiation in 15 (8.4%).
Celedon L, Carlos; Gambi A, Galo; Royer F, Michel; Esquivel C, Patricia; Arteaga J, Patricia; Valdes P, Constanza
Swallowing is a complex neuromuscular process that requires anatomical indemnity and an adequate coordination of several organs. Laryngeal cancer treatment may cause swallowing disorders. Traditionally, a high frequency of this type of disorder after surgery has been reported, but no actual data concerning its incidence in patients undergoing radiotherapy for early laryngeal cancer has been published. Aim. To compare swallowing disorders frequency posterior to treatment in early laryngeal cancer patients. Material and Method. Two groups of early laryngeal cancer patients were transversally studied, one treated with vertical partial surgery (CP), and the other treated exclusively with radiotherapy. Each patient had otorhinolaryngological, nasofibroscopic and video fluoroscopic evaluations after treatment. Differences between groups were compared using the - square test. Results. Twenty patients per group were entered in this study, predominantly males of similar age. Both groups presented a high incidence of aspiration symptoms (55% in RT and 35% in CP). There were no significant differences between both groups. Discussion and Conclusion. A high incidence of swallowing disorders in patients treated for early laryngeal cancer was found. It should then be considered as a frequent alteration in this group of patients, either treated with RT or CP
Elklit, Ask; Reinholt, N.; Nielsen, Louise Hjort
The aim of this study was to assess post-traumatic stress disorder (PTSD) and predictors of PTSD in individuals who experienced the loss of a close relative to cancer. A total of 251 bereaved relatives ages 14 to 76 (M = 41.3, SD = 16.8) were recruited at a counseling service for cancer patients...
Jansen, J.; Weert, J. van; Meulen, N. van der; Dulmen, S. van; Heeren, Th.; Bensing, J.
Purpose: Remembering medical treatment information may be particularly taxing for older cancer patients, but to our knowledge this ability has never been assessed in this specific age group only. Our purpose in this study was to investigate older cancer patients’ recall of information after
G.M.H.E. Dackus (Gwen); N.D. ter Hoeve (Natalie); M. Opdam (Mark); W. Vreuls (Willem); Z. Varga (Zsuzsanna); E. Koop (Esther); S.M. Willems (Stefan Martin); C.H.M. van Deurzen (Carolien); E.J. Groen (Emilie); A. Cordoba (Alicia); J. Bart (Jos); A.L. Mooyaart (Antien); J.G. van den Tweel (Jan); V. Zolota (Vicky); J. Wesseling (Jelle); A. Sapino (Anna); E. Chmielik (Ewa); A. Ryska (Ales); F. Amant (Frédéric); A. Broeks (Annegien); R.M. Kerkhoven (Ron); N. Stathonikos (Nikolas); M. Veta (Mitko); A.C. Voogd (Adri); K. Jóźwiak (Katarzyna); M. Hauptmann (Michael); M. Hoogstraat (Marlous); M.K. Schmidt (Marjanka); G.S. Sonke (Gabe); E. van der Wall (Elsken); S. Siesling (Sabine); P.J. van Diest (Paul); S.C. Linn (Sabine)
markdownabstract__Introduction__ Currently used tools for breast cancer prognostication and prediction may not adequately reflect a young patient’s prognosis or likely treatment benefit because they were not adequately validated in young patients. Since breast cancers diagnosed at a young age are
To study the serum protein fingerprint of patients with gastric cancer and to screen for protein molecules closely related to gastric cancer during the onset and progression of the disease using surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Serum samples from 80 gastric ...
Background: Little is known about risk factors for different cancers in Malawi. This study aimed to assess risk factors for and epidemiologic patterns of common cancers among patients treated at Kamuzu Central Hospital (KCH) in Lilongwe, and to determine the prevalence of Human Immunodeficiency Virus (HIV) infection in ...
Sminia, P; Barten, AD; Van Waarde, MAWH; Vujaskovic, Z; Van Tienhoven, G
We investigated whether the concentration of circulating transforming growth factor beta (TGF beta) yields diagnostic value in breast cancer. Blood was collected from twenty stage I and II breast cancer patients both prior to treatment and after surgical excision of the tumour. Both latent and
Sminia, P.; Barten, A. D.; van Waarde, M. A.; Vujaskovic, Z.; van Tienhoven, G.
We investigated whether the concentration of circulating transforming growth factor beta (TGFbeta) yields diagnostic value in breast cancer. Blood was collected from twenty stage I and II breast cancer patients both prior to treatment and after surgical excision of the tumour. Both latent and active
Conclusion: Adiponectin, which is secreted by adipose tissue, may have a role in the development and progression of cancer via its pro-apoptotic and/or anti-proliferative effects. Adiponectin expression in tumor tissues is likely to have a negative effect on disease - free survival in patients with stage II/III colon cancer; however, no statistically significant effect was demonstrated.
study demonstrated poor economic status of the patients as one of the major reasons for non-adherence to cancer chemotherapy in Nigeria. ... countries has been shown to be poorer [14-17]. ... 13(5.8%) 70years and above. ... Table 1: Age and Stage at Presentation of Women with Breast Cancer in Ile-Ife, ... Percentage.
Co, Michael; Ng, Judy; Kwong, Ava
Air travel has long been a dilemma in post-breast cancer surgery patients. Anecdotal reports have described adverse outcomes on surgical wound, implants, and lymphedema during air travel. This review aims to evaluate the best evidence from the literature concerning the air travel safety in breast cancer patients. A comprehensive review was performed of the Medline, Embase, CINAHL, and Cochrane databases using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by 2 researchers. We reviewed the best evidence on air travel safety in postoperative breast cancer patients. Evidence was limited in the current literature to suggest adverse effects on postoperative mastectomy wounds and drains by high-altitude travel. Similarly, adverse effects on breast implants were limited to case reports and ex vivo experiments. A systematic review of 12 studies concluded that air travel is not associated with upper limb lymphedema after breast cancer surgery. Deep-vein thrombosis (DVT) is a known complication after air travel; in addition, malignancy itself is a known risk factor for DVT. Evidence of safety to continue tamoxifen during the period of air travel is lacking in the literature. Evidence to support the use of systemic DVT prophylaxis in general postoperative breast cancer patients is also limited. Best evidence from a large retrospective study suggested that mechanical antiembolism devices and early mobilization are the only measures required. Air travel is generally safe in patients after breast cancer surgery. Copyright © 2018. Published by Elsevier Inc.
I. D. Rozanov
Full Text Available The risk of pulmonary embolism (PE in cancer patients is 4–7-fold, compared to other patient categories. PE is the second most frequent cause of death in the first year after cancer diagnosis. PE is diagnosed in 7.5% of patients with malignant brain tumors, in 1 to 25% of those with gastrointestinal tumors, in 4.5 to 17.5% of those with breast cancer and in 4 to 10% of lung cancer patients. The risk of PE is higher with surgical interventions and chemotherapy, as well as in metastatic tumors. In 13% of cases, PE may be the first symptom of cancer manifestation. For prevention and treatment of PE low molecular weight heparin (LMWH and warfarin are used. The risk of recurrent PE is 2-fold lower with LMWH. The frequency of bleeding with LMWH and warfarin treatment is from 14 to 19%. Placement of a cava filter is indicated only if anticoagulation is inefficient. New oral anticoagulants, which act as selective thrombin or Factor Xa inhibitors, are not used in cancer patients. Thus, diagnostics and treatment of PE is a very urgent problem in oncology that requires new approaches to be looked for.
Ozkaynak, Mustafa; Brennan, Patricia Flatley; Hanauer, David A; Johnson, Sharon; Aarts, Jos; Zheng, Kai; Haque, Saira N
Effective design of health information technology (HIT) for patient-centered care requires consideration of workflow from the patient's perspective, termed 'patient-oriented workflow.' This approach organizes the building blocks of work around the patients who are moving through the care system. Patient-oriented workflow complements the more familiar clinician-oriented workflow approaches, and offers several advantages, including the ability to capture simultaneous, cooperative work, which is essential in care delivery. Patient-oriented workflow models can also provide an understanding of healthcare work taking place in various formal and informal health settings in an integrated manner. We present two cases demonstrating the potential value of patient-oriented workflow models. Significant theoretical, methodological, and practical challenges must be met to ensure adoption of patient-oriented workflow models. Patient-oriented workflow models define meaningful system boundaries and can lead to HIT implementations that are more consistent with cooperative work and its emergent features.
IJpma, I; Renken, R J; Ter Horst, G J; Reyners, A K L
Metallic taste is a taste alteration frequently reported by cancer patients treated with chemotherapy. Attention to this side effect of chemotherapy is limited. This review addresses the definition, assessment methods, prevalence, duration, etiology, and management strategies of metallic taste in chemotherapy treated cancer patients. Literature search for metallic taste and chemotherapy was performed in PubMed up to September 2014, resulting in 184 articles of which 13 articles fulfilled the inclusion criteria: English publications addressing metallic taste in cancer patients treated with FDA-approved chemotherapy. An additional search in Google Scholar, in related articles of both search engines, and subsequent in the reference lists, resulted in 13 additional articles included in this review. Cancer patient forums were visited to explore management strategies. Prevalence of metallic taste ranged from 9.7% to 78% among patients with various cancers, chemotherapy treatments, and treatment phases. No studies have been performed to investigate the influence of metallic taste on dietary intake, body weight, and quality of life. Several management strategies can be recommended for cancer patients: using plastic utensils, eating cold or frozen foods, adding strong herbs, spices, sweetener or acid to foods, eating sweet and sour foods, using 'miracle fruit' supplements, and rinsing with chelating agents. Although metallic taste is a frequent side effect of chemotherapy and a much discussed topic on cancer patient forums, literature regarding metallic taste among chemotherapy treated cancer patients is scarce. More awareness for this side effect can improve the support for these patients. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available "nBackground: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need. "nMethods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated. "nResults: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin; it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need. "nConclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.
Tolkachov, Yu.A.; Vasil'jev, L.Ya.; Svinarenko, A.V.
Fifty-seven patients aged 34-67 were examined. Considerable circadian fluctuations of main hemodynamic and ECG parameters, which can suggest disorders of circadian rhythms or limit chemoradiotherapy were not noticed in different cancers. Functional criteria of biorhythm state require further investigation
Conclusions: Topical morphine is more effective and more satisfactory to patients than the magic mouthwash in reducing severity of cancer treatment-induced oral mucositis. More studies with larger sample size and longer follow-up are required in this regard.
Personal autonomy presupposes the notion of rationality. What is not so clear is whether, and how, a compromise of rationality to various degrees will diminish a person's autonomy. In bioethical literature, three major types of threat to the rationality of a patient's medical decision are identified: insufficient information, irrational beliefs/desires, and influence of different framing effects. To overcome the first problem, it is suggested that patients be provided with information about their diseases and treatment choices according to the objective standard. I shall explain how this should be finessed. Regarding the negative impact of irrational beliefs/desires, some philosophers have argued that holding irrational beliefs can still be an expression of autonomy. I reject this argument because the degree of autonomy of a decision depends on the degree of rationality of the beliefs or desires on which the decision is based. Hence, to promote patient autonomy, we need to eliminate irrational beliefs by the provision of evidence and good arguments. Finally, I argue that the way to smooth out the framing effects is to present the same information in different perspectives: it is too often assumed that medical information can always be given in a complete and unadorned manner. This article concludes with a cautionary note that the protection of patient autonomy requires much more time and effort than the current practice usually allows. © 2012 John Wiley & Sons Ltd.
Strong, Vivian E; Gholami, Sepideh; Shah, Manish A; Tang, Laura H; Janjigian, Yelena Y; Schattner, Mark; Selby, Luke V; Yoon, Sam S; Salo-Mullen, Erin; Stadler, Zsofia K; Kelsen, David; Brennan, Murray F; Coit, Daniel G
The aim of this study was to describe postoperative outcomes of total gastrectomy at our institution for patients with hereditary diffuse gastric cancer (HDGC). HDGC, which is mainly caused by germline mutations in the E-cadherin gene (CDH1), renders a lifetime risk of gastric cancer of up to 70%, prompting a recommendation for prophylactic total gastrectomy. A prospective gastric cancer database identified 41 patients with CDH1 mutation who underwent total gastrectomy during 2005 to 2015. Perioperative, histopathologic, and long-term data were collected. Of the 41 patients undergoing total gastrectomy, median age was 47 years (range 20 to 71). There were 14 men and 27 women, with 25 open operations and 16 minimally invasive operations. Median length of stay was 7 days (range 4 to 50). In total, 11 patients (27%) experienced a complication requiring intervention, and there was 1 peri-operative mortality (2.5%). Thirty-five patients (85%) demonstrated 1 or more foci of intramucosal signet ring cell gastric cancer in the examined specimen. At 16 months median follow-up, the median weight loss was 4.7 kg (15% of preoperative weight). By 6 to 12 months postoperatively, weight patterns stabilized. Overall outcome was reported to be "as expected" by 40% of patients and "better than expected" by 45%. Patient-reported outcomes were similar to those of other patients undergoing total gastrectomy. Total gastrectomy should be considered for all CDH1 mutation carriers because of the high risk of invasive diffuse-type gastric cancer and lack of reliable surveillance options. Although most patients have durable weight loss after total gastrectomy, weights stabilize at about 6 to 12 months postoperatively, and patients report outcomes as being good to better than their preoperative expectations. No patients have developed gastric cancer recurrence after resections.
Clauss, Dorothea; Tjaden, Christine; Hackert, Thilo; Schneider, Lutz; Ulrich, Cornelia M; Wiskemann, Joachim; Steindorf, Karen
Cancer patients frequently experience reduced physical fitness due to the disease itself as well as treatment-related side effects. However, studies on physical fitness in pancreatic cancer patients are missing. Therefore, we assessed cardiorespiratory fitness and muscle strength of pancreatic cancer patients. We included 65 pancreatic cancer patients, mostly after surgical resection. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing (CPET) and 6-min walk test (6MWT). Hand-held dynamometry was used to evaluate isometric muscle strength. Physical fitness values were compared to reference values of a healthy population. Associations between sociodemographic and clinical variables with patients' physical fitness were analyzed using multiple regression models. Cardiorespiratory fitness (VO 2 peak, 20.5 ± 6.9 ml/min/kg) was significantly lower (-24%) compared to healthy reference values. In the 6MWT pancreatic cancer patients nearly reached predicted values (555 vs. 562 m). Maximal voluntary isometric contraction (MVIC) of the upper (-4.3%) and lower extremities (-13.8%) were significantly lower compared to reference values. Overall differences were larger in men than those in women. Participating in regular exercise in the year before diagnosis was associated with greater VO 2 peak (p fitness with regard to both cardiorespiratory function and isometric muscle strength, already in the early treatment phase (median 95 days after surgical resection). Our findings underline the need to investigate exercise training in pancreatic cancer patients to counteract the loss of physical fitness.
Lowe, Sonya S; Tan, Maria; Faily, Joan; Watanabe, Sharon M; Courneya, Kerry S
Progressive, incurable cancer is associated with increased fatigue, increased muscle weakness, and reduced physical functioning, all of which negatively impact quality of life. Physical activity has demonstrated benefits on cancer-related fatigue and physical functioning in early-stage cancer patients; however, its impact on these outcomes in end-stage cancer has not been established. The aim of this systematic review is to determine the potential benefits, harms, and effects of physical activity interventions on quality of life outcomes in advanced cancer patients. A systematic review of peer-reviewed literature on physical activity in advanced cancer patients will be undertaken. Empirical quantitative studies will be considered for inclusion if they present interventional or observational data on physical activity in advanced cancer patients. Searches will be conducted in the following electronic databases: CINAHL; CIRRIE Database of International Rehabilitation Research; Cochrane Database of Systematic Reviews (CDSR); Database of Abstracts of Reviews of Effects (DARE); Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; MEDLINE; PEDro: the Physiotherapy Evidence Database; PQDT; PsycInfo; PubMed; REHABDATA; Scopus; SPORTDiscus; and Web of Science, to identify relevant studies of interest. Additional strategies to identify relevant studies will include citation searches and evaluation of reference lists of included articles. Titles, abstracts, and keywords of identified studies from the search strategies will be screened for inclusion criteria. Two independent reviewers will conduct quality appraisal using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP) and the Cochrane risk of bias tool. A descriptive summary of included studies will describe the study designs, participant and activity characteristics, and objective and patient-reported outcomes. This systematic review will summarize the current
Nahleh, Zeina; Tabbara, Imad A
Complementary and Alternative Medicine (CAM) is becoming increasingly popular among cancer patients, in particular those with breast cancer. It represents one of the fastest growing treatment modalities in the United States. Therefore, knowledge of CAM therapies is becoming necessary for physicians and other health care providers. CAM encompasses a wide range of modalities including special diet and nutrition, mind-body approaches, and traditional Chinese medicine. We reviewed the biomedical literature on CAM use in breast cancer patients, using Medline search from 1975 until 2002. In addition, consensus reports and books on CAM and breast cancer were included in the review. We evaluated the prevalence of CAM use in breast cancer patients, the reasons cited for its use, the different available modalities, and the reported outcomes. Use of CAM in breast cancer patients ranges between 48% and 70% in the United States. The most commonly used CAM modalities include dietary supplements, mind-body approaches, and acupuncture. The reasons cited for using CAM were to boost the immune system, improve the quality of life, prevent recurrence of cancer, provide control over life, and treat breast cancer and the side effects of treatment. Several studies reported favorable results including improved survival, better pain control, reduced anxiety, improvement in coping strategies and significant efficacy in treating nausea and vomiting. Other less well-organized trials have reported either no benefit or negative effect of CAM and potential toxicity of some commercial products. CAM is a growing field in health care and particularly among breast cancer patients. Knowledge of CAM by physicians, especially oncologists, is necessary. Oncologists should be willing to discuss the role of CAM with their patients and encourage patients to participate in well-organized research about CAM.
Full Text Available Objectives: The purpose of this study is to report a case series of advanced cancer patients whose cancer pain was relieved by using autonomic nerve pharmacopuncture (ANP treatment. ANP is a subcutaneous injection therapy of mountain ginseng pharmacopuncture (MGP along the acupoints on the spine (Hua-Tuo-Jia-Ji-Xue; 0.5 cun lateral to the lower border of the spinous processes of vertebrae to enhance the immune system and to balance autonomic nerve function. Methods: Patients with three different types of cancer (gastric cancer, lung cancer, colon cancer with distant metastases with cancer pain were treated with ANP. 1 mL of MGP was injected into the bilateral Hua-Tuo-Jia-Ji-Xue on the T1-L5 sites (total 12 ─ 20 mL injection of each patient’s dorsum by using the principle of symptom differentiation. During ANP treatment, the visual analogue scale (VAS for pain was used to assess their levels of cancer pain; also, the dosage and the frequency of analgesic use were measured. Results: The cancer pain levels of all three patients improved with treatment using ANP. The VAS scores of the three patients decreased as the treatment progressed. The dosage and the frequency of analgesics also gradually decreased during the treatment period. Significantly, no related adverse events were found. Conclusion: ANP has shown benefit in controlling cancer pain for the three different types of cancer investigated in this study and in reducing the dosage and the frequency of analgesics. ANP is expected to be beneficial for reducing cancer pain and, thus, to be a promising new treatment for cancer pain.
Kuo, Ya-Hui; Tsay, Shiow-Luan; Chang, Chun-Chi; Liao, Yen-Chi; Tung, Heng-Hsin
The purpose of this study was to explore the relationships among cancer impact, belief in complementary and alternative medicine (CAM), CAM use, and quality of life (QOL). The study used a cross-sectional, descriptive correlational design with convenience sampling. A total of 122 cancer patients participated. Data were collected at a medical center in Chunghua, Taiwan. The questionnaires included the Chinese version of the Cancer Problem in Living Scale (CPILS), Complementary and Alternative Medicine Belief Inventory (CAMBI), Complementary and Alternative Medicine scale, and Chinese versions of QOL scales, including the Functional Assessment of Cancer Therapy-General (FACT-G). The mean age was 56.5 years, and most participants were male (n = 69, 56.6%), had completed high school or above (n = 56, 45.9%), and were married (n = 109, 89.3%). The most common type of cancer was oral (n = 17, 13.9%), followed by esophageal (n = 15, 12.3%) and colorectal (n = 13, 10.7%). Cancer patients, on average, use one or two types of CAM. The impact of cancer is significantly related to age (F = 7.12, p cancer was highly negatively associated with QOL (r = -0.71, p = 0.001). The predictors of QOL were the impact of cancer and use of CAM, and the impact of cancer accounted for 51% of the variance in QOL. This study supports research on the impact of cancer, belief in CAM, and use of CAM as related to QOL in cancer patients. These results can be used to provide options to clinicians and cancer patients.
Henselmans, Inge; Jacobs, Marc; van Berge Henegouwen, Mark I.; de Haes, Hanneke C. J. M.; Sprangers, Mirjam A. G.; Smets, Ellen M. A.
Objective: Given the poor prognosis of esophageal cancer and the impact of surgery on health-related quality of life (HRQL), addressing patients' postoperative information needs is important. This study aimed to examine (1) the content and type of patients' information needs and (2) patient
These results extend previous findings showing that QOL improves in cancer patients who quit smoking. Specifically, patients who quit smoking experience a greater reduction in depression and pain levels at all time points, and the reduction increases over time. In the case of fatigue, the results suggest that patients experience the greatest improvement with longer (≥ 4 months abstinence.
Levin, J; Kay, G; Da Fonseca, M [University of the Witwatersrand, Johannesburg (South Africa). Department of Nuclear Medicine; Lange, M [University of the Witwatersrand, Johannesburg (South Africa). Dept. of Surgery; De Moor, N G [University of the Witwatersrand, Johannesburg (South Africa). Department of Radiation Therapy; Savage, N [University of the Witwatersrand, Johannesburg (South Africa). Department of Physiological Chemistry
Oestrogen receptors were measured in the cytoplasmic fraction of tumors from patients with breast cancer. Receptors were detected in 48% of patients, and 52% showed no receptors. A follow-up study of a small group of patients on hormone therapy is reported.
Dariy, E V
To date, there is no unified approach to evaluating and treating patients with suspected prostate cancer taking into account their age and comorbidities. That was the rationale for conducting this study. To assess the clinical course of prostate cancer in men of all ages with comorbidities. The study included 408 patients aged 50 to 92 years (mean age 74.3 years) with histologically verified prostate cancer. 30 (7.4%) patients had stage T1 disease, 273 (66.9%) - T2, 91 (22.3%) - T3 and 14 (3.4%) - T4. The maximum follow-up was 22 years, the minimum one - 6 months (on average 15.4 years). During the follow-up 159 patients died (39%), 51 of them (32%) of prostate cancer, 108 (68%) - from other diseases. Among the latter the causes of death were cancer (20.4%), cardiovascular and bronchopulmonary diseases (79.6%). Cancer-specific survival rate was 41.4 +/-12,4%, the survival rate for other diseases 23.4 +/-10,6% (pcancer, especially of old age, including the option for active surveillance of patients with clinically insignificant prostate cancer.
Listl, Stefan; Jansen, Lina; Stenzinger, Albrecht; Freier, Kolja; Emrich, Katharina; Holleczek, Bernd; Katalinic, Alexander; Gondos, Adam; Brenner, Hermann
The purpose of the present study was to describe the survival of patients diagnosed with oral cavity cancer in Germany. The analyses relied on data from eleven population-based cancer registries in Germany covering a population of 33 million inhabitants. Patients with a diagnosis of oral cavity cancer (ICD-10: C00-06) between 1997 and 2006 are included. Period analysis for 2002–2006 was applied to estimate five-year age-standardized relative survival, taking into account patients' sex as well as grade and tumor stage. Overall five-year relative survival for oral cavity cancer patients was 54.6%. According to tumor localization, five-year survival was 86.5% for lip cancer, 48.1% for tongue cancer and 51.7% for other regions of the oral cavity. Differences in survival were identified with respect to age, sex, tumor grade and stage. The present study is the first to provide a comprehensive overview on survival of oral cavity cancer patients in Germany. PMID:23349710
Full Text Available Background Despite the remarkable development of medical sciences, cancer has yet remained one of the most important diseases of the current century and the second cause of death following cardiovascular diseases. Although we witnessed considerable development in treating cancer and increased number of survivors, cancer is a unique disease that makes the patients deeply feel helplessness and fear. Methods A qualitative content analysis research was done. The present study investigated patients’ experience and behaviors after hearing about their cancer. Purposeful sampling was carried out and continued until data saturation. We used qualitative validation methods to verify the results. Results Study participants consisted of 14 patients. 10 main components emerged from the data including: 1 getting shocked, 2 fear, 3 anxiety and stress, 4 guilt, 5 hopelessness, 6 depression, 7 isolation, 8 lack of affection and dependency on family members, 9 getting prepared to die and, 10 reviving spiritual relationship with God. Conclusions There is a necessity to understand the mental feelings of cancer patients, and program suitable clinical interventions based on patients’ mental needs. As the number of cancer patients is increasing, the results of the present study can be useful for patients’ families and clinical personnel especially physicians and nurses in dealing with cancer patients.
Shaharudin, Soraya Hanie; Sulaiman, Suhaina; Shahril, Mohd Razif; Emran, Nor Aina; Akmal, Sharifah Noor
Breast cancer patients often show an interest in making dietary changes after diagnosis of breast cancer to improve their health condition and prevent cancer recurrence. The objective of the study was to determine changes in dietary intake 2 years after diagnosis among breast cancer patients. One hundred sixteen subjects were asked to complete a semiquantitative food frequency questionnaire, diet recalls, and dietary changes questionnaire to assess dietary intake before and after diagnosis. The information on sociodemographic background, cancer treatment history, and anthropometric indices was also collected. Seventy-two subjects considered diet as a contributing factor to breast cancer, and 67 subjects changed their dietary habits after breast cancer diagnosis. The reasons for changes in diet were physician and dietitian advice and desire to cure cancer. The sources of information were derived from their physician, mass media, and family members. Total energy, protein, total fat, fatty acids, and vitamin E intake were significantly decreased after diagnosis. Meanwhile, the intake of β-carotene and vitamin C increased significantly after diagnosis. The changes included reduction in red meat, seafood, noodles, and poultry intake. An increased consumption of fruits, vegetables, fish, low-fat milk, and soy products was observed. The subjects tended to lower high-fat foods intake and started to eat more fruits and vegetables. Breast cancer patients had changed to a healthier diet after breast cancer diagnosis, although the changes made were small. This will be helpful to dietitians in providing a better understanding of good eating habits that will maintain patients' health after breast cancer diagnosis.
N. V. Yunusova
ovarian tumors resulted in significantly decreased levels of NK-cells in peripheral blood and increased levels in ascites. The differences in the functional activity of NK-cells in ascites and peripheral blood of patients with ovarian cancer require further investigation of the lymphocyte receptor status and possibly cytokine-producing function of NK-cells. Key words: ovarian cancer, colorectal cancer, natural killer cells, functional activity of peripheral blood, ascites.>< 0.05. The proportion of activated peripheral blood NK-cells, containing granules of cytolytic enzymes GB and perforin (PF increased with tumor growth. However, lymph node metastasis in patients with colorectal cancer did not affect the level and activation of NK-cells. The comparative analysis of NK-populations in patients with benign and malignant ovarian tumors revealed that the level of CD56 + cells was significantly higher in tumor ascites compared to peripheral blood. In patients with BTs, the levels of CD56 + CD107a + and activated CD56 + CD107a + GB-PF-degranulated cells was higher in ascites than in blood. In patients with ovarian cancer, the level of degranulated cells was higher in peripheral blood than in malignant ascites. Conclusion. The tumor cells and tumor microenvironment were found to affect the number and the functional activity of NK-cells. The accumulation of free fluid within the peritoneal cavity in patients with both benign and malignant ovarian tumors resulted in significantly decreased levels of NK-cells in peripheral blood and increased levels in ascites. The differences in the functional activity of NK-cells in ascites and peripheral blood of patients with ovarian cancer require further investigation of the lymphocyte receptor status and possibly cytokine-producing function of NK-cells.
Strömgren, Annette S; Goldschmidt, Dorthe; Groenvold, Mogens
the symptomatology of participating patients and examines differences in symptomatology between patients in three palliative care functions: inpatient, outpatient, and palliative home care. RESULTS: Of 267 eligible patients who were referred to a department of palliative medicine, initial self......-based study of symptomatology in consecutive cancer patients in palliative care, achieving rather complete data from the participants. The symptomatology in these patients was very pronounced. The questionnaires were able to detect clinically important differences between places of service....
Marks, Lawrence B
Purpose: To determine the incidence dose/time-dependence and functional significance of regional cardiac perfusion abnormalities in patients with left-sided breast cancer treated with radiation therapy (RT...
Sommer, Maja S; Trier, Karen; Vibe-Petersen, Jette
Introduction: Surgical resection in patients with non-small cell lung cancer (NSCLC) may be associated with significant morbidity, functional limitations, and decreased quality of life. Objectives: The safety and feasibility of a preoperative and early postoperative rehabilitation program...
Inadequate pain treatment in patients with cancer remains a significant problem and appears to be more frequent among minorities, according to a new study published online April 16, 2012, in the Journal of Clinical Oncology.
Kruijver, IPM; Kerkstra, A; Bensing, JM; van de Wiel, H.B.M.
Aim. In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. Rationale. The balance of affective and instrumental communication employed by nurses appears to be important,
Kruijver, I.P.M.; Kerkstra, A.; Bensing, J.M.; Wiel, H.B.M. van der
In this paper the balance of affective and intrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated. Rationale: The balance of affective and instrumental communication employed by nurses appears to be important, especially
Corradini, Andrea; Bøgelund Hansen, Martin; Savic, Toma
In this paper, we report on a responsive web-based application that we have been developing for the cancer hospital in the city of Vejle, Denmark. The application administers and handles systematic frailty scoring of patients with multiple myeloma (bone marrow cancer) and thereby helps the doctor...... make a more efficient and more effective treatment choice. The application is currently being tested with a small number of patients and is to replace the frailty measurement system used until now, which is usually done by the doctor on a per patient basis.......In this paper, we report on a responsive web-based application that we have been developing for the cancer hospital in the city of Vejle, Denmark. The application administers and handles systematic frailty scoring of patients with multiple myeloma (bone marrow cancer) and thereby helps the doctor...
Jacobs, Linda A
This ongoing longitudinal study examines hot flashes and Quality of Life (QoL) in breast cancer (BC) patients undergoing initial treatment, and develops a taxonomy of the medical and Complementary and Alternative Medicine...
Zhu, Lei; Schroevers, Maya J.; van der Lee, Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, Robbert; Ranchor, Adelita V.
Objective: This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential
Eliana C.A. Benites
Conclusions: the prevalence of respiratory viruses was relevant in the infectious episode, with no increase in morbidity and mortality. Viral co‐detection was frequent in patients with cancer and ARIs.
Hoole, J; Kanatas, A; Calvert, A; Rogers, S N; Smith, A B; Mitchell, D A
Problems with intimacy in patients with cancer of the head and neck may not be recognised. Our aim was to review published papers on patient-reported outcomes that record concerns about intimacy, sex, and function, to help develop a tool for use in head and neck cancer. We specifically looked for instruments with evidence of validation in patients with cancer, which could be used to identify problems with intimacy and sexuality. After evaluating 2563 papers, we identified 20 that satisfied our inclusion criteria, and these have been presented in a tabulated form. This review has shown the need to develop a questionnaire on intimacy that is specific to patients with cancer of the head and neck. It is an important issue that must be addressed by clinical and research teams, and will be done most effectively if it is linked to specific interventions. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Zhu, Lei; Schroevers, Maya J.; van der Lee, Marije; Garssen, Bert; Stewart, Roy E.; Sanderman, Robbert; Ranchor, A.V.
Objective This study aimed to (1) identify subgroups of cancer patients with distinct personal control trajectories during psychological care, (2) examine whether socio-demographic, clinical, and psychological care characteristics could distinguish trajectories, and (3) examine differential patterns
Rehder, Douglas S; Nelson, Randall W; Borges, Chad R
On the basis of the results of activity studies, previous reports have suggested that vitamin D binding protein (DBP) is significantly or even completely deglycosylated in cancer patients, eliminating the molecular precursor of the immunologically important Gc macrophage activating factor (GcMAF), a glycosidase-derived product of DBP. The purpose of this investigation was to directly determine the relative degree of O-linked trisaccharide glycosylation of serum-derived DBP in human breast, colorectal, pancreatic, and prostate cancer patients. Results obtained by electrospray ionization-based mass spectrometric immunoassay showed that there was no significant depletion of DBP trisaccharide glycosylation in the 56 cancer patients examined relative to healthy controls. These results suggest that alternative hypotheses regarding the molecular and/or structural origins of GcMAF must be considered to explain the relative inability of cancer patient serum to activate macrophages.
Hill, Amanda; Kiss, Nicole; Hodgson, Belinda; Crowe, Timothy C; Walsh, Adam D
Patients with gastrointestinal cancers are susceptible to nutritional deterioration which may be compounded by radiotherapy treatment toxicities. This study aimed to determine whether nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy were associated with treatment toxicity and outcomes in gastrointestinal cancer patients. Seventy-three gastrointestinal cancer patients receiving curative radiotherapy underwent medical record audits assessing body weight, radiotherapy toxicity, unplanned treatment breaks or hospital admissions and completion of prescribed treatment/s. Nutritional status was assessed in a subset of patients (n = 11) using the Patient-Generated Subjective Global Assessment tool. Seventy-five percent of patients lost weight throughout radiotherapy. Weight loss was significantly greater in patients experiencing unplanned radiotherapy breaks (-3.1% vs -1.6%, p nutritional status during radiotherapy (as measured by weight loss) may be associated with poorer short-term treatment outcomes in gastrointestinal cancer patients. Patient numbers were too small to definitively determine the effect of nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy (defined by PG-SGA) on treatment outcomes. Further research is required to investigate this in larger, longer-term studies. Copyright © 2010. Published by Elsevier Ltd.
Physical exercise plays an important role in cancer prevention as well as in the prevention and treatment of cancer related fatigue during and after treatment. Some of these effects are presented in the thesis of M.J. Velthuis. In Part I effects of physical exercise on anthropometric measurements
Yilmaz, Sema Dereli; Bal, Meltem Demirgöz; Beji, Nezihe Kzlkaya; Arvas, Macit
Stress is commonly encountered among cancer patients and may be a challenge affecting immune system resistance. Social support may contribute positively to the health of cancer patients, playing a role in coping with stress. The aim of this study was to determine whether ways of coping are related to social support given to women with gynecologic cancer. The study was performed as a cross-sectional design in a university hospital in Istanbul, Turkey, with 221 women with gynecologic cancer; the data were collected via 3 questionnaires, the first with sociodemographic and clinical features, the second with multidimensional scale of perceived social support, and the third with the scale of ways of coping with stress. Women with gynecologic cancer who were employed and declared their incomes as balanced and reported more years of education were more likely to perceive higher social support and to use the ineffective coping ways with stress at a lower rate (P perceived social support from family, friends, significant other, and total increases (P support from family members is the mainstay of coping with stress by women with gynecologic cancer. Nurses are indispensable in increasing social support required by women with gynecologic cancer. Well-trained clinical nurses via in-service programs should be experienced and aware of women diagnosed with gynecologic cancer in need of social support during hospital visits and provide necessary guidance.
Full Text Available Dionisios Spyratos, Eleni Papadaki, Sofia Lampaki, Theodoros Kontakiotis Pulmonary Department, Lung Cancer Oncology Unit, Aristotle University of Thessaloniki, G. Papanicolaou Hospital, Thessaloniki, Greece Abstract: Chronic obstructive pulmonary disease (COPD and lung cancer share a common etiological factor (cigarette smoking and usually coexist in everyday clinical practice. The prevalence of COPD among newly diagnosed patients with lung cancer sometimes exceeds 50%. COPD is an independent risk factor (2–4 times higher than non-COPD subjects for lung cancer development.The presence of emphysema in addition to other factors (e.g., smoking history, age could be incorporated into risk scores in order to define the most appropriate target group for lung cancer screening using low-dose computed tomography. Clinical management of patients with coexistence of COPD and lung cancer requires a multidisciplinary oncology board that includes a pulmonologist. Detailed evaluation (lung function tests, cardiopulmonary exercise test and management (inhaled drugs, smoking cessation, pulmonary rehabilitation of COPD should be taken into account for lung cancer treatment (surgical approach, radiotherapy. Keywords: lung cancer, COPD, coexistence, risk factor, therapy decisions
Wiener, Renda Soylemez; Koppelman, Elisa; Bolton, Rendelle; Lasser, Karen E; Borrelli, Belinda; Au, David H; Slatore, Christopher G; Clark, Jack A; Kathuria, Hasmeena
Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings. To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making. Qualitative study entailing semi-structured interviews and focus groups. We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net). Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making. Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making. Due to multiple perceived barriers, patient
Papadakos, Janet; D'souza, Anna; Masse, Adeline; Boyko, Susan; Clarke, Susan; Giuliani, Meredith; MacKinnon, Keira; McBain, Sarah; McCallum, Meg; MacVinnie, Jan; Papadakos, Tina
Patient educators come into the field from diverse professional backgrounds and often lack training in how to teach and develop patient education resources since no formal patient education professional certification program exists. A professional certification program for patient educators would further define the professional scope of practice and reduce variability in performance. The purpose of this study was to (1) determine the level of interest among Canadian cancer patient educators in a patient education professional certification program and (2) determine the competencies to be included in the professional certification program. A 12-item survey was designed by executive members of the Canadian Chapter of the Cancer Patient Education Network. The survey included a list of competencies associated with patient education, and a 4-point Likert scale ranging from "slightly important" to "very important" was used to determine the rank of each competency. The survey was sent to 53 patient educators across Canada. Ninety-two percent of the patient educators are interested in a professional certification program. Patient educators indicated that competencies related to developing patient resources, collaboration, plain language expertise, and health literacy were of most importance. Patient educators support the development of a patient education professional certification program and endorsed the competencies proposed. This information provides the foundation for the creation of a professional certification program for cancer patient educators.
Ross, Lone; Petersen, Morten Aagaard; Johnsen, Anna Thit
To validate five items (CPWQ-inf) regarding satisfaction with information provided to cancer patients from health care staff, assess the prevalence of dissatisfaction with this information, and identify factors predicting dissatisfaction.......To validate five items (CPWQ-inf) regarding satisfaction with information provided to cancer patients from health care staff, assess the prevalence of dissatisfaction with this information, and identify factors predicting dissatisfaction....
Nikola Džakula; Josip Kranjčić; Denis Vojvodić
The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The tw...
Gallo, Marco; Muscogiuri, Giovanna; Felicetti, Francesco; Faggiano, Antongiulio; Trimarchi, Francesco; Arvat, Emanuela; Vigneri, Riccardo; Colao, Annamaria
Diabetes and cancer are common, chronic, and potentially fatal diseases that frequently co-exist. Observational studies have reported an increased risk of cancer in patients with diabetes. Furthermore, many patients with cancer already have diabetes, or develop hyperglycaemia as a consequence of the tumor or of cancer therapies, and coexisting diabetes confers a greater risk of mortality for many malignancies. Managing oncologic patients with diabetes is often complicated, since the co-existence of diabetes and cancer poses several complex clinical questions: what level of glycaemic control to achieve, which therapy to use, how to deal with glucocorticoid therapies and artificial nutrition, how diabetes complications can affect cancer management, which drug-drug interactions should be taken into account, or even how to manage diabetes at the end of life. In the clinical setting, both at hospital and at home, there are little agreed, evidence-based guidelines on the best management and criteria upon which clinical decisions should be based. A practical solution lies in the implementation of care networks based on communication and ongoing collaboration between Oncologists, Endocrinologists, and the nursing staff, with the patient at the centre of the care process. This manuscript aims to review the current evidence on the effect of cancer therapies on glucose metabolism and to address some of the more common challenges of diabetes treatment in patients with cancer. Copyright © 2017 Elsevier Inc. All rights reserved.
Adiel Goes de FIGUEIREDO JUNIOR
Full Text Available Context Capecitabine, an oral drug, is as effective as traditional chemotherapy drugs. Objectives To investigate the adhesion to treatment with oral capecitabine in breast and colorectal cancer, and to determine any correlation with changes in patient’s quality of life. Methods Patients with colorectal cancer or breast cancer using capecitabine were included. The patients were asked to bring any medication left at the time of scheduled visits. The QLQ-C30 questionnaire was applied at the first visit and 8-12 weeks after treatment. Results Thirty patients were evaluated. Adherence was 88.3% for metastatic colon cancer, 90.4% for non-metastatic colon cancer, 94.3% for rectal cancer and 96.2% for metastatic breast cancer. No strong correlation between adherence and European Organisation for Research and Treatment of Cancer QLQ-C30 functional or symptom scale rates had been found. There was no statistically significant correlation between compliance and the functional and symptom scales of the questionnaire before and after chemotherapy, with the exception of dyspnea. Conclusions Although no absolute adherence to oral capecitabine treatment had been observed, the level of adherence was good. Health professionals therefore need a greater focus in the monitoring the involvement of patients with oral treatment regimens. Patients with lesser degrees of dyspnea had greater compliance.
Many patients with life-limiting illnesses continue to work because of financial reasons and because work provides good psychosocial support. A lack of appropriate advice/support through patient education could, however, make having a job detrimental to well-being (eg, symptom worsening). This study investigated the frequency with which patients received information that empowers their understanding of their condition, treatment, side effects of treatment and the likely impact on occupational functioning. A cross-sectional study. An analysis of survey data from 3457 patients with cancer in employment. Logistic regression showed that patients who received information about the impact of cancer on work life or education are 1.72 times more likely to have a positive treatment outcome. Patients who receive written information about the type of cancer are 1.99 times more likely to have a positive treatment outcome. Also, patients who receive written information before a cancer-related operation are 1.90 times more likely to have a positive treatment outcome. Information about the side effects of cancer treatment produces worse odds of a positive treatment outcome (0.65-1). A stepwise logistic regression analysing the effects irrespective of current employment status in 6710 patients showed that preparing them produces nearly twice better odds of cancer treatment responsiveness. Palliative care teams should consider ways of actively advising patients who work. Whereas the results showed evidence of good practice in cancer care, there is a need to ensure that all working patients with potentially life-limiting illnesses receive similar support. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Noordman, J.; Driesenaar, J.A.; Henselmans, I.; Heijmans, M.; Verboom, J.; Dulmen, S. van
Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data
Orive, Miren; Quintana, Jose M; Vrotsou, Kalliopi; Las Hayas, Carlota; Bilbao, Amaia; Barrio, Irantzu; Matellanes, Begoña; Padierna, Jesús A
One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.
Oh, Sung Jin; Shin, Jin Yong
Currently, circumferential resection margins (CRM) are used as a clinical endpoint in studies on the prognosis of rectal cancer. Although the concept of a circumferential resection margin in extraperitoneal rectal cancer differs from that in intraperitoneal rectal cancer due to differences in anatomical and biologic behaviors, previous reports have provided information on CRM involvement in all types of rectal cancer including intraperitoneal lesions. Therefore, the aim of this study was to analyze risk factors of CRM involvement in extraperitoneal rectal cancer. From January 2005 to December 2008, 306 patients with extraperitoneal rectal cancer were enrolled in a prospectively collected database. Multivariate logistic regression analysis was used to identify predictors of CRM involvement. The overall rate of CRM involvement was found to be 16.0%. Multivariate analysis showed that male sex, larger tumor size (≥4 cm), stage higher than T3, nodal metastasis, tumor perforation and non-sphincter preserving proctectomy (NSPP) were risk factors for CRM involvement. Male sex, larger tumor size (≥4 cm), advanced T stage, nodal metastasis, tumor perforation, and NSPP are significant risk factors of CRM involvement in extraperitoneal rectal cancer. Given that postoperative chemoradiotherapy is recommended for patients with a positive CRM, further oncologic studies are warranted to ascertain which patients with these risk factors would require adjuvant therapy.
Honnens de Lichtenberg, M; Miskowiak, J; Rolff, H
A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation...... or hormonal medication alone and 11 patients needed percutaneous nephrostomy or ureteric catheters in addition. Drainage improved in 58% of the kidneys. The diverting catheter was withdrawn in 9 of the 11 patients after a median of 4 weeks. In all, 95% of patients were discharged. The patients with hormonal...
Swart, Siebe J; Rietjens, Judith A C; van Zuylen, Lia; Zuurmond, Wouter W A; Perez, Roberto S G M; van der Maas, Paul J; van Delden, Johannes J M; van der Heide, Agnes
Palliative care is often focused on cancer patients. Palliative sedation at the end of life is an intervention to address severe suffering in the last stage of life. To study the practice of continuous palliative sedation for both cancer and noncancer patients. In 2008, a structured questionnaire was sent to 1580 physicians regarding their last patient receiving continuous sedation until death. A total of 606 physicians (38%) filled out the questionnaire, of whom 370 (61%) reported on their last case of continuous sedation (cancer patients: n=282 [76%] and noncancer patients: n=88 [24%]). More often, noncancer patients were older, female, and not fully competent. Dyspnea (odds ratio [OR]=2.13; 95% confidence interval [CI]: 1.22, 3.72) and psychological exhaustion (OR=2.64; 95% CI: 1.26, 5.55) were more often a decisive indication for continuous sedation for these patients. A palliative care team was consulted less often for noncancer patients (OR=0.45; 95% CI: 0.21, 0.96). Also, preceding sedation, euthanasia was discussed less often with noncancer patients (OR=0.42; 95% CI: 0.24, 0.73), whereas their relatives more often initiated discussion about euthanasia than relatives of cancer patients (OR=3.75; 95% CI: 1.26, 11.20). The practice of continuous palliative sedation in patients dying of cancer differs from patients dying of other diseases. These differences seem to be related to the less predictable course of noncancer diseases, which may reduce physicians' awareness of the imminence of death. Increased attention to noncancer diseases in palliative care practice and research is, therefore, crucial as is more attention to the potential benefits of palliative care consultation. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Van Poppel, Hein; Tombal, Bertrand
The objective of this review is to provide information on cardiovascular risk following androgen-deprivation therapy (ADT) in prostate cancer patients and to suggest potential prevention and management strategies. Androgen deprivation therapy can cause peripheral insulin resistance, increase fat mass and low-density lipoprotein cholesterol, and induce type 2 diabetes. While recent studies have reported an association in patients with prostate cancer between ADT and increased risk of cardiovascular events, other studies have not detected the association. However, at this time, it is plausible that ADT could increase cardiovascular risk because of the adverse effect of ADT on risk factors for cardiovascular disease. It is advisable that prostate cancer patients in whom ADT is initiated be referred to their physician, who will carefully monitor them for potential metabolic effects. Therefore, physicians should be informed about these potential side effects. This especially applies to men aged >65 years and those with pre-existing cardiovascular comorbidities. Adopting a healthy lifestyle including a balanced diet and regular physical activity is recommended. Patients with cardiovascular disease should receive appropriate preventive therapies, including lipid-lowering, antihypertensive, glucose-lowering, and antiplatelet therapy. ADT should preferably not be unnecessarily administered to prostate cancer patients with pre-existing cardiovascular disease, certainly not to those in whom the risk of prostate cancer-specific mortality is low. The physician should carefully weigh the potential benefits of ADT against the possible risks in individual patients with prostate cancer
Al-Maweri, Sadeq Ali; Al-Soneidar, Walid Ahmed; Dhaifullah, Esam; Halboub, Esam Saleh; Tarakji, Bassel
More than 50 % of oral cancer cases are diagnosed at advanced stages. Public knowledge about oral cancer can help in prevention and early detection of the disease. The aim of the present study was to assess the levels of awareness and knowledge about signs and risk factors of oral cancer among dental patients in Saudi Arabia. A self-administered questionnaire was used to collect information from 1410 randomly selected patients attending dental departments within public hospitals in Riyadh, Saudi Arabia. The collected data were analyzed using SPSS software. The significance level was set at P oral cancer. Some 68.2 and 56.5 %, respectively, were able to correctly identify tobacco and alcohol as risk factors. More than two thirds of subjects had no knowledge about any signs of oral cancer. Participants with lower than university education were significantly less aware, and had much less knowledge, of the signs and risk factors of oral cancer. The knowledge regarding oral cancer among Saudi dental patients is alarmingly low. Interventions to improve public knowledge about oral cancer and attitudes towards early diagnosis and treatment are urgently indicated.
Liang Jun; Feng Qinfu; Wang Luhua; Zhang Yaohong; Zhao Hongfa; Weng Xinran
Objective: To analyze the clinical characteristics and prognosis of the second primary lung cancer. Methods: The interval between the second primary lung cancer and the previous primary cancer ranged from 10 days to 317 months (median 49 months). Of the 129 patients treated from 1971 to 1997 by surgery only, radiotherapy only and chemotherapy only or combined therapy, 11 (8.5%) patients had stage I, 29 (22.5%) stage II, 75 (58.1%) stage III and 14 (10.9%) stage IV; 30 patients received surgery alone, 54 radiotherapy alone, 8 chemotherapy alone, 12 surgery plus radiotherapy, 20 radiotherapy plus chemotherapy, 4 surgery plus chemotherapy and 1 surgery plus radiotherapy plus chemotherapy. Results: The overall 2-, 3- and 5-year survival rates were 40.2%, 27.2% and 15.3%. The stage I, II, III and IV 2-year survival rates were 71.6%, 60.7%, 32.9% and 0%, respectively (P 49 and ≤49 months of the interval between the second primary lung cancer and the previous primary cancer (P>0.05). Conclusions: Second primary lung cancer are similar to the first primary lung cancer in clinical characteristics and prognosis. The main cause of failure is lung cancer perse. Stage and being able to operation are prognostic factors
Tam, Laura; Garvey, Gail; Meiklejohn, Judith; Martin, Jennifer; Adams, Jon; Walpole, Euan; Fay, Michael; Valery, Patricia
Amongst Indigenous Australians, “cancer” has negative connotations that detrimentally impact upon access to cancer care services. Barriers to accessing cancer services amongst Indigenous Australians are widely reported. In contrast, factors that facilitate this cohort to successfully navigate cancer care services (“enablers”) are scarcely reported in the literature. Through qualitative interviews, this article examines factors that assist Indigenous Australians to have positive cancer experiences. Semi-structured interviews were conducted with twelve adult Indigenous oncology patients recruited from a tertiary hospital in Queensland, Australia during 2012–2014. Data generated from the interviews were independently reviewed by two researchers via inductive thematic analytical processes. Discussions followed by consensus on the major categories allowed conclusions to be drawn on potential enablers. Two major categories of enablers were identified by the researchers: resilience and communication. Individual’s intrinsic strength, their coping strategies, and receipt of support improved participant’s resilience and consequently supported a positive experience. Communication methods and an effective patient-provider relationship facilitated positive experiences for participants. Despite potential barriers to access of care for Indigenous cancer patients, participants in the study demonstrated that it was still possible to focus on the positive aspects of their cancer experiences. Many participants explained how cancer changed their outlook on life, often for the better, with many feeling empowered as they progressed through their cancer diagnosis and treatment processes. PMID:29342934
Survivorship is a complicated notion because people often confuse a process of survivorship with a mythic identity of being a cancer survivor. This confusion may be a distraction to addressing the real-life struggles and challenges experienced by all people diagnosed with cancer. A more expansive perspective of survivorship, one that attends to patients' physical, psychological, social, spiritual, and existential challenges throughout a continuum of care, would be more in line with what is known empirically about people's experiences with cancer. In an effort to gain a patient-centered perspective on cancer, and one that emphasizes multiple dimensions of cancer survivorship, the author reports findings from a non-scientific social media poll (via Facebook and personal emails) in which survivors and colleagues working in the field of cancer survivorship answered the question: What does cancer survivorship mean to you? The comments are enlightening and useful for guiding the development of a patient-centered, and, thus, more comprehensive, approach to caring for people affected by cancer.
Full Text Available Abstract Background Individuals heterozygous for germline ATM mutations have been reported to have an increased risk for breast cancer but the role for ATM genetic variants for breast cancer risk has remained unclear. Recently, a common ATM variant, ATMivs38 -8T>C in cis with the ATMex39 5557G>A (D1853N variant, was suggested to associate with bilateral breast cancer among familial breast cancer patients from Northern Finland. We have here evaluated the 5557G>A and ivs38-8T>C variants in an extensive case-control association analysis. We also aimed to investigate whether there are other ATM mutations or variants contributing to breast cancer risk in our population. Methods Two common ATM variants, 5557G>A and ivs38-8T>C, previously suggested to associate with bilateral breast cancer, were genotyped in an extensive set of 786 familial and 884 unselected breast cancer cases as well as 708 healthy controls. We also screened the entire coding region and exon-intron boundaries of the ATM gene in 47 familial breast cancer patients and constructed haplotypes of the patients. The identified variants were also evaluated for increased breast cancer risk among additional breast cancer cases and controls. Results Neither of the two common variants, 5557G>A and ivs38-8T>C, nor any haplotype containing them, was significantly associated with breast cancer risk, bilateral breast cancer or multiple primary cancers in any of the patient groups or subgoups. Three rare missense alterations and one intronic change were each found in only one patient of over 250 familial patients studied and not among controls. The fourth missense alteration studied further was found with closely similar frequencies in over 600 familial cases and controls. Conclusion Altogether, our results suggest very minor effect, if any, of ATM genetic variants on familial breast cancer in Southern Finland. Our results do not support association of the 5557G>A or ivs38-8T>C variant with
Janiszewska, Justyna; Lichodziejewska-Niemierko, Monika; Gołębiewska, Justyna; Majkowicz, Mikołaj; Rutkowski, Bolesław
Anxiety is the most frequent emotional reaction to the chronic somatic disease. However, little is known about anxiety and coping strategies in patients with end-stage renal disease (ESRD) undergoing renal replacement therapies (RRTs). The purpose of the study was to assess the intensity and determinants of anxiety in patients treated with different RRTs in comparison with end-stage breast cancer patients and healthy controls. The study involved (1) ESRD patients undergoing different RRTs: 32 renal transplant recipients, 31 maintenance haemodialysis and 21 chronic peritoneal dialysis patients, (2) women with end-stage breast cancer (n = 25) and (3) healthy persons (n = 55). We used State-Trait Anxiety Inventory, Scale of Personal Religiousness, Mental Adjustment to Cancer Scale, Rotterdam Symptom Checklist with reference to medical history. The data thus obtained were analysed using the analysis of variance, the Tukey's HSD post hoc test and Spearman's rank correlation coefficient. Both ESRD and breast cancer patients revealed higher level of anxiety state and trait than healthy controls; however, there was no statistically significant difference found between both findings. There was a tendency towards higher levels of anxiety state in breast cancer patients when compared to ESRD patients undergoing the RRT treatment and for both groups non-constructive coping strategies correlated with the levels of anxiety state. With ESRD patients undergoing RRTs, the intensity of anxiety state did not depend on the mode of treatment but on the correlation between the levels of anxiety and the general quality of their life, psychological condition and social activity. In patients with advanced somatic disease (ESRD and end-stage breast cancer), non-constructive strategies of coping with the disease require further evaluation and possibly psychological support.
Hillen, Marij A.; de Haes, Hanneke C. J. M.; van Tienhoven, Geertjan; Bijker, Nina; van Laarhoven, Hanneke W. M.; Vermeulen, Dani?lle M.; Smets, Ellen M. A.
Trust in the oncologist is crucial for breast cancer patients. It reduces worry, enhances decision making, and stimulates adherence. Optimal nonverbal communication by the oncologist, particularly eye contact, body posture, and smiling, presumably benefits patients? trust. We were the first to experimentally examine (1) how the oncologist?s nonverbal behavior influences trust, and (2) individual differences in breast cancer patients? trust. Analogue patients (APs) viewed one out of eight vers...
Sorbye, Halfdan; Pfeiffer, Per; Cavalli-Björkman, Nina
BACKGROUND: Trial accrual patterns were examined to determine whether metastatic colorectal cancer (mCRC) patients enrolled in trials are representative of a general cancer population concerning patient characteristics and survival. METHODS: A total of 760 mCRC patients referred for their first...... oncological consideration at 3 hospitals in Scandinavia covering defined populations were registered consecutively during 2003 to 2006. Clinical trial enrollment, patient characteristics, and treatment were recorded prospectively, and the follow-up was complete. RESULTS: Palliative chemotherapy was initiated...
Iqbal, A.; Intikhab, K.; Saeed, K.
Objective: To find out major non-medial factors associated with psychological disorders in cancer patients. Design: An observational study conducted on adult cancer patients. Place and Duration of Study: The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center Lahore Pakistan from January 1999. Patients and Methods: Two hundred and twenty-four newly-diagnosed adult cancer patients were interviewed by the clinical psychologist and data was collected regarding non-medical causal factors, patients age, gender family support system, general home atmosphere and marital status. Collected data was analyzed by utilizing. SPSS for windows version 10.0. Results: Of the 224 patients 142 (63.4%) reported non-medical factors causing psychological distress and 82 (36.6%) reported that medical sources are the most distressing. Ten most common non-medical sources of developing psychological disorders were identified. It was observed that family support system and general home atmosphere were significantly associated with the development of psychological disorders whereas the other variables such as age, gender and marital status had no significant relationship with the non Medical factors. Conclusion: It was concluded that non-medical factors causing psychological problems are significant in cancer patients. The results suggest that we should identify these factors and target psychosocial intervention for those patients most at risk. (author)
Nadzirah Ahmad Basri
Full Text Available Active religious practice is central to Muslim livelihood. Among Muslims, this religious engagement is rarely studied with regards to its association in coping with critical illnesses. This study investigated the association between Islamic religiosity with depression and anxiety in Muslim cancer patients. Fifty-nine cancer patients recruited from a Malaysian public hospital and a cancer support group completed the Muslim Religiosity and Personality Inventory, Beck Depression Inventory and Beck Anxiety Inventory in July and August 2010. Islamic religiosity score, obtained from the sum of subscale scores of Islamic worldview and religious personality represents a greater understanding and practice of Islam in a comprehensive manner. Results yielded a significant negative correlation between Islamic religiosity score with both depression and anxiety. Depression was also found to be negatively associated with religious personality subscale. Older patients scored significantly higher on both Islamic worldview and religious personality whereas patients with higher education scored higher on Islamic worldview. Married patients scored significantly higher scores on religious personality than the single patients. Results provided an insight into the significant role of religious intervention which has huge potentials to improve the psychological health of cancer patients particularly Muslims in Malaysia. Research implication includes the call for professionals to meet the spiritual needs of Muslim cancer patients and incorporating religious components in their treatment, especially in palliative care.
Religioni, Urszula; Czerw, Aleksandra; Deptała, Andrzej
Physical symptoms related to cancer are associated with various mental conditions. An adopted attitude towards pain and disease affects the quality of life of patients and may even decide about the final outcome of therapy. The objective of the study was to assess the degree of mental adjustment of patients diagnosed with breast, lung, colorectal and prostate cancer. The analysis also covered the effect of socioeconomic factors on mental adjustment in patients in the above groups. The study included 902 patients treated on an outpatient basis at the Center of Oncology, the Maria Skłodowska-Curie Institute in Warsaw, in the year 2013. The study participants were patients diagnosed with breast, lung, colorectal and prostate carcinoma. The Paper and Pencil Interview (PAPI) technique was applied. The questionnaire interview included demographic-type questions (socioeconomic variables) and the Mini-Mental Adjustment to Cancer (mini-MAC) scale, which measures the degree of mental adjustment to disease. The highest scores in the anxious preoccupation and helplessness-hopelessness subclasses were those of the lung, colorectal, breast and prostate cancer patients. In breast and lung cancer study participants, differences between individual categories distinguished due to socioeconomic features proved statistically insignificant. However, significant dependencies were observed between mental adjustment to disease and chemotherapy in the past year; though, the results differ with respect to the primary site. The primary site affects patient adjustment to disease. Socioeconomic factors in the area of mental adaptation differentiate colorectal carcinoma patients.