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Volz F, Wolf K, Fung C, Carroll I, Lahmann C, Lützen N, Urbach H, Klingler JH, Beck J, El Rahal A. Impact of Spinal CSF Leaks on Quality of Life and Mental Health and Long-Term Reversal by Surgical Closure. Neurol Clin Pract 2024; 14:e200272. [PMID: 38585435 PMCID: PMC10996905 DOI: 10.1212/cpj.0000000000200272] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/09/2024] [Indexed: 04/09/2024]
Abstract
Background and Objectives Spontaneous intracranial hypotension (SIH) caused by a spinal CSF leak is a multisymptom syndrome, which can dramatically affect physical and mental health. However, systematic data on health-related quality of life (HRQoL) and mental health are scarce. We hypothesized that surgical treatment leads to significant and sustained improvements in HRQoL and mental health in patients with SIH. Methods In this single-center cohort study, we prospectively collected HRQoL and mental health data in patients undergoing surgical closure of a spinal CSF leak from September 2020 to November 2022. EuroQoL (EQ-5D-5L), including the health state index (EQ-Index) and the visual analog scale (EQ-VAS), measured HRQoL. The 21-item version of the Depression Anxiety Stress Scales (DASS-21) measured symptoms of mental health. Follow-ups were performed 3 and 6 months postoperatively. Primary outcome was the change in EQ-Index, EQ-VAS, and DASS-21 subscales. Secondary outcome was the impact of baseline depression symptoms on HRQoL outcomes following surgery. Results Seventy-four patients were included. EQ-VAS improved from 40 (interquartile range [IQR] 30-60) preoperatively to 70 (IQR 55-85) at 3 months and to 72 (IQR 60-88) at 6 months postoperatively (p < 0.001, respectively). EQ-Index increased from 0.683 (IQR 0.374-0.799) to 0.877 (0.740-0.943) at 3 months and to 0.907 (0.780-0.956) at 6 months postoperatively (p < 0.001, respectively). Depression, anxiety, and stress significantly improved after surgery. Preoperative depressive symptoms did not affect the HRQoL outcome. Discussion The severe impact of a spinal CSF leak on HRQoL and mental health significantly improved after closure of the leak. Higher levels of depressive symptoms do not predict worse outcomes and should not discourage invasive treatment. Further systematic evaluation of outcomes, with special regard to quality of life, is needed, as it allows a comparison of symptom burden between SIH and more familiar diseases as well as a comparison of different treatment modalities in future studies.
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Affiliation(s)
- Florian Volz
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Katharina Wolf
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Christian Fung
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Ian Carroll
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Claas Lahmann
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Niklas Lützen
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Horst Urbach
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Jan-Helge Klingler
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
| | - Amir El Rahal
- Department of Neurosurgery (FV, KW, CF, J-HK, JB, AER), Medical Center - University of Freiburg, Germany; Stanford CSF Leak Headache Program (IC), Stanford Headache Clinic, Stanford School of Medicine, CA; Department of Psychosomatic Medicine and Psychotherapy (CL); and Department of Neuroradiology (NL, HU), Medical Center - University of Freiburg, Germany
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Aljawadi MH, Alkhudair N, Alrasheed M, Alsuhaibani AS, Alotaibi BJ, Almuqbil M, Alhammad AM, Arafah A, AlGahtani FH, Rehman MU. Understanding the Quality of Life Among Patients With Cancer in Saudi Arabia: Insights From a Cross-Sectional Study. Cancer Control 2024; 31:10732748241263013. [PMID: 38870396 PMCID: PMC11179550 DOI: 10.1177/10732748241263013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/25/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Cancer patients' quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients' experience. This study measures the OoL among patients with cancer and influencing factors. METHODS A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported. RESULTS Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning (P = .016 and .03) and experienced more significant financial impact (P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others (P = .0127). Patients traveling long distances were more likely to face adverse financial consequences (P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05). CONCLUSION Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.
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Affiliation(s)
- Mohammad H Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nora Alkhudair
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Marwan Alrasheed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz S Alsuhaibani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Basil J Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Almuqbil
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Azhar Arafah
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Farjah H AlGahtani
- Department of internal Medicine, King Saud University College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Muneeb U Rehman
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Nallasamy P, Nimmakayala RK, Parte S, Are AC, Batra SK, Ponnusamy MP. Tumor microenvironment enriches the stemness features: the architectural event of therapy resistance and metastasis. Mol Cancer 2022; 21:225. [PMID: 36550571 PMCID: PMC9773588 DOI: 10.1186/s12943-022-01682-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer divergence has many facets other than being considered a genetic term. It is a tremendous challenge to understand the metastasis and therapy response in cancer biology; however, it postulates the opportunity to explore the possible mechanism in the surrounding tumor environment. Most deadly solid malignancies are distinctly characterized by their tumor microenvironment (TME). TME consists of stromal components such as immune, inflammatory, endothelial, adipocytes, and fibroblast cells. Cancer stem cells (CSCs) or cancer stem-like cells are a small sub-set of the population within cancer cells believed to be a responsible player in the self-renewal, metastasis, and therapy response of cancer cells. The correlation between TME and CSCs remains an enigma in understanding the events of metastasis and therapy resistance in cancer biology. Recent evidence suggests that TME dictates the CSCs maintenance to arbitrate cancer progression and metastasis. The immune, inflammatory, endothelial, adipocyte, and fibroblast cells in the TME release growth factors, cytokines, chemokines, microRNAs, and exosomes that provide cues for the gain and maintenance of CSC features. These intricate cross-talks are fueled to evolve into aggressive, invasive, migratory phenotypes for cancer development. In this review, we have abridged the recent developments in the role of the TME factors in CSC maintenance and how these events influence the transition of tumor progression to further translate into metastasis and therapy resistance in cancer.
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Affiliation(s)
- Palanisamy Nallasamy
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198-5870, USA
| | - Rama Krishna Nimmakayala
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198-5870, USA
| | - Seema Parte
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198-5870, USA
| | - Abhirup C Are
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198-5870, USA
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198-5870, USA.
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Moorthy P Ponnusamy
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198-5870, USA.
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
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Yao S, Ding K, Liu S, Zhang Q, Li W, Tang L, Yu S, Pang L, Yin X, Cheng H. The Managing Cancer and Living Meaningfully (CALM) Intervention Alleviates Chemotherapy-Related Cognitive Impairment in Patients with Breast Cancer by Modulating Pan-Immune-Inflammation Values. Integr Cancer Ther 2022; 21:15347354221140498. [DOI: 10.1177/15347354221140498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The number of patients with breast cancer is increasing worldwide, resulting in a growing number of patients with chemotherapy-related cognitive impairment (CRCI), which seriously affects their quality of life. CRCI is associated with inflammatory factors and systemic inflammatory markers such as pan-immune-inflammation value (PIV) and monocyte-to-lymphocyte ratio (MLR), which can reflect the level of inflammation in the body. While the Managing Cancer and Living Meaningfully (CALM) intervention has been demonstrated to alleviate CRCI in patients with breast cancer, the specific mechanism remains unclear. Objective: This study evaluated the impact of the CALM intervention on systemic inflammation. Methods: Ninety patients with breast cancer with CRCI were enrolled and randomized into care as usual (CAU) and CALM intervention groups. All patients were assessed using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), Mini-Mental State Exam (MMSE), and Functional Assessment of Cancer Therapy-Breast (FACT-B) before and after the CAU/CALM intervention. The blood levels of inflammatory markers were also analyzed before and after the intervention. Results: Compared to the CAU group, the CALM group showed significantly improved cognitive function and significantly decreased PIV ( P < .05). PIV was significantly negatively correlated with FACT-Cog ( P < .05). The levels of other inflammatory markers, including MLR, neutrophil-to-lymphocyte ratio (NLR), granulocyte-to-lymphocyte ratio (GLR), and systemic immune-inflammation index (SII), were also reduced in the CALM group. Conclusion: PIV is an important marker of inflammation. The CALM intervention may improve the cognitive function of patients by regulating the systemic inflammation marker PIV through the neuroimmune axis.
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Affiliation(s)
- Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ke Ding
- Department of Radiation Oncology, Fuyang Cancer Hospital, Fuyang, Anhui, China
| | - Shaochun Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qianqian Zhang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen Li
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lingxue Tang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Sheng Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lulian Pang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiangxiang Yin
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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