Ulipristal acetate on quality of life and sexual function of women with uterine fibromatosis

To evaluate quality of life and sexual function of childbearing-age women, affected by uterine fibromatosis undergoing medical treatment with ulipristal acetate. The data obtained by filling the questionnaires European Quality of Life Five-Dimension Scale and modified Female Sexual Function Index, were analyzed to assess UPA usefulness in improving QoL and sexual activity. A total of 139 patients affected by uterine fibromatosis undergoing conservative ulipristal acetate treatment were enrolled in this prospective observational cohort study. Seventy-one women (average age 46.5 years) answered the questionnaires: QoL and sexuality were evaluated before and after ulipristal acetate treatment. 59 patients (83.1%) had an improvement of QoL and general health state, with a reduction of VAS score after ulipristal acetate treatment. EQ-5D-5L showed a statistically significant improvement of usual act impairment, mobility, discomfort, anxiety/depression (p < .0005). There was no difference in personal care management after therapy. Modified FSFI showed a statistically significant improvement (p < .0001) of sexual satisfaction and sexual life. A not statistically significant improvement in dyspareunia was also highlighted. This study provides a clear picture about QoL impact on women and confirms the effectiveness of the ulipristal acetate in improving different aspects of daily and sexual life of patients undergoing medical treatment.

Preliminary data on the lived experience of having multiple primary cancer diagnoses

Approximately one in two Canadians will develop some form of cancer, and some will live long enough to be diagnosed with multiple primary cancers. There is some indication that multiple primary cancer diagnoses negatively impact survivors' mental and physical status, and quality of life. Existing research studies do not fully capture the complexity of what it is like to have multiple primary cancer diagnoses. Accordingly, a qualitative study was conducted to elicit detailed descriptions of the lived experiences of having multiple primary cancer diagnoses. Participants included 10 individuals from Atlantic Canada with a history of two or more cancer diagnoses. Data were captured through semi-structured interviews and participant-generated photographs. Interviews were transcribed and reviewed for common meanings. Preliminary data analyses suggest that the essential meaning of having cancer multiple times is that cancer is "unwanted encore". This study yields findings that can provide empirically-based guidance to healthcare providers to help support cancer survivors in a more holistic way throughout the extended continuum of care and ultimately improve the health of individuals who have had multiple primary cancers.

[Correlation between sonographic findings and level of knowledge/self-report of symptoms in women with uterine leiomyomata]

PURPOSE

Is there any correlation between the pre-therapeutic level of knowledge concerning the number/size of leiomyomata or self-reported symptoms and confirmation by sonography? How does the assumption of the number/size of leiomyomata influence the self-perception of symptoms?

MATERIALS AND METHODS

In an anonymous questionnaire 498 patients were asked about the number, size and symptoms induced by leiomyomata using a visual chart from 0 - 10. The data were correlated with findings from transvaginal and abdominal ultrasound.

RESULTS

The self-reported number of leiomyomata corresponded with the sonographic findings in 80 % of patients with 1 leiomyoma and in 54 % of patients with 2 or 3 leiomyomata, while the self-reported size only corresponded with the sonographic findings in 20 % to 70 % of patients. There was no correlation between the number of leiomymata confirmed by sonography and self-reported symptoms. There are significant correlations between the sonography-defined size and self-reported level of dysmenorrhea (p = 0.003) and self-reported pressure in the abdomen (p = 0.02), as well as submucosal leiomyomata and hypermenorrhea (p = 0.01). Patients who assumed multiple or large leiomyomata ≥ 10 cm reported strong pressure on the bladder or pressure in the abdomen significantly more frequently than patients who assumed 1 leiomyoma (p = 0.03) or a leiomyoma less than 10 cm (p = 0.018).

CONCLUSION

There is a discrepancy between the relatively good knowledge about the number of leiomyomata and the lack of knowledge about their size. Subjective incorrect presumptions concerning the number or size of leiomymata can result in different disorders. Therefore, they should not be the exclusive indication for further operative interventions.

A novel mutation in the SDHD gene responsible for familial paraganglioma. Medical and psychological implications

Familial paragangliomas/pheochromocytomas are dominantly inherited disorders characterized by the development of highly vascularized tumors of the head and neck, derived from non-chromaffin cells of the extra-adrenal paraganglia, and tumors with endocrine activity, derived from chromaffin cells, usually located in the adrenal medulla and pre- and para-vertebral thoracoabdominal regions. Germline inactivating heterozygous mutations in one of the genes encoding for succinate dehydrogenase subunits B, C or D (SDHB, SDHC or SDHD) are responsible for hereditary paragangliomas (PGLs), accounting for nearly 70% of familial cases. Particularly in the SDHD gene, different types of mutations have been found, nevertheless, alterations other than point mutations and deletion leading to missense/nonsense/splicing mutations are extremely rare. Here we report a family with multiple cases of PGL which co-segregates with a novel SDHD gene mutation predictable to give rise to an abnormal gene product (CybS). The identification of the molecular event responsible for PGL in our family made genetic counseling particularly useful for younger first degree relatives at risk to develop this late-onset disease.

Quality of life in survivors of multiple primary cancers compared with cancer survivor controls

BACKGROUND

Cancer survivors may develop additional cancers after their first diagnosis, but to the authors' knowledge the quality of life (QOL) consequences of a second cancer are not known. The current study assessed QOL and its correlates after a second cancer diagnosis.

METHODS

QOL was compared between 487 survivors of second-order and higher-order primary cancer diagnoses, and a matched group of 589 survivors of a single cancer diagnosis. Outcome measures included standardized questionnaires that assessed depressive symptoms, perceived stress, vitality, post-traumatic growth, existential well-being, sexual adjustment, and global QOL.

RESULTS

Survivors of multiple primary cancer diagnoses had significantly lower global QOL (t (792) = 5.42; P < .001), vitality (Student t test [t] (794) = 2.41; P < .01), and existential well-being (t (775) = 2.78; P < .01), and higher intrusive stress symptoms (t (775) = -1.93; P < .05). Controlling for demographic, medical, and trait-like psychosocial characteristics (eg, optimism and resilience), having multiple primary cancer diagnoses explained small, although significant, variances in global QOL (coefficient of determination [R(2)] = .04; P < .001), vitality (R(2) = .01; P < .05), and existential well-being (R(2) = .01; P < .05), with patients in the multiple primary cancer group faring worse on all of these measures.

CONCLUSIONS

The results of the current study suggest that the typical survivor of multiple primary cancers experiences modest but lasting QOL deficits.

Comparison of four common stressors across the breast cancer trajectory

OBJECTIVE

Studies of cancer stressors have typically assessed a limited number of factors using cross-sectional designs. There is little information about aspects of cancer that patients consider most stressful at different points along the disease trajectory.

METHODS

Seventy-two breast cancer patients rated the degrees to which they experienced each of four common cancer concerns as stressful during the preceding month at 3, 7, 11, and 15 months, and at 6 years after diagnosis. Stressors included fear of the future; physical limitations; pain; and problems with family or friends due to cancer.

RESULTS

Overall, the cancer concerns were rated as not especially stressful, with the exception of fear of the future which was the most stressful of the four concerns on all measurement occasions. Although fear of the future decreased from 3 to 7 months following diagnosis, it remained elevated at all of other time points. Physical limitations and pain were reported to induce equivalent levels of stress and their intensities decreased over time. However, there was a resurgence of the stressfulness of physical limitations and pain at the 6-year follow-up point when women experienced a second cancer during the long-term follow-up period. At all measurement occasions, breast cancer survivors reported very low levels of concern in relation to family and friends.

CONCLUSION

Breast cancer can be stressful for years after diagnosis for some women and especially for those who experience a second cancer. Fear of the future is the most pressing target for psychosocial interventions.

[Challenging conversation with a patient about the change in treatment strategy from a curative to a palliative setting]

Palliative care is fortunately gaining importance in the treatment of endstage oncological patients. Patient information regarding therapeutic strategies, especially when treatments are suggested to alleviate symptoms and are not curing the disease can be the most challenging part. Our case of a 49 year old female presenting with a colorectal adenocarcinoma and vertebral body metastasis required spinal stabilization surgery to prevent paralysis. However, she did not consent to the necessary treatment, completely refusing to recognize the seriousness of her disease. In spite of many attempts to enlighten her, the disease was allowed to progress, and it was only when thrombosis caused massive edema of the right leg that the patient finally started to ask about prognosis and potential treatment. An interdisciplinary approach to provide medical and psychosocial help could be established. This case shows the typical problems of a physician-patient relationship in an oncologic clinic and emphasizes the importance of integrating medical with psychosocial care.

[Bilateral thalamic gliomas: report of a case with cognitive impairment]

INTRODUCTION

Bilateral thalamic tumours are very rare and have been recently identified as a subgroup of thalamic neoplasms due to their characteristic clinical presentation, with behavioural and memory disorders and without sensory or motor changes. We describe a patient who presented with mood and behaviour changes due to a bilateral thalamic glioma, discuss the literature related to these rare neoplasms and review the anatomical bases of their particular clinical presentation.

CASE REPORT

A 67-year-old woman consulted because of behavioural changes and frequent forgetfulness. Neurological examination was normal except from a deficit in the retention of words and numbers. MR images revealed bilateral thalamic swelling by a isointense in T1, hyperintense in T2 and protonic density mass that did not enhance. The tumour was diagnosed as an astrocytoma by stereotactic biopsy. She continued to deteriorate and a year after diagnosis she was bedridden and with a severe dementia.

CONCLUSION

Bithalamic tumors, as other lesions that affect the thalamus bilaterally, characteristically present with mood and behaviour changes and memory impairment.

Panic attacks, complex partial seizures, and multiple meningiomas

A 39-year-old woman presented with typical panic disorder symptoms of two years duration. Imipramine (IMI) treatment yielded complete remission of her symptoms for three years. At that time, however, her symptoms recurred. Neither increasing the IMI dose nor an adequate trial of fluoxetine controlled her symptoms. Further history revealed subtle changes in her symptoms suggestive of complex partial seizures. Scalp EEG was normal, but an MRI revealed multiple meningiomas. Her symptoms remitted completely on carbamazepine. This case illustrates the phenomenologic overlap between panic attacks and complex partial seizures, and a neuroanatomic overlap between the two syndromes is hypothesized.

[Psychoanalysis and cancer. A case report and a hypothesis]

The psychoanalytic treatment of a 39 year old female cancer patient demonstrates a close connection between psychic factors (cumulative separation trauma, conflict-laden relationship to the mother, oedipal conflicts etc.) and the onset and course of the cancer. After eight years of analytic therapy the cancer symptoms disappeared. The authors formulate the hypothesis that cancer may occur on a primarily somatic or psychic basis.

Paraneoplastic limbic encephalitis: neuropsychiatric presentation

Limbic encephalitis as a distinct clinicopathological entity is becoming increasingly familiar to neurologists. However, despite its classical clinical presentation of mental status changes and behavioral abnormalities, the disorder is not well known in the psychiatric literature and premortem diagnosis is rare. We recently participated in the care of a patient who spent two months on a psychiatric service and in whom a medical disorder was consistently suspected but not confirmed until autopsy revealed paraneoplastic limbic encephalitis and two primary systemic malignancies. A detailed neuropsychiatric description of this clinical entity is provided from presentation to autopsy with review of the literature.

Managing noncompliance in the 'difficult' medical patient: the contributions of insight. A case report

Psychodynamics can interfere with medical compliance, especially in psychologically vulnerable patients. A case is presented of a cancer patient who developed a powerful transference reaction to her oncologist, jeopardizing her treatment for cancer. Strategies for integrating techniques of insight-oriented psychotherapy with those of supportive psychotherapy are discussed in managing such reactions and improving compliance.

The relationship between dependency and the development of cancer

Theoretical speculations have raised the possibility that oral-dependent traits may predispose certain individuals to cancer. Alternatively, some have suggested that such traits are more broadly predictive of an array of illnesses. This study sought to test whether dependency characteristics predispose men to illness in general or cancer in particular whether such characteristics have no particular effect on the development of illness. Comparisons were made of the premorbid MMPI records of 58 V.A. male domiciliary residents who later developed cancer with the records of 104 residents who either remained disease free or developed one of three other conditions (benign tumors, hypertension, or gastrointestinal ulcers). Scores on eight scales, demonstrated to measure dependency related characteristics, were derived for all subjects. Results showed that four dependency measures predicted the later occurrence of illness. However, none of the measures specifically differentiated cancer from the other illness conditions or the no-disease group. Thus, while findings suggest that dependency may predispose men toward illness, no support was found for a specific link between dependency and cancer.