Prostate cancer and supportive care: a systematic review and qualitative synthesis of men's experiences and unmet needs

Prostate cancer is the second most common cancer in men worldwide, accounting for an estimated 1.1 million new cases diagnosed in 2012 (www.globocan.iarc.fr). Currently, there is a lack of specific guidance on supportive care for men with prostate cancer. This article describes a qualitative systematic review and synthesis examining men's experience of and need for supportive care. Seven databases were searched; 20 journal articles were identified and critically appraised. A thematic synthesis was conducted in which descriptive themes were drawn out of the data. These were peer support, support from partner, online support, cancer specialist nurse support, self‐care, communication with health professionals, unmet needs (emotional support, information needs, support for treatment‐induced side effects of incontinence and erectile dysfunction) and men's suggestions for improved delivery of supportive care. This was followed by the development of overarching analytic themes which were: uncertainty, reframing, and the timing of receiving treatment, information and support. Our results show that the most valued form of support men experienced following diagnosis was one‐to‐one peer support and support from partners. This review highlights the need for improved access to cancer specialist nurses throughout the care pathway, individually tailored supportive care and psychosexual support for treatment side effects.

Prolonged remission from hepatic encephalopathy with rifaximin: results of a placebo crossover analysis

BACKGROUND

Rifaximin therapy reduced risk of hepatic encephalopathy (HE) recurrence and HE-related hospitalisations during a 6-month, randomised, placebo-controlled trial (RCT) and a 24-month open-label maintenance (OLM) study. However, the impact of crossover from placebo to rifaximin therapy is unclear.

AIM

To study the impact of crossing over from placebo to rifaximin treatment on breakthrough HE and hospitalisation rates using a within-subjects design.

METHODS

Adults with cirrhosis and history of overt HE episodes, currently in HE remission, received placebo during the RCT and crossed over to rifaximin 550 mg twice daily during the OLM study. Rate of breakthrough overt HE episodes, hospitalisations and incidence and rate of adverse events (AEs) were analysed during RCT and first 6 months of OLM.

RESULTS

Of 82 patients randomised to placebo in the RCT who crossed over to the OLM study, 39 experienced an HE episode during the RCT compared with 14 during the OLM study (P < 0.0001). Significantly lower rates of HE events were observed with rifaximin treatment compared with placebo treatment (P < 0.0001). Rates of HE-related hospitalisation were numerically lower during rifaximin treatment compared with placebo treatment, although not significant. Rates of most common AEs, serious AEs and infection-related AEs were similar between the two treatments.

CONCLUSIONS

This analysis confirms the repeatability of results from the RCT on safety and efficacy of rifaximin 550 mg twice daily in reducing the risk of hepatic encephalopathy recurrence, and suggests these findings are translatable outside of a rigorous, controlled trial setting.

A retrospective analysis: the development of patient reported outcome measures for the assessment of Crohn's disease activity

BACKGROUND

The Crohn's Disease Activity Index (CDAI) is a measure of disease activity based on symptoms, signs and a laboratory test. The US Food and Drug Administration has indicated that patient reported outcomes (PROs) should be the primary outcome in randomised controlled trials for Crohn's disease (CD).

AIM

As no validated PRO exists for CD, to investigate whether CDAI diary card items could be modified for this purpose.

METHODS

Data from a trial of rifaximin-extended intestinal release were used to identify cut-points for stool frequency, pain and general well-being using receiver operating characteristic curves with CDAI <150 as criterion. The operating properties of 2- and 3-item PRO were evaluated using data from a trial of methotrexate in CD. Regression analysis determined PRO2 and PRO3 scores that correspond to CDAI-defined thresholds of 150, 220 and 450 and changes of 50, 70 and 100 points.

RESULTS

Optimum cut-points for CDAI remission were mean daily stool frequency ≤1.5, abdominal pain ≤1, and general well-being score of ≤1 (areas under the ROC curve 0.79, 0.91 and 0.89, respectively). The effect estimates were similar using 2- and 3-item PROs or CDAI. PRO2 and PRO3 values corresponding to CDAI scores of 150, 220 and 450 points were 8, 14, 34 and 13, 22, 53. The corresponding values for CDAI changes of 50, 70 and 100, were 2, 5, 8 and 5, 9, 14. Responsiveness to change was similar for both PROs.

CONCLUSION

Patient reported outcomes derived from CDAI diary items may be appropriate for use in clinical trials for CD.

Safety and tolerability of rifaximin for the treatment of irritable bowel syndrome without constipation: a pooled analysis of randomised, double-blind, placebo-controlled trials

BACKGROUND

The efficacy of rifaximin, a nonsystemic, gut-targeted antibiotic for reducing non-constipation-predominant irritable bowel syndrome (non-C IBS) symptoms, has been demonstrated in one phase 2b and two phase 3 randomised, double-blind, placebo-controlled trials, but detailed data about rifaximin safety and tolerability during treatment and subsequent follow-up periods are lacking.

AIM

To assess and determine the frequency of rifaximin and placebo adverse events (AEs) in phase 2b and phase 3 non-C IBS trials.

METHODS

A post hoc pooled safety analysis of the phase 2b (rifaximin 275, 550, and 1100 mg twice daily for 2 weeks; 550 mg twice daily for 4 weeks) and phase 3 (rifaximin 550 mg three times daily for 2 weeks) studies was performed. Data on treatment and post-treatment AEs were collected. Patients were followed up for 12 weeks and 10 weeks post-treatment in the phase 2b and phase 3 trials, respectively.

RESULTS

Patients receiving rifaximin (n = 1103) and placebo (n = 829) had a similar incidence of drug-related AEs (12.1% vs. 10.7%), serious AEs (1.5% vs. 2.2%), drug-related AEs resulting in study discontinuation (0.8% vs. 0.8%), gastrointestinal-associated AEs (12.2% vs. 12.2%) and infection-associated AEs (8.5% vs. 9.5%). There were no cases of Clostridium difficile colitis or deaths.

CONCLUSIONS

The safety and tolerability profile of rifaximin during treatment and post-treatment was comparable to placebo. Future research should define the safety and tolerability profile, including risk of C. difficile colitis and microbial antibiotic resistance, with repeated courses of rifaximin in patients with non-constipation-predominant irritable bowel syndrome (ClinicalTrials.gov: NCT00269412, NCT00731679, and NCT00724126).

Sequential TPF chemotherapy followed by concurrent chemoradiotherapy in locally advanced head and neck cancer--a retrospective analysis of toxicity and outcomes

BACKGROUND AND AIMS

Phase III trials have shown that the addition of a taxane to cisplatin/5FU-based induction chemotherapy (TPF) improves response rates and overall survival in unresectable stage III/IV head and neck cancer. We sought to assess the tolerability, compliance and clinical outcomes of this treatment regime.

METHODS

A retrospective study of patients treated within a single centre between September 2007 and November 2010. Toxicities were graded according to CTCAE version 3.0. Survival, distant metastasis and local control rates are expressed as percentages at two years using the Kaplan-Meier method.

RESULTS

A total of 100 patients were identified (11% stage III, 86% stage IV) and 32% of patients were admitted as an emergency after TPF. The rate of neutropenic fever was 31%, this number fell to 9% when prophylactic G-CSF was used. In addition, 89% of patients underwent radical chemoradiation. Of these, 96% completed the full radiotherapy course. However, only 64% of patients received a minimum of two cycles of concurrent platinum chemotherapy. The two-year overall survival, metastasis free survival and local control rates were 62.6%, 88.5% and 73.3%, respectively.

CONCLUSIONS

TPF chemotherapy can be delivered safely in a non-trial cohort of patients. There is, however, a significant reduction in concurrent chemotherapy dose intensity. The long-term impact of this remains unclear.

Scanning ophthalmoscope retinal image registration using one-dimensional deformation fields

We present a new, robust and automated method for registering sequences of images acquired from scanning ophthalmoscopes. The method uses a multi-scale B-spline representation of the deformation field to map images to each other and an hierarchical optimization method. We applied the method to video sequences acquired from different parts of the retina. In all cases, the registration was successful, even in the presence of large distortions from microsaccades, and the resulting deformation fields describe the fixational motion of the eye. The registration reveals examples of dynamic photoreceptor behaviour in the sequences.

Precise measurement of the neutron magnetic form factor G(M)n in the few-GeV2 region

The neutron elastic magnetic form factor was extracted from quasielastic electron scattering on deuterium over the range Q;{2}=1.0-4.8 GeV2 with the CLAS detector at Jefferson Lab. High precision was achieved with a ratio technique and a simultaneous in situ calibration of the neutron detection efficiency. Neutrons were detected with electromagnetic calorimeters and time-of-flight scintillators at two beam energies. The dipole parametrization gives a good description of the data.

Search for the photoexcitation of exotic mesons in the pi+pi+pi- system

A search for exotic mesons in the pi;{+}pi;{+}pi;{-} system photoproduced by the charge exchange reaction gammap-->pi;{+}pi;{+}pi;{-}(n) was carried out by the CLAS Collaboration at Jefferson Lab. A tagged-photon beam with energies in the 4.8 to 5.4 GeV range, produced through bremsstrahlung from a 5.744 GeV electron beam, was incident on a liquid-hydrogen target. A partial wave analysis was performed on a sample of 83 000 events, the highest such statistics to date in this reaction at these energies. The main objective of this study was to look for the photoproduction of an exotic J;{PC}=1;{-+} resonant state in the 1 to 2 GeV mass range. Our partial wave analysis shows production of the a_{2}(1320) and the pi_{2}(1670) mesons, but no evidence for the a_{1}(1260), nor the pi_{1}(1600) exotic state at the expected levels. An upper limit of 13.5 nb is determined for the exotic pi_{1}(1600) cross section, less than 2% of the a_{2}(1320) production.

Measurement of direct f0(980) photoproduction on the proton

We report on the results of the first measurement of exclusive f_{0}(980) meson photoproduction on protons for E_{gamma}=3.0-3.8 GeV and -t=0.4-1.0 GeV2. Data were collected with the CLAS detector at the Thomas Jefferson National Accelerator Facility. The resonance was detected via its decay in the pi;{+}pi;{-} channel by performing a partial wave analysis of the reaction gammap-->ppi;{+}pi;{-}. Clear evidence of the f_{0}(980) meson was found in the interference between P and S waves at M_{pi;{+}pi;{-}} approximately 1 GeV. The S-wave differential cross section integrated in the mass range of the f_{0}(980) was found to be a factor of about 50 smaller than the cross section for the rho meson. This is the first time the f_{0}(980) meson has been measured in a photoproduction experiment.

Assessment of endotoxin levels in the home and current asthma and wheeze in school-age children

The relationship between household endotoxin and asthma in children is not clear. To further investigate the relationship between sources of endotoxin and childhood asthma, we conducted a case-control study of children with and without asthma and examined their more frequent household exposures in the home. Children ages 6-13 years with current asthma (n = 70) or wheeze only (n = 19) were sex and age matched (+/-1 year) to 107 controls. Play area and mattress dust were collected for endotoxin analysis. Atopic status was determined by skin prick testing for allergies. A family size of >4 per household was associated with higher endotoxin levels (EU/mg) in the bed dust (P < 0.05). Passive smoking (P < 0.05) and the presence of a cat were associated with higher levels of endotoxin in mattress dust. Endotoxin levels in either the play dust or the bed dust did not differ between cases and controls. Within atopic cases, those with higher endotoxin loads (EU/m2) in bed or play areas were more likely to miss school for chest illness (P < 0.05). In this study, household endotoxin is not a risk factor for current asthma overall but may be associated with increased severity in children with atopic asthma.

PRACTICAL IMPLICATIONS

This study did not find that household sources of endotoxin were associated with asthma. However, within atopic asthmatics, asthma severity (as measured by a history of being kept home from school because of a chest illness in the past year) was associated with higher levels of endotoxin in dust from the child's bed. There is a need to further investigate the nature of the relationship between household endotoxin and asthma severity in children which could lead to better management of childhood asthma.

Measurement of deeply virtual compton scattering beam-spin asymmetries

The beam-spin asymmetries in the hard exclusive electroproduction of photons on the proton (e p-->epgamma) were measured over a wide kinematic range and with high statistical accuracy. These asymmetries result from the interference of the Bethe-Heitler process and of deeply virtual Compton scattering. Over the whole kinematic range (x(B) from 0.11 to 0.58, Q2 from 1 to 4.8 GeV2, -t from 0.09 to 1.8 GeV2), the azimuthal dependence of the asymmetries is compatible with expectations from leading-twist dominance, A approximately a sinphi/(1+c cosphi). This extensive set of data can thus be used to constrain significantly the generalized parton distributions of the nucleon in the valence quark sector.

Bayesian analysis of pentaquark signals from CLAS data

We examine the results of two measurements by the CLAS collaboration, one of which claimed evidence for a Theta(+) pentaquark, while the other found no such evidence. The unique feature of these two experiments was that they were performed with the same experimental setup. Using a Bayesian analysis, we find that the results of the two experiments are in fact compatible with each other, but that the first measurement did not contain sufficient information to determine unambiguously the existence of a Theta(+). Further, we suggest a means by which the existence of a new candidate particle can be tested in a rigorous manner.

Search for medium modifications of the rho meson

The photoproduction of vector mesons on various nuclei has been studied using the CLAS detector at Jefferson Laboratory. The vector mesons, rho, omega, and varphi, are observed via their decay to e;{+}e;{-}, in order to reduce the effects of final-state interactions in the nucleus. Of particular interest are possible in-medium effects on the properties of the rho meson. The rho mass spectrum is extracted from the data on various nuclei, 2H, C, Fe, and Ti. We observe no significant mass shift and some broadening consistent with expected collisional broadening for the rho meson.

Experimental study of exclusive 2H(e,e'p)n reaction mechanisms at high Q2

The reaction 2H(e,e'p)n has been studied with full kinematic coverage for photon virtuality 1.75<Q2<5.5 GeV2. Comparisons of experimental data with theory indicate that for very low values of neutron recoil momentum (p(n)<100 MeV/c) the neutron is primarily a spectator and the reaction can be described by the plane-wave impulse approximation. For 100<p(n)<750 MeV/c, proton-neutron rescattering dominates the cross section, while Delta production followed by the NDelta-->NN transition is the primary contribution at higher momenta.

Applications of ultrasonography in the reproductive management of Dux magnus gentis venteris saginati

Dux magnus gentis venteris saginati is considered to be a Scottish delicacy; however, depleting wild stocks have resulted in attempts to farm them. Selective breeding has been successful in modifying behaviour, increasing body length, reducing hair coat and improving fank (litter) size. However, there are still significant problems associated with the terrain in which they are farmed. This article describes the use of ultrasonography in the reproductive management of this species and the introduction of new genetic material in an attempt to address these problems, with the aim of improving welfare and productivity.

Search for Theta++ pentaquarks in the exclusive reaction gammap-->K+K-p

The reaction gammap --> pK+K- was studied at Jefferson Lab with photon energies from 1.8 to 3.8 GeV using a tagged photon beam. The goal was to search for a Theta++ pentaquark, a narrow, doubly charged baryon state having strangeness S=+1 and isospin I=1, in the pK+ invariant mass spectrum. No statistically significant evidence of a Theta++ was found. Upper limits on the total and differential cross section for the reaction gammap --> K-Theta++ were obtained in the mass range from 1.5 to 2.0 GeV/c2, with an upper limit for a narrow resonance with a mass M(Theta++) = 1.54 GeV/c2 of about 0.15 nb, 95% C.L.. This result places a stringent upper limit on the Theta++ width Gamma(Theta++) <0.1 MeV/c2.

Measurement of deeply virtual compton scattering with a polarized-proton target

The longitudinal target-spin asymmetry AUL for the exclusive electroproduction of high-energy photons was measured for the first time in ep-->e;'pgamma. The data have been accumulated at JLab with the CLAS spectrometer using 5.7 GeV electrons and a longitudinally polarized NH3 target. A significant azimuthal angular dependence was observed, resulting from the interference of the deeply virtual Compton scattering and Bethe-Heitler processes. The amplitude of the sinvarphi moment is 0.252+/-0.042stat+/-0.020sys. Theoretical calculations are in good agreement with the magnitude and the kinematic dependence of the target-spin asymmetry, which is sensitive to the generalized parton distributions H and H.

Search for the Theta+ Pentaquark in the gammad--> DeltanK+ reaction measured with the CLAS spectrometer

For the first time, the reaction gammad-->DeltanK+ has been analyzed in order to search for the exotic pentaquark baryon Theta+(1540). The data were taken at Jefferson Laboratory, using the Hall-B tagged-photon beam of energy between 0.8 and 3.6 GeV and the CEBAF Large Acceptance Spectrometer (CLAS). No statistically significant structures were observed in the nK+ invariant-mass distribution. The upper limit on the gammad-->DeltaTheta+ integrated cross section has been calculated and found to be between 5 and 25 nb, depending on the production model assumed. The upper limit on the differential cross section is also reported.

Search for the Theta+ pentaquark in the reaction gammad --> pK-K+n

A search for the Theta+ in the reaction gammad --> pK-K+n was completed using the CLAS detector at Jefferson Lab. A study of the same reaction, published earlier, reported the observation of a narrow Theta+ resonance. The present experiment, with more than 30 times the integrated luminosity of our earlier measurement, does not show any evidence for a narrow pentaquark resonance. The angle-integrated upper limit on Theta+ production in the mass range of 1.52-1.56 GeV/c2 for the gammad --> pK-Theta+ reaction is 0.3 nb (95% C.L.). This upper limit depends on assumptions made for the mass and angular distribution of Theta+ production. Using Lambda(1520) production as an empirical measure of rescattering in the deuteron, the cross section upper limit for the elementary gamman --> K-Theta+ reaction is estimated to be a factor of 10 higher, i.e., approximately 3 nb (95% C.L.).

Eta' photoproduction on the proton for photon energies from 1.527 to 2.227 GeV

Differential cross sections for the reaction gamma p --> eta' p have been measured with the CLAS spectrometer and a tagged photon beam with energies from 1.527 to 2.227 GeV. The results reported here possess much greater accuracy than previous measurements. Analyses of these data suggest for the first time the coupling of the eta'N channel to both the S11(1535) and P11(1710) resonances, known to couple strongly to the etaN channel in photoproduction on the proton, and the importance of J = 3/2 resonances in the process.

Search for Theta+ (1540) Pentaquark in High-Statistics Measurement of gammap-->K0K+n at CLAS

The exclusive reaction gammap-->K0K+n was studied in the photon energy range between 1.6 and 3.8 GeV searching for evidence of the exotic baryon Theta+ (1540)-->nK+. The decay to nK+requires the assignment of strangeness S=+1 to any observed resonance. Data were collected with the CLAS detector at the Thomas Jefferson National Accelerator Facility corresponding to an integrated luminosity of 70 pb-1. No evidence for the Theta+ pentaquark was found. Upper limits were set on the production cross section as function of center-of-mass angle and nK+ mass. The 95% C.L. upper limit on the total cross section for a narrow resonance at 1540 MeV was found to be 0.8 nb.

Beam-helicity asymmetries in double-charged-pion photoproduction on the proton

Beam-helicity asymmetries for the two-pion-photoproduction reaction gammap-->ppi(+)pi(-) have been studied for the first time in the resonance region for center-of-mass energies between 1.35 and 2.30 GeV. The experiment was performed at Jefferson Lab with the CEBAF Large Acceptance Spectrometer using circularly polarized tagged photons incident on an unpolarized hydrogen target. Beam-helicity-dependent angular distributions of the final-state particles were measured. The large cross-section asymmetries exhibit strong sensitivity to the kinematics and dynamics of the reaction. The data are compared with the results of various phenomenological model calculations, and show that these models currently do not provide an adequate description for the behavior of this new observable.

Atmospheric turbulence and orbital angular momentum of single photons for optical communication

The effects of propagation through random aberrations on coherence for single-photon communication systems based on orbital angular momentum states are quantified. A rotational coherence function is derived which leads to scattering equations for azimuthal modes of different orbital angular momentum states. The effect on a single-photon communication system is quantified using the channel capacity. The work shows that the decoherence effect of atmospheric turbulence on such systems is important even for weak turbulence.

Increased epithelial uptake of protein antigens in the ileum of Crohn's disease mediated by tumour necrosis factor alpha

BACKGROUND AND AIMS

The exact nature of the epithelial barrier defect in Crohn's disease remains to be elucidated. Previously we showed increased permeability to proteins in ileal Crohn's disease. Our aims were to study if this barrier defect (a) involves endocytotic uptake of antigens and (b) is related to low grade inflammation not detectable by histology.

METHODS

Macroscopically normal segments of distal ileum of Crohn's disease patients (n = 10) were subgrouped into non-inflamed (histologically unaffected) and slightly inflamed tissues and studied in Ussing chambers, with normal ileal specimens from colon cancer patients (n = 9) as controls. Endocytotic uptake into enterocytes of the protein antigen horseradish peroxidase was assessed by measuring the area of horseradish peroxidase containing endosomes in electron photomicrographs. Mucosal tumour necrosis factor alpha (TNF-alpha) mRNA was quantified using real time polymerase chain reaction. For comparison, the effects of low doses of TNF-alpha on endosomal uptake of horseradish peroxidase were studied in cultured T84 cells grown on filter supports.

RESULTS

The area of horseradish peroxidase containing endosomes was increased (p<0.001) in enterocytes of non-inflamed ileum of Crohn's disease (2.8 (0.7) mum(2)/300 mum(2)) compared with control ileum (0.6 (0.06)). In non-inflamed mucosa, a significant association between endosomal uptake and mucosal expression of TNF-alpha mRNA (p = 0.03) was found. Low concentrations of TNF-alpha (0.25-1.0 ng/ml) enhanced the endosomal uptake of horseradish peroxidase in polarised T84 cells, without affecting transepithelial electrical resistance.

CONCLUSIONS

Our findings suggest increased endosomal uptake of antigens in ileal Crohn's disease that may be mediated by TNF-alpha. These data highlight the transcellular route of antigen uptake in barrier dysfunction and implicate the interaction between epithelial cells and the innate immune system in the development of mucosal inflammation.

Developing the Medication Change Questionnaire

OBJECTIVE

People who seek non-pharmaceutical interventions are often motivated by a desire to avoid or reduce orthodox medication. Effectiveness research in these areas needs to measure change in medication as an outcome. We set out to develop a data collection tool that is sensitive to changes in individual drug use over time.

METHOD

A multi-disciplinary team designed, piloted, and revised the Medication Change Questionnaire (MCQ) on two occasions, and used qualitative interviews to understand the patient's perspective and ensure that the final product accurately reflected the medication that patients were taking. Thirty patients in one general practice completed the questionnaire on two occasions and a purposive sample of 14 were interviewed. The design sought to enable patients to record all their ingested medication accurately, both prescription and over-the-counter drugs, over a period of 7 days. It was designed to be administered face-to face on the first occasion, and to be self-completed on subsequent occasions.

RESULTS

In considering in detail what medication was taken each day, the interview data fully correlated with the MCQ data in only one of the five people who were interviewed after completing the first draft of the questionnaire, but in eight of the nine people who completed the second draft. Of these eight people all but one had made some change to their medication, either by stopping or starting a drug, varying the dose of a drug or always taking one or more drugs in varying doses. The interviews demonstrated the complex and individual ways that people took their medicines, and the disparity between what was prescribed and what was actually taken. The qualitative data were also useful for reflecting on the potential advantages and disadvantages of other data collection methods, such as single medication questions and pill counts.

CONCLUSION

By involving patients at every level of research, we have developed a questionnaire that enables people to record their medication use accurately over a 7-day period, and to demonstrate changes in medication over time. Further work is required to assess its acceptability by different patient populations and its feasibility in terms of completion rates over longer periods of repeated use. We believe the MCQ to be an improvement over the variety of ad-hoc tools used in the past and it is freely available from the authors.