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Shinan-Altman S, Levkovich I, Hamama-Raz Y. Cervical cancer survivors: The experiences of the journey. Palliat Support Care 2024; 22:563-570. [PMID: 35975560 DOI: 10.1017/s1478951522000785] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical cancer affects survivors' overall coping. Yet, specifically emotional and behavioral expression patterns among cervical cancer survivors have barely been examined. In addition, no study has focused on survivors' experiences of sequences related to coping. Understanding these perceptions can help provide a tailored response and improve psycho-social interventions. The aim of this study was to gain a better understanding of the emotional and behavioral motives involved in coping with cervical cancer recovery. METHODS Qualitative interviews were conducted with 15 survivors of cervical cancer (stages I and II), using a semi-structured in-depth questionnaire. The interviews were recorded, transcribed, and analyzed by three researchers using thematic analysis. RESULTS Six main themes emerged: (i) Reasons and benefits for keeping the disease a secret or sharing it with others; (ii) "When you get used to despair, there's also room for hope": Despair alongside hope; (iii) Self-guilt following the disease, but also knowing how to forgive yourself; (iv) Deep loneliness alongside a significant need for support; (v) Finding the way from passivity to activity; and (vi) When meaning in life is missing, and the importance of meaning when it is present. There was a balance between negative emotions and behaviors (despair, confidentiality, guilt, loneliness, passivity, lack of meaning) and positive emotions and behaviors (hope, openness, forgiveness, significant support, activity, meaning). SIGNIFICANCE OF THE RESULTS The study revealed that in some cases cervical cancer coping during the recovery period moves across sequences. The women's narratives portray past difficulties as the reason for present psychological health, and their experience of a healthy present is intensified by their past difficulties. Implications for practice are discussed.
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Affiliation(s)
- Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tivon, Israel
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Zhao Z, Cheng W, Qu W, Shao G, Liu S. Antibiotic Alleviates Radiation-Induced Intestinal Injury by Remodeling Microbiota, Reducing Inflammation, and Inhibiting Fibrosis. ACS OMEGA 2020; 5:2967-2977. [PMID: 32095719 PMCID: PMC7033964 DOI: 10.1021/acsomega.9b03906] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/20/2020] [Indexed: 05/05/2023]
Abstract
Radiation-induced intestinal injury is a common complication of abdominal radiation therapy. However, the pathological features of radiation-induced intestinal injury and its therapeutic regimen are not very clear. The aim of this study was to investigate the effects of antibiotic pretreatment on radiation-induced intestinal injury. Abdominal radiation disrupted the intestinal microbiota balance and significantly reduced bacterial diversity in mice. Antibiotic cocktail (Abx) pretreatment effectively removed the intestinal microbiota of mice, and metronidazole also reduced the diversity of intestinal bacteria to some extent. Two antibiotic pretreatment regimens improved the reconstitution ability of the gut microbiota in mice after radiation. Further experiments showed that Abx pretreatment effectively reduced the content of lipopolysaccharide (LPS) and inhibited the TLR4/MyD88/NF-κB signaling pathway in the ileum. In addition, Abx pretreatment regulated macrophage cell polarization in the ileum, downregulated TGF-β1, phosphorylated Smad-3 and α-SMA protein levels, and upregulated E-cadherin protein expression. Eventually, Abx pretreatment significantly improved the survival rate and attenuated intestinal injury of mice after radiation by reducing inflammation and preventing intestinal fibrosis. These results revealed that antibiotic pretreatment can effectively alleviate gut microbiota turbulence and intestinal damage caused by abdominal radiation in mice. Collectively, these findings add to our understanding of the pathogenesis of radiation enteritis.
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Affiliation(s)
- Zhenguo Zhao
- Department
of General Surgery, The Affiliated Jiangyin
Hospital of Southeast University Medical College, Wuxi, Jiangsu 214400, China
| | - Wei Cheng
- Department
of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese
Medicine, Nanjing 210029, China
| | - Wei Qu
- Department
of Pharmacy, The Affiliated Jiangyin Hospital
of Southeast University Medical College, Wuxi, Jiangsu 214400, China
| | - Guoyi Shao
- Department
of General Surgery, The Affiliated Jiangyin
Hospital of Southeast University Medical College, Wuxi, Jiangsu 214400, China
- E-mail: (G.S.)
| | - Shuanghai Liu
- Department
of General Surgery, The Affiliated Jiangyin
Hospital of Southeast University Medical College, Wuxi, Jiangsu 214400, China
- E-mail: (S.L.)
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Al-Qadami G, Van Sebille Y, Le H, Bowen J. Gut microbiota: implications for radiotherapy response and radiotherapy-induced mucositis. Expert Rev Gastroenterol Hepatol 2019; 13:485-496. [PMID: 30907164 DOI: 10.1080/17474124.2019.1595586] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiotherapy is a mainstay of solid tumor management but can be associated with unacceptable levels of off-target tissue toxicity which impact treatment outcomes and patients' quality of life. Tumour response to radiotherapy and the frequency and severity of radiotherapy-induced toxicities, especially mucositis, varies among patients. Gut microbiota has been found to modulate both the efficacy and toxicity of some types of cancer chemotherapies and immunotherapies but has yet to be investigated thoroughly in the setting of radiotherapy. Area covered: In this review, we discuss the potential role of gut microbiota on modulating radiotherapy-induced oral and gastrointestinal mucositis and the anti-tumor response to radiotherapy through modulation of immune responses. Expert opinion: The gut microbiota plays a major role in the modulation of systemic immune responses, which influence both radiotherapy response and gastrointestinal toxicities such as mucositis. Hence, investigating the gut microbiota link to the variation in radiotherapy responses and toxicities among patients is warranted. Future targeting of these responses with a patient-tailored restoration of optimal microbial composition could lead to a new era of mucositis prevention and enhanced tumor responses.
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Affiliation(s)
- Ghanyah Al-Qadami
- a Adelaide Medical School , The University of Adelaide , Adelaide , Australia
| | - Ysabella Van Sebille
- b Division of Health Sciences , The University of South Australia , Adelaide , Australia
| | - Hien Le
- c Department of Radiation Oncology , Royal Adelaide Hospital , Adelaide , Australia
| | - Joanne Bowen
- a Adelaide Medical School , The University of Adelaide , Adelaide , Australia
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Total Reference Air Kerma is Associated with Late Bowel Morbidity in Locally Advanced Cervical Cancer Patients Treated with Image-Guided Adaptive Brachytherapy. J Clin Med 2019; 8:jcm8010125. [PMID: 30669569 PMCID: PMC6352249 DOI: 10.3390/jcm8010125] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 01/29/2023] Open
Abstract
No dose volume parameter has been identified to predict late bowel toxicities in locally advanced cervical cancer (LACC) patients treated with image-guided adaptive brachytherapy. We examined the incidence of bowel toxicities according to the total reference air kerma (TRAK) in 260 LACC patients. In both univariate and multivariate analysis, late morbidity positively correlated with a TRAK ≥2 cGy (centigray) at 1 meter, emphasizing the importance of this parameter in term of late bowel morbidity. Objective: There is no validated dose volume parameter to predict late bowel toxicities in cervical cancer patients treated with image-guided adaptive brachytherapy (IGABT). We examined the incidence of bowel toxicities according to the TRAK, which is proportional to the integral dose to the patients. Material/Methods: Clinical data of 260 LACC patients treated with curative intent from 2004 to 2016 were examined. Patients received chemoradiation plus a pulse-dose rate IGABT boost. The relationship between TRAK and morbidity was assessed by Kaplan-Meier method, log-rank tests, and Cox proportional-hazards model on event-free periods. Results: Median follow-up was 5.2 years (SE (Standard Error): 0.21). Probability of survival without late bowel toxicity Grade ≥ 2 rate for patients without recurrence (n = 227) at 5 years was 66.4% (SE 3.7). In univariate analysis, bowel and/or sigmoid dose/volume parameters were not significant. Late morbidity positively correlated with active smoking, CTVHR volume >25 cm3, and a TRAK ≥2 cGy at 1 meter. In multivariate analysis, the following factors were significant: Active smoking (p < 0.001; HR: 2.6; 95%CI: 1.4–5.0), and the TRAK (p = 0.02; HR: 2.4; 95%CI: 1.2–5.0). Conclusion: TRAK was associated with late bowel toxicities probability, suggesting that the integral dose should be considered, even in the era of IGABT.
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Tas S, Ozkan OF, Cikman O, Kiraz A, Akgun Y, Karaayvaz M. L-carnitine has a protective effect on the colonic mucosa during abdominopelvic radiotherapy in rats. Acta Cir Bras 2016; 31:615-620. [PMID: 27737347 DOI: 10.1590/s0102-865020160090000007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/23/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE: To evaluate histopathologically the radioprotective effect of L-carnitine on the colonic mucosa in rats undergoing abdominopelvic irradiation. METHODS: Thirty-two rats were randomly assigned to four experimental groups: intraperitoneal administration of normal saline (group 1) or L-carnitine (300 mL/kg; group 2), followed in groups 3 and 4, respectively, by one dose of abdominopelvic radiation (20 Gy) 30 min later. Rats were sacrificed 5 days after radiation, and their descending colons were resected for histopathological evaluation of the presence and severity of damage. RESULTS: Average damage scores did not differ significantly between groups 1 and 2 (0.13 ± 0.35 and 0.25 ± 0.46, respectively); the group 3 score was highest (10.25 ± 0.71), and the group 4 score (3.63 ± 1.41) was significantly lower than that of group 3 (both p = 0.0001). Pre-radiation L-carnitine administration significantly reduced mucosal thinning, crypt distortion, reactive atypia, inflammation, cryptitis, and reactive lymph-node hyperplasia (all p < 0.01). CONCLUSIONS: L-carnitine had a radioprotective effect on rat colonic mucosa. L-carnitine use should be explored for patients with gastrointestinal cancer, who have reduced serum L-carnitine levels.
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Affiliation(s)
- Sukru Tas
- Assistant Professor, Department of General Surgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey. Conception and design of the study, technical procedures, manuscript writing, final approval
| | - Omer Faruk Ozkan
- Associated Professor, Department of General Surgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey. Scientific and intellectual content of the study, statistical analysis
| | - Oztekin Cikman
- Assistant Professor, Department of General Surgery, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey. Acquisition of data, manuscript writing
| | - Asli Kiraz
- Specialist Doctor, Department of Medical Microbiology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey. Histopathological examinations, manuscript writing, critical revision
| | - Yilmaz Akgun
- Professor, Department of General Surgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey. Analysis and interpretation of data, manuscript preparation, critical revision
| | - Muammer Karaayvaz
- Professor, Department of General Surgery, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey. Conception and design of the study, critical revision
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Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health 2016; 16:29. [PMID: 27259656 PMCID: PMC4893293 DOI: 10.1186/s12905-016-0306-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/21/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. METHODS We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories. RESULTS A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts. CONCLUSIONS Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.
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Affiliation(s)
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - May Maloba
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Florence Ndikum-Moffor
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA
| | - Elizabeth Bukusi
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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7
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Kim HS, Baik GH. Chronic radiation colitis with rectopelvic fistula diagnosed 30 years after radiation therapy. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:258-60. [PMID: 26084056 DOI: 10.4166/kjg.2015.65.4.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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8
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Wang A, Ling Z, Yang Z, Kiela PR, Wang T, Wang C, Cao L, Geng F, Shen M, Ran X, Su Y, Cheng T, Wang J. Gut microbial dysbiosis may predict diarrhea and fatigue in patients undergoing pelvic cancer radiotherapy: a pilot study. PLoS One 2015; 10:e0126312. [PMID: 25955845 PMCID: PMC4425680 DOI: 10.1371/journal.pone.0126312] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/31/2015] [Indexed: 12/13/2022] Open
Abstract
Fatigue and diarrhea are the most frequent adverse effects of pelvic radiotherapy, while their etiologies are largely unknown. The aim of this study is to investigate the correlations between fatigue, diarrhea, and alterations in gut microbiota induced by pelvic radiotherapy. During the 5-week treatment of pelvic radiotherapy in 11 cancer patients, the general fatigue score significantly increased and was more prominent in the patients with diarrhea. The fatigue score was closely correlated with the decrease of serum citrulline (an indicator of the functional enterocyte mass) and the increases of systemic inflammatory proteins, including haptoglobin, orosomuoid, α1-antitrypsin and TNF-α. Serum level of lipopolysaccharide (LPS) was also elevated, especially in the patients with diarrhea indicating epithelial barrier breach and endotoxemia. Pyrosequencing analysis of 16S rRNA gene revealed that microbial diversity, richness, and the Firmicutes/Bacteroidetes ratio were significantly altered prior to radiotherapy in patients who later developed diarrhea. Pelvic radiotherapy induced further changes in fecal microbial ecology, some of which were specific to the patients with or without diarrhea. Our results indicate that gut microbial dysbiosis prior to radiation therapy may be exploited to predict development of diarrhea and to guide preventive treatment options. Radiation-induced dysbiosis may contribute to pelvic radiation disease, including mucositis, diarrhea, systemic inflammatory response, and pelvic radiotherapy-associated fatigue in cancer patients.
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Affiliation(s)
- Aiping Wang
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Zongxin Ling
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhixiang Yang
- Department of Oncology, Chongqing Zhongshan Hospital, Chongqing, China
| | - Pawel R. Kiela
- Departments of Pediatrics & Immunobiology, College of Medicine, the University of Arizona, Tucson, Arizona, United States of America
| | - Tao Wang
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Cheng Wang
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Le Cao
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Fang Geng
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Mingqiang Shen
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Xinze Ran
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Yongping Su
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Tianmin Cheng
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Junping Wang
- Institute of Combined Injury, State Key Laboratory of Trauma, Burns and Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
- * E-mail:
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Living through pelvic radiotherapy:A mixed method study of self-care activities and distressful symptoms. Eur J Oncol Nurs 2014; 19:301-9. [PMID: 25533805 DOI: 10.1016/j.ejon.2014.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 08/01/2014] [Accepted: 10/27/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore patients' experience of their illness when undergoing pelvic radiotherapy by describing the presence and severity of distressful symptoms and to explore initiated self-care activities in response to illness and symptoms. METHODS A mixed-method study was performed which included a core qualitative dataset and a supplementary quantitative dataset. Twenty-nine women undergoing five weeks of radiotherapy were prospectively interviewed during five weeks of treatment in order to capture experiences, distressful symptoms and quality of life during treatment. Grounded theory formed collection and analysis of the qualitative dataset and statistics were used to analyze the quantitative dataset. RESULTS A maintained self-identity was concluded as being central during the trajectory of treatment. Initiated self-care activities served to alleviate physical, emotional, and social suffering; helping the respondents keep their integrity and sense of self. Previous life experiences influenced the process of being able to maintain self-identity. The gastrointestinal symptoms and pain caused most distress. CONCLUSIONS In order to be able to maintain self-identity patients endure treatment by focusing on symptoms, on getting cured and on their self-image. Several distressful symptoms implied social limitations and a sense that the body would not take the strain. The result of this study can help health care professionals to gain a better understanding of the struggle to endure pelvic radiotherapy. Further, health care professionals should be more proactive in alleviating their patients' distressful symptoms. The results imply that previous life experiences should precede initiated interventions because these life experiences affect the patients' self-care activities.
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Quality of life (QOL) in women treated for gynecologic malignancies with radiation therapy: A literature review of patient - reported outcomes. Gynecol Oncol 2014; 134:403-9. [DOI: 10.1016/j.ygyno.2014.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/21/2022]
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Duska LR, Dizon DS. Improving quality of life in female cancer survivors: current status and future questions. Future Oncol 2014; 10:1015-26. [DOI: 10.2217/fon.13.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Almost 14 million people in the USA alone have been diagnosed with cancer. Given the improvements in diagnosis and treatment, over 60% of patients are expected to survive 5 years or more from the point of diagnosis. Treatments for cancer may result in long-term issues including those that impact the physical, emotional, spiritual or social domains. However, how best to care for issues in survivors remains unclear. Although much attention has been focused on survivorship care plans and survivorship clinics, there are limited data to show they improve outcomes. This article reviews the issues in female cancer survivors that can occur following diagnosis and treatment and suggest strategies that may assist in management. Finally, we review the current views regarding the care of cancer survivors and suggest important issues that must be addressed so that we can reach our goal of improvement in the quality of life of this emerging population.
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Affiliation(s)
- Linda R Duska
- Department of Obstetrics–Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, VA, USA
| | - Don S Dizon
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA
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Chao YH, Wang SY, Hsu TH, Wang KWK. The desire to survive: the adaptation process of adult cancer patients undergoing radiotherapy. Jpn J Nurs Sci 2014; 12:79-86. [PMID: 24751238 DOI: 10.1111/jjns.12050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 02/04/2014] [Indexed: 11/30/2022]
Abstract
AIM Radiotherapy is one of the primary treatment strategies for cancer. However, patients not only deal with the side-effects of radiotherapy, but they must also endure the psychological distress caused by cancer. This study explores how cancer patients adapt to the treatment process when receiving radiotherapy. METHODS This study used a grounded theory approach, and eight in-depth interviews were conducted with newly diagnosed cancer patients who received radiotherapy as a primary treatment. RESULTS The core category that emerged from this study was "the desire to survive". The categories and subcategories that emerged from the data include facing unknown situations (e.g. searching for relevant information and decision-making considerations, and listening to healthcare professionals' suggestions), experiencing the pain of treatment (e.g. tolerating side-effects, tolerating inconvenience during the treatment, accepting support during the treatment, and adjusting lifestyles), and chances to extend life (e.g. accepting fate, determination to undergo the treatment, and adjusting negative emotions). CONCLUSION The study results provide a better understanding of the experiences of cancer patients undergoing radiotherapy. Healthcare professionals should provide effective medical management for side-effects and psychological support to cancer patients during the journey of radiotherapy.
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Affiliation(s)
- Yu Huan Chao
- Department of Nursing, Hung Kuang University, Taichung, Taiwan
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13
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Abstract
Radiation enteritis continues to be a major health concern in recipients of radiation therapy. The incidence of radiation enteritis is expected to continue to rise during the coming years paralleling the unprecedented use of radiotherapy in pelvic cancers. Radiation enteritis can present as either an acute or chronic syndrome. The acute form presents within hours to days of radiation exposure and typically resolves within few weeks. The chronic form may present as early as 2 months or as long as 30 years after exposure. Risk factors can be divided into patient and treatment-related factors. Chronic radiation enteritis is characterized by progressive obliterative endarteritis with exaggerated submucosal fibrosis and can manifest by stricturing, formation of fistulae, local abscesses, perforation, and bleeding. In the right clinical context, diagnosis can be confirmed by cross-sectional imaging, flexible or video capsule endoscopy. Present treatment strategies are directed primarily towards symptom relief and management of emerging complications. Recently, however, there has been a shift towards rational drug design based on improved understanding of the molecular basis of disease in an effort to limit the fibrotic process and prevent organ damage.
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Affiliation(s)
- Ali H Harb
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Demers M, Dagnault A, Desjardins J. A randomized double-blind controlled trial: impact of probiotics on diarrhea in patients treated with pelvic radiation. Clin Nutr 2013; 33:761-7. [PMID: 24200199 DOI: 10.1016/j.clnu.2013.10.015] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Radical radiation therapy is commonly used for treatment of pelvic cancer. Up to 80% of patients receiving radiotherapy will develop acute radiation induced diarrhea. The primary aim of this randomized double blind controlled trial is to evaluate the effect of the probiotic Bifilact(®) on moderate and severe treatment-induced diarrhea during pelvic radiation. METHODS Patients with pelvic cancers were treated between 2006 and 2010 at L'Hôtel-Dieu de Québec, University Health Center. Some patients had surgery before pelvic radiotherapy and some received chemotherapy. A total of 246 Patients were randomized between a placebo and either of two regiments of double strain Bifilact(®) probiotics (Lactobacillus acidophilus LAC-361 and Bifidobacterium longum BB-536): a standard dose twice a day (1.3 billion CFU) or a high dose three times a day (10 billion CFU). Patients were trained to record their digestive symptoms daily with a standardized scale and they met a registered dietician and radiation oncologist every week during treatment. The main analysis compared time to first appearance of grade ≥2-3-4 diarrhea using Kaplan-Meier curves as measured by proportion of patients without moderate and severe diarrhea. RESULTS 229 patients were analyzed. The difference between the groups for overall grade 2-3-4 diarrhea was not statistically significant (p = 0.13). However at 60 days, the proportion of patients without moderate and severe diarrhea in the standard dose group (35%) was more than twice as high as that of the placebo group (17%) with a hazard ratio of 0.69 (p = 0.04). In patients who had surgery, the standard probiotics dose group had a better proportion of patients without very severe diarrhea than the placebo group, respectively 97% and 74% (p = 0.03). In all groups, the average number of bowel movements per day during treatment was less than 3 soft stools (p = 0.80) and the median abdominal pain less than 1 based on the National Cancer Institute scale (p = 0.23). CONCLUSION Standard dose of Bifilact(®) may reduce radiation induced grade 2-3-4 diarrhea at the end of the treatment of patients with pelvic cancer. In patients operated on before RT, a standard dose of probiotics may reduce radiation induced grade 4 diarrhea. Nutritional interventions by a registered dietician seemed to reduce global digestive symptoms. TRIAL REGISTRATION clinicaltrials.gov. Identifier NCT01839721.
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Affiliation(s)
- Mimi Demers
- Department of Radio-Oncology, University Health Center, Hôtel Dieu de Québec, Québec, Canada; Department of Clinical Nutrition, University Health Center, Hôtel Dieu de Québec, Québec, Canada.
| | - Anne Dagnault
- Department of Radio-Oncology, University Health Center, Hôtel Dieu de Québec, Québec, Canada
| | - Josée Desjardins
- Department of Radio-Oncology, University Health Center, Hôtel Dieu de Québec, Québec, Canada; Department of Clinical Nutrition, University Health Center, Hôtel Dieu de Québec, Québec, Canada
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Fregnani CMS, Fregnani JHTG, Dias de Oliveira Latorre MDR, de Almeida AM. Evaluation of the psychometric properties of the Functional Assessment of Cancer Therapy-Cervix questionnaire in Brazil. PLoS One 2013; 8:e77947. [PMID: 24147102 PMCID: PMC3797824 DOI: 10.1371/journal.pone.0077947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
Abstract
Background Although cervical cancer is the second most common tumor among Brazilian women, studies that evaluate the quality of life of these women are still scarce. This situation is explained by the lack of specific and validated tools for this purpose in Portuguese (Brazil). The aim of this study was to evaluate the psychometric properties of the Portuguese version of the FACT-CX (Functional Assessment of Cancer Therapy-Cervix) questionnaire in a population of Brazilian women with cervical cancer. Methods The psychometric properties of the FACT-CX questionnaire were tested in a sample of 100 women diagnosed with cervical cancer who were previously treated in the Barretos Cancer Hospital. We analyzed the internal consistency (Cronbach's alpha), reproducibility (intraclass correlation coefficient - ICC), confirmatory factor analysis, convergent validity (correlation with the SF-36 questionnaire), and discriminant validity by disease stage and two questions related to self-perception of health was also performed. Results The scales had Cronbach´s alpha coefficients ranging from 0.61 to 0.80. However, three scales did not have a statistically significant coefficient greater than 0.70. The ICC ranged from 0.68 to 0.82 and all considered satisfactory. Factor analysis did not generate consistent components. The FACT-G and FACT-CX total scores had good internal consistency and reproducibility, and also correlated well with the General Health and Vitality scales of the SF-36. However, only two FACT-CX scales had a significant correlation with SF-36. Discriminant analysis showed that FACT-CX failed to discriminate groups according to clinical stage but was able to divide the women according to the self-perception of health. Conclusion FATC-CX total score had good internal consistency, reproducibility and discriminant validity. In addition, it correlated well with General Health and Vitality scales of SF-36. However, three scales had questionable internal consistency and only two had significant correlation with SF-36.
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Affiliation(s)
- Cristiane Menezes Sirna Fregnani
- Graduation Program in Public Health Nursing, College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
- Research and Teaching Institute, Barretos Cancer Hospital (IEP-HCB), Barretos, Brazil
- * E-mail:
| | | | | | - Ana Maria de Almeida
- Department of Maternal-Infant and Public Health Nursing, College of Nursing, University of São Paulo, Ribeirão Preto, Ribeirão Preto, Brazil
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Abstract
Radiation enteritis is defined as the loss of absorptive capacity of the intestine following irradiation, which is most commonly seen after radiotherapy for pelvic and abdominal malignancies. It is divided into acute and chronic forms and usually presents with diarrhea and malabsorption. Malnutrition is a common complication of chronic radiation enteritis (CRE). We reviewed the etiology, prevalence, symptoms, diagnosis and management of CRE and CRE with malnutrition in this article. Functional short bowel syndrome as a cause of malnutrition in CRE is also considered. The diagnostic work-up includes serum markers, endoscopy, cross-sectional imaging and the exclusion of alternative diagnoses such as recurrent malignancy. Management options of CRE include dietary manipulation, anti-motility agents, electrolyte correction, probiotics, parenteral nutrition, surgical resection and small bowel transplantation. Treatment may also be required for coexisting conditions including vitamin B12 deficiency, bile acid malabsorption and depression.
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Pasek M, Urbański K, Suchocka L. Quality of life in advanced cervical cancer patients subjected to radiotherapy — a WHOQOL BREF questionnaire study. PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huang M, Lian S, Wu H, Chai C. Effects of zinc supplementation on the radiation-induced damage in mouse intestine. ACTA ALIMENTARIA 2013. [DOI: 10.1556/aalim.42.2013.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pasek M, Suchocka L, Urbański K. Quality of life in cervical cancer patients treated with radiation therapy. J Clin Nurs 2012; 22:690-7. [PMID: 23121048 DOI: 10.1111/j.1365-2702.2012.04350.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the quality of life in hospitalised patients with cervical cancer treated by radiation therapy. BACKGROUND Aside from clinical variables, the quality of life should be considered in the planning and monitoring of the therapeutic process in patients with cancer. Although it is widely known that this parameter can have a considerable impact on the therapeutic outcome, it is not routinely screened in oncological patients. DESIGN Survey. METHODS The study was performed in six cancer centres in Poland between June 2004-December 2005, and included 205 women hospitalised for any stage of cervical cancer. The EORTC QLQ-C30 questionnaire (v.3) was used to evaluate the patients' quality of life. The survey was conducted three times: (1) stage 1 - before treatment, on admission, (2) stage 2 - after treatment, at discharge, and (3) stage 3 - five to six months after treatment. RESULTS Physical functioning was assessed the worst before the radiation treatment and increased gradually throughout further stages; all interstage differences proved to be significant. In contrast, emotional functioning was scored the highest before the initiation of the treatment and was the lowest at stage 2, a difference that proved to be significant. Role functioning was highest immediately after the treatment and the lowest prior to the treatment. Differences between stages proved to be significant. Financial problems increased their negative impact on the quality of patients' lives significantly throughout consecutive stages of this study. Age and cancer stage did not significantly influence the way participants perceived their global health, physical, cognitive, emotional and social functioning, nor their financial difficulties. Overall, the quality of life was evaluated as highest immediately after the end of radiotherapy. CONCLUSION Although this study revealed that patients with cervical cancer subjected to radiotherapy are satisfied with their global quality of life, attention should be paid to certain dimensions of the latter (i.e. emotional functioning and role functioning) during post-treatment period. RELEVANCE TO CLINICAL PRACTICE The ability to performing everyday activities independently is perceived as the most important during all stages of the cervical cancer treatment, and therefore, appropriate support in this matter is necessary on the part of the nursing personnel.
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Affiliation(s)
- Małgorzata Pasek
- Department of Nursing Oncology, Maria Skłodowska-Curie Memorial Institute of Oncology, Cracow, Poland.
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Lam MCW, Parliament M, Wong CKW. Argon plasma coagulation for the treatment of hemorrhagic radiation colitis. Case Rep Gastroenterol 2012; 6:446-51. [PMID: 22933988 PMCID: PMC3398092 DOI: 10.1159/000339462] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radiation colitis is a common consequence of pelvic radiation. Its complications may include anemia due to chronic bleeding requiring transfusions. Many of these patients are managed with rectal medications which are often inadequate for control. Argon plasma coagulation (APC) has been well described for its efficacy in treating radiation proctitis. Here we present two cases in whom APC therapy was used to treat severe radiation colitis. We reviewed two cases originally seen at the regional cancer center (Cross Cancer Institute) in Edmonton, Alberta, Canada. Both patients received pelvic radiation for recurrent endometrial cancers and were referred for active bleeding secondary to radiation colitis that had required numerous transfusions. Radiation-induced telangiectasias were found from 10–50 cm in the sigmoid colon. Both patients had significant improvement of symptoms after one session of APC treatment set at 40–60 W and gas flow of 2.0 l/min. There were no complications from the procedures. Neither patient required blood transfusions after the treatment with improvement in their hemoglobin levels and were doing well at 3- and 6-month follow-up. APC can be used effectively to provide immediate and sustained resolution of symptoms in patients with radiation colitis.
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Affiliation(s)
- Mindy C W Lam
- Cross Cancer Institute and Royal Alexandra Hospital, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alta., Canada
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21
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Henson CC, Andreyev HJ, Symonds RP, Peel D, Swindell R, Davidson SE. Late-onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists. Clin Oncol (R Coll Radiol) 2011; 23:552-7. [PMID: 21550216 DOI: 10.1016/j.clon.2011.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/21/2011] [Accepted: 02/22/2011] [Indexed: 12/23/2022]
Abstract
AIMS Seventeen thousand patients receive treatment with radical pelvic radiotherapy annually in the UK. It is common for patients to develop gastrointestinal symptoms after treatment. The aim of this study was to determine the current practice of clinical oncologists in the UK with respect to late-onset bowel dysfunction after pelvic radiotherapy, and to discuss the wider issues surrounding current and future service provision for this patient group. MATERIALS AND METHODS A questionnaire was developed to establish current practice. This was sent to the 314 clinical oncologists in the UK who treat pelvic malignancies up to a maximum of three times. RESULTS One hundred and ninety (61%) responses were received. Most oncologists (76%) screen for gastrointestinal dysfunction after pelvic radiotherapy, usually through history taking rather than formal tools. Clinical oncologists view toxicity as a significant problem, with most estimating that up to 24% of patients at 1 year have bowel symptoms. Most oncologists refer less than 50% of their symptomatic patients, with most referring less than 10%. These referrals are 31% to a gastroenterologist, 23% to a gastrointestinal surgeon and 33% to both. Most (58%) do not have access to a gastroenterologist or a gastrointestinal surgeon with a specialist interest in their area. Sixty-five per cent of oncologists think a service is required specifically for patients with bowel dysfunction after pelvic radiotherapy, but half (52%) think that the current service in their area is inadequate. CONCLUSIONS Clinical oncologists recognise late-onset bowel dysfunction after pelvic radiotherapy as a significant problem, but one that is linked to poor recognition of symptoms and an inadequate patchy service.
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Affiliation(s)
- C C Henson
- The Christie NHS Foundation Trust, Manchester, UK.
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Ghezzi F, Cromi A, Serati M, Uccella S, Formenti G, Bogani G, Vanoli P. Radiation-induced bowel complications: laparoscopic versus open staging of gynecologic malignancy. Ann Surg Oncol 2011; 18:782-791. [PMID: 20960065 DOI: 10.1245/s10434-010-1382-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Indexed: 09/19/2023]
Abstract
PURPOSE To evaluate whether the type of surgical approach used to stage gynecologic malignancies influences the risk of developing nonrectal radiation-induced intestinal injury (NRRIII) in patients who subsequently receive adjuvant radiotherapy. METHODS A prospectively entered database was queried for all women with either primary or recurrent gynecologic malignancy who underwent external-beam radiation therapy ± brachytherapy and who had prior abdominopelvic surgery at our institution. Univariate and multivariate analysis of variables potentially affecting the risk of developing significant bowel toxicity (defined as grade 2 or more according to Radiation Therapy Oncology Group scoring) were performed. RESULTS One hundred fifty-nine patients were identified. The site of primary tumor was the cervix in 61 (38%) patients and the corpus uteri in the remaining patients (98, 62%). Treatment was delivered with a combination of external-beam and intracavitary irradiation to 50 (31.4%) patients, and 109 (68.6%) patients received only external-beam irradiation. Staging procedures were performed by open surgery in 93 (58.5%) patients, whereas laparoscopy was the surgical approach of choice in 66 (41.5%) women. Fifteen patients (9.4%) developed grade 2 or greater NRRIII, at median latency of 10 months (range 3-64 months); six were diagnosed as grade 3 complications requiring surgery, and three developed grade 4 complication. Multiple regression revealed an independent protective effect of pretreatment laparoscopic staging against the risk of developing both grade ≥2 and grade ≥3 NRRIII. CONCLUSIONS Notwithstanding potential limitations of nonrandomized study design, our findings suggest that the benefits of minimal-access surgery used to perform staging procedures may translate into long-term reduction in radiation-induced bowel injury.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Jakobsson S, Ahlberg K, Taft C, Ekman T. Exploring a link between fatigue and intestinal injury during pelvic radiotherapy. Oncologist 2010; 15:1009-15. [PMID: 20667967 DOI: 10.1634/theoncologist.2010-0097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The association between cancer-related fatigue and pathological processes in the body is largely unknown. This study was designed to investigate a possible linkage between fatigue and intestinal injury during pelvic radiotherapy. METHODS Twenty-nine women undergoing pelvic radiotherapy for anal or uterine cancer were prospectively followed. Fatigue and diarrhea were assessed using patient self-reported questionnaires. Plasma citrulline concentration, as a sign of intestinal injury, and C-reactive protein, orosomucoid, albumin, α(1)-antitrypsin, and haptoglobin, as signs of systemic inflammation, were analyzed. RESULTS Fatigue increased significantly (p < .001) and citrulline decreased significantly (p < .001) during treatment. A significant negative correlation (r = -0.40; p < .05) was found between fatigue and epithelial atrophy in the intestine (as assessed by plasma citrulline) after 3 weeks of treatment and a significant positive correlation (r = 0.75; p < .001) was found between fatigue and diarrhea. Signs of systemic inflammation were evident, with significant increases in serum orosomucoid, serum haptoglobin (p < .05) and serum α(1)-antitrypsin (p < .001) and a significant decrease in serum albumin (p < .001). CONCLUSION The present study indicates a link between fatigue and intestinal injury during pelvic radiotherapy. This observation should be considered as a preliminary finding because of the small sample size but may serve as a rationale for therapeutic interventions aimed at alleviating both fatigue and gastrointestinal symptoms during pelvic radiotherapy.
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Affiliation(s)
- Sofie Jakobsson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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van der Aa MA, Siesling S, v d Poll-Franse LV, Schutter EM, Lybeert ML, Coebergh JWW. Age-specific differences in the treatment of cervical cancer in the east and the south of The Netherlands 1989-2004. Eur J Obstet Gynecol Reprod Biol 2009; 147:78-82. [PMID: 19713027 DOI: 10.1016/j.ejogrb.2009.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 05/07/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aims to describe trends and variation in treatment and survival of cervical cancer in two regions in The Netherlands and to relate this to adherence to the treatment recommendations. STUDY DESIGN Patient characteristics, tumour characteristics, treatment and follow-up data were collected for 1954 cervical cancer cases diagnosed in the period 1989-2004. RESULTS In FIGO stages IB-IIA 93% of patients were treated according to the recommendations of The Netherlands Working Group Gynaecologic Oncology. Older patients received radiotherapy more often than younger patients: 48% (95%CI 40-57) of patients older than 70 compared to 15% (95%CI 10-20) of patients aged 50-69 and 5% (95%CI 3-7) of patients aged 50 or younger (p<0.05). In FIGO stages IIB-IVA 76% of patients were treated according to the recommendations of the Working Group. Chemoradiation was given to older patients less often than to younger patients: 2% (95%CI 0.5-5) versus 23% (95%CI 16-29). A decreased risk of death was found for patients receiving chemoradiation (RER 0.6, 95%CI 0.3-0.9) compared to those receiving "radiotherapy only". CONCLUSION Far from being always followed, the treatment recommendations were better implemented for treatment of patients with FIGO IB-IIA. Elderly patients received different treatment compared to younger patients in this study and showed an independent increased risk of death in the lower stages, which confirms that the need becomes stronger for paying attention to treatment of elderly patients.
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Affiliation(s)
- Maaike A van der Aa
- Comprehensive Cancer Centre North East, Enschede/Groningen, The Netherlands.
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Abayomi JC, Kirwan J, Hackett AF. Coping mechanisms used by women in an attempt to avoid symptoms of chronic radiation enteritis. J Hum Nutr Diet 2009; 22:310-6. [DOI: 10.1111/j.1365-277x.2009.00963.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abayomi J, Kirwan J, Hackett A. The prevalence of chronic radiation enteritis following radiotherapy for cervical or endometrial cancer and its impact on quality of life. Eur J Oncol Nurs 2009; 13:262-7. [PMID: 19640788 DOI: 10.1016/j.ejon.2009.02.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 02/17/2009] [Accepted: 02/27/2009] [Indexed: 01/12/2023]
Abstract
BACKGROUND Studies suggest that 50% of people may suffer from chronic radiation enteritis (CRE) (Andreyev, J., 2005. Gastrointestinal complications of pelvic radiotherapy: are they of any importance? Gut 54, 1051-1054). Gami et al. (Gami, B., Harrington, K., Blake, P., Dearnaley, D., Andreyev, H.J.N., 2003. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Alimentary Pharmacology and Therapeutics 18, 987-994) argue that this is unimportant if quality of life is unaffected. The aim of this study was to identify how many women experience CRE following radiotherapy and to investigate whether women who have higher doses of radiotherapy or more advanced stage of cancer are more at risk. METHODS Women (=117) who had completed radiotherapy for cervical or endometrial cancer were asked to complete a validated questionnaire exploring bowel problems and quality of life. Responses were scored and compared to scores for women with known faecal incontinence (Bugg, G.J., Kiff, E.S., Hosker, G., 2001. A new condition-specific health-related quality of life questionnaire for the assessment of women with anal incontinence. British Journal of Obstetrics and Gynaecology 108 (10), 1057-1067). RESULTS Using a score of '0' to indicate no symptoms, 47% of women gained scores indicative of CRE (>0), range 20-85 (mean 34, SD 14.4). Younger women (p<0.001) and women with cervical cancer (p<0.05) were more likely to score for CRE. No significant relationship was observed between score and either radiotherapy dose or stage of cancer. CONCLUSIONS Scoring suggests that about half of woman treated with radiotherapy develop CRE. Quality of life is affected, particularly regarding tiredness and coping behaviours due to lack of warning signs for CRE.
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Affiliation(s)
- J Abayomi
- Liverpool Women's Hospital, Liverpool John Moores University, Community and Leisure, IM Marsh Campus, Barkhill Road, Liverpool L17 6BD, UK.
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Bernhardson BM, Tishelman C, Rutqvist LE. Olfactory changes among patients receiving chemotherapy. Eur J Oncol Nurs 2008; 13:9-15. [PMID: 19028142 DOI: 10.1016/j.ejon.2008.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 10/02/2008] [Accepted: 10/14/2008] [Indexed: 11/17/2022]
Abstract
Taste and smell changes (TSCs) are known side effects of chemotherapy, but smell changes (SCs) in the absence of taste changes are understudied. This study aims to explore SCs occurring without taste changes during chemotherapy, to better understand the characteristics of such changes, and how these experiences affect patients in their daily lives. Data derives from a qualitative interview study and a cross-sectional survey of 518 patients, with all patients receiving out-patient cancer chemotherapy in Sweden. Case studies of three patients with SCs and the 8% of survey participants with SCs only are in focus. All 43 participants with exclusively SCs reported increased sensitivity to one or several odors, with no participants reporting decreased sensitivity. Those reporting SCs significantly more often reported weight gain than those reporting TSCs, with oral problems and appetite loss significantly less common in the SC group. There were no differences in reported nausea between SC and TSC groups, but nausea was more common in the SC group than in those without TSCs. The case study reports were linked to and discussed in relation to possible explanatory models for increased olfactory sensitivity. SCs increase during chemotherapy, were often unpredictable and led to emotional consequences. The participants all reported heightened sensitivity to one or several odors which could not fully be explained by the potential explanatory models of anticipatory nausea and vomiting, pseudohallucinations, or increased chemical sensitivity.
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Coping mechanisms initiated by women in an attempt to avoid symptoms of chronic radiation enteritis. Proc Nutr Soc 2008. [DOI: 10.1017/s0029665108000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Herzog TJ, Wright JD. The impact of cervical cancer on quality of life--the components and means for management. Gynecol Oncol 2007; 107:572-7. [PMID: 17963826 DOI: 10.1016/j.ygyno.2007.09.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 09/11/2007] [Accepted: 09/14/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review how cervical cancer patients are affected on a psychological, psychosocial, and sexual level, resulting in an overall decrease in quality of life (QoL). METHODS This article reviews influential studies on QoL in women with cervical cancer, as well as the effects on patients' partners. Based on the decreased QoL, we present three suggestions on how clinicians can better patients' QoL after an abnormal Papanicolaou (Pap) test or diagnosis and treatment of cervical cancer. RESULTS Fear, self-blame, distress, and anxiety about cervical cancer are common in women who receive abnormal Pap test results or positive human papillomavirus DNA tests. Such results impact body image, self-esteem, relationships with partners, and sexual and reproductive issues, while adding to an overall decrease of QoL in women with cervical cancer. CONCLUSIONS In order to minimize the deleterious effects, the impact of cervical cancer and precancerous lesions on QoL should be managed as part of a complete healthcare plan. To improve QoL, cervical cancer patients should seek supportive counseling and education about self-care and adherence to treatment and follow-up plans, continue cervical cancer screening, and receive vaccination against prevalent oncogenic virus types.
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Affiliation(s)
- Thomas J Herzog
- Columbia University, Obstetrics and Gynecology Department, 161 Fort Washington Ave, 8th Floor, Room 838, New York, NY 10032, USA.
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Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study. BMC Cancer 2007; 7:102. [PMID: 17578579 PMCID: PMC1925112 DOI: 10.1186/1471-2407-7-102] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 06/19/2007] [Indexed: 11/10/2022] Open
Abstract
Background Quality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care. Methods Responses of oncology outpatients with breast cancer (117), cervical cancer (46) and ovarian cancer (18) (aged 44.6, SD 11.5) were compared with those of their family caregivers and matched general population groups. Data were analyzed by univariate and multivariate statistics. Results The cancer groups had similar QOL domain scores, which were significantly lower than those of their caregivers, but higher than the control group as well as those of psychiatric and diabetic patients studied previously. Patients who were married, with higher education, better employment, and with longer duration of illness had higher QOL. Patients on radiotherapy and their caregivers had higher QOL scores. Correlations between patient's ratings and caregiver impression of patient's QOL were high. Caregiver impression was a significant predictor of patient's and caregiver's QOL. Other predictors for the patient were: currently feeling sick and duration of illness; for the caregiver: feeling sick, relationship to patient, and age. Conclusion Cancer patients in stable condition and with psychosocial support can hope to enjoy good QOL with treatment. The findings constitute an evidence base for the country's cancer care program, to boost national health education about prognosis in cancer. Families living with women cancer patients are vulnerable and need support if the patient is recently diagnosed, less educated, single, not formally employed; and the caregiver is female, parent, younger, less educated, unemployed and feels sick. Clinicians need to invest in the education and support of family caregivers. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.
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