Effects of a Web-based Health Education Program on Quality of Life and Symptom Distress of Initially Diagnosed Advanced Non-Small Cell Lung Cancer Patients: A Randomized Controlled Trial

Advanced non-small cell lung cancer (NSCLC) patients treated with chemotherapy experience functional decline and decreased quality of life. The purpose of this study was to evaluate the effects of a web-based health education program on global quality of life, quality of life-related functional dimensions, and symptom distress of initially diagnosed advanced non-small cell lung cancer patients. This study used a randomized, pre- and post-repeated measures design. A total of 55 participants were randomly assigned to an experimental group (n = 27) and a control group (n = 28). The experimental group participated in a web-based health education program, and the control group received usual care. Patients were assessed at 4 time points: baseline assessment (T0), and then 1, 2, and 3 months (T1, T2, and T3) after participating in the web-based health education program or receiving usual care. Patients in the experimental group had significantly greater global quality of life and emotional function, and significantly less top ten significant symptom distresses compared to those in the control group. There were no differences between the groups and within groups with respect to physical function, role function, cognitive function, and social function. The web-based health education can improve global quality of life, emotional function, and top ten significant symptom distresses in patients receiving chemotherapy during the first 3 months after initial diagnosis of advanced NSCLC. Web-based health education can improve quality of life and lessen distress of initially diagnosed NSCLC patients treated with chemotherapy.

Comprehensive evaluation of clinical efficacy and safety of celecoxib combined with chemotherapy in management of gastric cancer

BACKGROUND

To evaluate the clinical efficacy and safety of celecoxib combined with chemotherapy in the treatment of gastric cancer.

METHODS

In total, 240 gastric cancer patients undergoing radical gastrectomy followed by adjuvant chemotherapy were randomly assigned into 2 groups. In the experimental group (n = 120), patients were administered with celecoxib-based chemotherapy, and chemotherapy alone was performed in the control group. Disease-free survival (DFS) and progression-free survival (PFS) were considered as the primary efficacy parameters, and objective response rate (ORR), overall survival (OS), quality of life (QOL), and safety as the secondary efficacy parameters.

RESULTS

The 3-year OS did not significantly differ between the experimental (72%) and control groups (68%, P = .67). The 3-year DFS in the experimental group was 64%, which did not significantly differ from 51% in the control group (P = .41). In patients with positive cyclooxygenase-2 (COX-2) from the experimental group, the 3-year OS was 78%, significantly higher compared with 66% in the control group (P = .02), and the 3-year DFS was 70%, considerably >50% in the control group (P = .01). No statistical significance was identified in the incidence of nausea, neutropenia, anorexia, peripheral neurotoxicity, diarrhea, vomiting, asthenia, and thrombocytopenia, etc. The EORTC quality of life questionnaire (QLQ)-C30 questionnaire revealed that the global QOL in the experimental group was significantly higher than that in the control group (P < .05). No statistical significance was noted in the scores of functioning scale between 2 groups, whereas the scores of the symptom scale, especially pain and fatigue in the experimental group were remarkably higher than that in the control group (P < .05). The global score of EORTC QLQ-STO22 in the experimental group was considerably higher compared with that in the control group (P < .05). No statistical significance was identified in term of the domains of restrictions on feeding, dysphagia, anxiety, reflux, sense of taste, dry mouth, hair loss, and body shape between groups (all P > .05).

CONCLUSION

Celecoxib combined with chemotherapy yields clinical benefits for gastric cancer patients with positive COX-2, which not only enhances the OS, DFS, PFS, QOL, and short-term clinical efficacy, but also does not increase the risk of adverse events.

When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment

BACKGROUND

The role of primary care providers (PCPs) in decision making around cancer care remains largely unknown. We evaluated how frequently men with localized prostate cancer report receiving help from their PCP about their treatment, and whether those men who do are less likely to receive definitive treatment.

METHODS

We mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. Participants were asked whether their PCP helped decide how to treat their cancer. The outcome was receipt of definitive treatment (either radical prostatectomy or radiotherapy).

RESULTS

A total of 2386 men responded (adjusted response rate, 51.1%). Among these men, 38.2% reported receiving help from their PCP regarding choosing a treatment, and 79.6% received definitive treatment. In adjusted analyses, non-Hispanic black men (odds ratio, 1.76; 95% confidence interval, 1.37-2.27) were more likely than non-Hispanic white men to report receiving help from their PCP. However, men who did receive help were not more likely to forgo definitive treatment overall (P = .58) or in the subgroups of men who may be least likely to benefit from definitive treatment.

CONCLUSIONS

Though a substantial proportion of men reported receiving help from their PCP about prostate cancer treatment, these discussions were not associated with different treatment patterns. Further effort is needed to determine how to optimize the role of PCPs in supporting patients to make preference-sensitive cancer decisions.

Fatigue During and After Breast Cancer Therapy-A Prospective Study

CONTEXT

Chronic fatigue (CF) in breast cancer (BC) survivors is multifactorial and may be caused by immune activation triggered by BC or its treatment. In the Neoadjuvant Avastin in Breast Cancer study, BC patients received neoadjuvant chemotherapy (FEC100→taxane) ± bevacizumab, a monoclonal antibody with fatigue as a potential side effect.

OBJECTIVES

To examine fatigue levels and prevalence of CF before and during chemotherapy and at follow-up, and their associations with C-reactive protein (CRP) and clinical variables.

METHODS

Eighty-four HER2-negative patients with cT2-4N0-3M0 BC responded to questionnaires and had CRP measured before treatment (T0), after FEC100 (T1), after taxanes before surgery (T2), and at two-year follow-up (T3).

RESULTS

The prevalence of CF increased from 8% at T0 to 36% at T3, P < 0.0001. Fatigue levels peaked during chemotherapy from 12.0 at T0 to 20.0 at T2, and declined to 16.7 at T3, P < 0.001. Women with CF at T3 had higher fatigue levels at T0, T2, and T3 than those without CF (P ≤ 0.01). Psychological distress (P = 0.03) and pain (P = 0.04) at T3 were associated with CF at T3. Only psychological distress remained a significant predictor in multivariate analysis. CRP increased from T0 to T1 (P < 0.01) and declined to baseline values at T3, but changes were not associated with bevacizumab treatment. No association was found between bevacizumab or CRP, and fatigue levels or CF.

CONCLUSION

Neither bevacizumab treatment nor low-grade systemic inflammation as measured by CRP was associated with the increased fatigue levels and raised prevalence of CF, observed during and after BC therapy. Increased fatigue levels at baseline and psychological distress at T3 were associated with CF at T3.

Prognostic value of health-related quality of life in patients with metastatic pancreatic adenocarcinoma: a random forest methodology

PURPOSE

Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is currently an important parameter in the choice of treatment strategy for metastatic pancreatic adenocarcinoma (mPA) patients. However, previous research has shown that patients' self-reported health-related quality of life (HRQOL) scales provided additional prognostic information in homogeneous groups of patients with respect to ECOG-PS. The aim of this study was to identify HRQOL scales with independent prognostic value in mPA and to propose prognostic groups for these patients.

METHODS

We analysed data from 98 chemotherapy-naive patients with histologically proven mPA recruited from 2007 to 2011 in the FIRGEM phase II study which aimed to compare the effectiveness of two chemotherapy regimen. HRQOL data were assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. A random survival forest methodology was used to impute missing data and to identify major prognostic factors for overall survival.

RESULTS

Baseline HRQOL assessment was completed by 60 % of patients (59/98). Twelve prognostic variables were identified. The three most important prognostic variables were fatigue, appetite loss, and role functioning, followed by three laboratory variables. The model's discriminative power assessed by Harrell's C statistic was 0.65. Fatigue score explained almost all the survival variability.

CONCLUSION

HRQOL scores have prognostic value for mPA patients with good ECOG-PS. Moreover, the patient's fatigue, appetite loss, and self-perception of daily activities were more reliable prognostic indicators than clinical and laboratory variables. These HRQOL scores, especially the fatigue symptom, should be urgently included for prognostic assessment of mPA patients (with good ECOG-PS).

Linguistic Validation of the M. D. Anderson Symptom Inventory in Persian-Speaking Iranian Cancer Patients

CONTEXT

Various symptoms frequently affect cancer patients' quality of life. Appropriate assessment of these symptoms provides valuable data for cancer management.

OBJECTIVES

This study aimed to validate the Persian version of the M. D. Anderson Symptom Inventory (MDASI-P).

METHODS

This cross-sectional study was conducted at four cancer treatment centers in two cities in Iran. Breast cancer and colorectal cancer patients aged 18 years and older were consecutively included in the study. The standard forward-backward translation method was applied. Patients completed the MDASI-P along with the previously validated Persian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Construct validity (factor analysis), criterion validity (against the EORTC QLQ-C30), and reliability (Cronbach's alpha) were analyzed.

RESULTS

A total of 146 breast cancer and 94 colorectal cancer patients were studied. Factor analysis for the symptom severity items resulted in a three-factor solution, further reduced to a two-factor solution: general symptoms and gastrointestinal symptoms. Correlation of the MDASI-P symptom severity items with corresponding EORTC QLQ-C30 symptom items (r = 0.48-0.75) and MDASI-P interference items with corresponding EORTC QLQ-C30 functioning domains (r = -0.46 to -0.23) supported the criterion validity. Cronbach's alpha was 0.90, 0.88, and 0.77 for the total questionnaire, symptom severity items, and the interference subscale, respectively.

CONCLUSION

The MDASI-P is a feasible, valid, and reliable instrument for evaluation of symptoms in Persian-speaking cancer patients and can be used to improve symptom management in these patients.

Reliability and validity of the Cancer Therapy Satisfaction Questionnaire in lung cancer

PURPOSE

To test the reliability and validity of the Cancer Treatment Satisfaction Questionnaire (CTSQ), to assess its relation with quality of life (QoL), and to assess the interpretability of the domain scores in lung cancer patients receiving intravenous chemotherapy.

METHODS

Patients with stage IIIB and IV non-squamous non-small cell lung carcinoma treated with pemetrexed were enrolled in our study. They completed the 16-item CTSQ and two other (health-related) QoL questionnaires. Information about sociodemographic characteristics, cancer stage, and the experience of adverse events was collected. Internal consistency, construct validity, and clinical interpretability were calculated.

RESULTS

Fifty-five patients completed the CTSQ. Correlations of the CTSQ items with its domain were all above 0.40. A high correlation between item 8 and the expectations of therapy and satisfaction with therapy domain was observed (0.50 and 0.48, respectively). The CTSQ domains demonstrated good internal consistency and low to moderate correlations of the CTSQ with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and World Health Organization Quality of Life-BREF. No significant differences in mean domain scores were observed in relation to the number and severity of different adverse events and chemotherapy-related adverse events.

CONCLUSIONS

The Dutch version of the CTSQ was found to be a reliable and valid instrument to assess satisfaction and expectations of treatment in lung cancer patients receiving intravenous chemotherapy. Furthermore, the CTSQ proved to be of additional informative value as not all of its domains correlated with the various domains of the existing HRQoL instruments.

High PSA anxiety and low health literacy skills: drivers of early use of salvage ADT among men with biochemically recurrent prostate cancer after radiotherapy?

BACKGROUND

Although commonly used, early initiation of salvage androgen deprivation therapy (ADT) has not been proven to enhance survival. We evaluated whether prostate-specific antigen (PSA) anxiety or health literacy are associated with use of early salvage ADT among men with recurrent prostate cancer after radiotherapy.

PATIENTS AND METHODS

The prospective Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma Registry was used to study 375 men with biochemically recurrent prostate cancer after external beam radiation or brachytherapy. Multivariable logistic regression was used to determine whether PSA anxiety and health literacy are associated with salvage ADT as initial management after biochemical recurrence.

RESULTS

Sixty-eight men (18.1%) received salvage ADT as initial management for PSA recurrence. Men with high PSA anxiety were twice as likely to receive salvage ADT compared with men who did not have high PSA anxiety on both univariable [28.8% versus 13.1%; odds ratio (OR) 2.15; 95% confidence interval (CI) 1.16-4.00; P = 0.015] and multivariable analysis [adjusted OR (AOR) 2.36; 95% CI 1.21-4.62; P = 0.012]. Furthermore, men who had higher levels of health literacy were nearly half as likely to undergo salvage ADT compared with men who had lower levels of health literacy on univariable analysis (15.2% versus 26.3%; OR 0.50; 95% CI 0.29-0.88; P = 0.016), with a trend toward this association on multivariable analysis (AOR 0.58; 95% CI 0.32-1.05; P = 0.07).

CONCLUSIONS

Among men with PSA recurrence after radiotherapy, odds of use of salvage ADT were nearly twice as great among men with high PSA anxiety or low health literacy, suggesting that these men are receiving higher rates of unproven treatment. Given that early salvage ADT is costly, worsens quality of life, and has not been shown to improve survival, quality improvement strategies are needed for these individuals.

Improving couples' quality of life through a Web-based prostate cancer education intervention

PURPOSE/OBJECTIVES

To evaluate the feasibility and acceptability of a newly developed web-based, couple-oriented intervention called Prostate Cancer Education and Resources for Couples (PERC).

DESIGN

Quantitative, qualitative, mixed-methods approach.

SETTING

Oncology outpatient clinics at the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center at UNC–Chapel Hill.

SAMPLE

26 patients with localized prostate cancer (PCa) and their partners.

METHODS

Pre- and postpilot quantitative assessments and a postpilot qualitative interview were conducted.

MAIN RESEARCH VARIABLES

General and PCa-specific symptoms, quality of life, psychosocial factors, PERC’s ease of use, and web activities.

FINDINGS

Improvement was shown in some PCa-specific and general symptoms (small effect sizes for patients and small-to-medium effect sizes for partners), overall quality of life, and physical and social domains of quality of life for patients (small effect sizes). Web activity data indicated high PERC use. Qualitative and quantitative analyses indicated that participants found PERC easy to use and understand,as well as engaging, of high quality, and relevant. Overall, participants were satisfied with PERC and reported that PERC improved their knowledge about symptom management and communication as a couple.

CONCLUSIONS

PERC was a feasible, acceptable method of reducing the side effects of PCa treatment–related symptoms and improving quality of life.

IMPLICATIONS FOR NURSING

PERC has the potential to reduce the negative impacts of symptoms and enhance quality of life for patients with localized PCa and their partners, particularly for those who live in rural areas and have limited access to post-treatment supportive care.

Quality of Life after Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM)

AIM

Endoluminal Loco-Regional Resection (ELRR) by Transanal Endoscopic Microsurgery (TEM) may be considered a valid alternative surgical treatment in patients with rectal cancer. Aim of this study is to evaluate the short and medium term Quality of Life (QoL) from prospectively collected data in patients who underwent ELRR by TEM.

MATERIAL OF STUDY

From May 2010 to June 2013, 31 patients with iT1-iT2-iT3N0 rectal cancer were enrolled in this study. Patients with T1 rectal cancer underwent ELRR by TEM. Patients with iT2-iT3 rectal cancer underwent neoadjuvant radio-chemoterapy (n-RCT) before surgery. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires before surgery and 1, 6, and 12 months after surgery.

RESULTS

Mean distance from the anal verge was 5.4 cm (range 1-10). Mean operative time was 145.8 minutes (range 60-300). Pathological staging was as follows: pT0N0 (6), pT1N0 (18), pT2N0 (7). At 1 month after surgery, in QLQC30 questionnaire, significant worsening was observed in Global Health Status (p=0.0028), Physical Functioning (p=0.0016), Role Functioning (p=0.0004), Fatigue (p=0.0024), Pain (p=0.0003) and Dyspnoea (p=0.0192). In QLQCR38 questionnaire significant worsening at 1 month was observed in Defecation Problems (p=0.0005) and Weight Loss (p=0.0008). At six and twelve months after surgery, no significant differences were observed in QLQ-C30 and in QLQCR38 questionnaires.

DISCUSSION

QoL evaluation showed worsening results at 1 month after ELRR by TEM, in QLQ-C30 and in QLQCR38 questionnaires.

CONCLUSIONS

At 6 and 12 months after surgery, no significant differences in QoL as compared to preoperative status were observed.

Health state utility values associated with advanced gastric, oesophageal, or gastro-oesophageal junction adenocarcinoma: a systematic review

OBJECTIVES

To systematically identify utility values associated with advanced gastric cancer (GC), oesophageal cancer (OC), or gastro-oesophageal junction (GEJ) cancer. Utility values relating to health states are an essential component for cost-utility analysis (CUA).

METHODS

MEDLINE, Embase, Cochrane Library, and EconLit databases were reviewed for relevant studies using a pre-defined search strategy. Studies eligible for inclusion reported health state utility values (HSUVs) using direct (standard gamble [SG] and time-trade-off [TTO]) and indirect (such as EuroQol 5D [EQ-5D], short-form 6D [SF-6D], and the 15-dimensional instrument [15D]) methods for patients with advanced GC, OC, or GEJ cancer.

RESULTS

A total of 539 unique publications were identified, of which eight met the inclusion criteria (GC, n = 2; mixed population [gastrointestinal cancers], n = 4; OC, n =  ). The most commonly used instrument to estimate HSUVs was the EQ-5D (n = 7). Utilities were also estimated using the SF-6D and the 15D in the same study (n = 1). Direct elicitation methods included the TTO (n = 2) and SG (n = 1). Across the eight identified publications, health states and study populations were heterogeneous and sample sizes were limited.

LIMITATIONS

This review, as with all summaries of this nature, is only as robust as the data derived from the identified studies. The systematic review process does not resolve any design issues or biases associated with the original studies.

CONCLUSIONS

Limited data estimate HSUVs in patients with advanced GC, OC, or GEJ cancer. Utilities for advanced GC alone and advanced OC alone were reported in only two publications for each cancer type. No publications considered advanced GEJ utilities alone, and four publications considered utilities for a mixed population of gastrointestinal cancer types. Comparisons are confounded by heterogeneity across the identified publications. Further research into HSUVs associated with advanced GC and OC is required to improve the evidence available for use in CUAs.

Depression in older patients with advanced colorectal cancer is closely connected with immunosuppressive acidic protein

Colorectal cancer (CRC) is one of the most common tumors. CRC patients are susceptible to suffering from depression. Whether the immune system of CRC patients with depression is impaired or stimulated is controversial. Possible reasons for this conflict are the involvement of confounding factors, such as the age of the patient, the stage of the CRC and the types of treatment in previous studies. To demonstrate clearly the relationship between depression and the immune system in the context of CRC, the present study included only older patients with advanced CRC who received only chemotherapy, and the study adopted immunosuppressive acidic protein (IAP) as an immune parameter for the first time. A total of 56 older patients with advanced CRC completed the Zung Self-Rating Depression Scale (SDS) and were divided into two groups according to SDS scores. The patients exhibiting depression were treated with fluoxetine until their symptoms remitted. The serum levels of IAP and the percentages of CD3-positive (CD3+), CD4+, CD8+ T lymphocytes and CD56+ natural killer (NK) cells and Neutrophil-lymphocyte ratio (NLR) were calculated at the time of enrollment and once the symptoms remitted. Correlation analyses revealed that the SDS score was positively associated with serum IAP levels but negatively associated with CD3 and CD4 levels. Among the depressed and non-depressed patients, serum IAP levels and the percentages of CD3 and CD4 cells were dramatically different. After the depression symptoms were treated, the IAP levels dramatically decreased, while the levels of CD3, CD4, CD8 and CD56 were unchanged. All of above suggested that IAP was closely correlated with depression and might be a relatively objective parameter for predicting depression.

Improved quality of life in patients with adenocarcinoma of esophagogastric junction after gastric tube reconstruction

BACKGROUND/AIMS

This study aims to compare postoperative quality of life (QOL) in adenocarcinoma of esophagogastric junction (AEG) patients who underwent different reconstructions after proximal gastrectomy.

METHODOLOGY

A total of 158 consecutive AEG patients (Siewert type II/III) between January 2009 and February 2012 were included in this study. Eighty-seven patients underwent gastric tube reconstruction (anastomosis between tubular stomach and esophagus), and 71 patients had traditional direct anastomosis (anastomosis between gastric remnant and esophagus) after proximal gastrectomy. Quality of life was evaluated using the Chinese versions of the European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC QLQ) Core-30 and EORTC QLQ-STO22 at pre-operation as well as one and two years post-operation.

RESULTS

Patients with gastric tube reconstruction had better quality of life than the traditional group patients with respect to global health status, emotional function, cognitive function, nausea and vomiting, reflux, and anxiety scales at one year post-surgery. At 2 years after surgery, reflux as well as nausea and vomiting remained higher in the traditional group than in the gastric group. In addition, the traditional group exhibited a higher score for body image scale than the gastric tube group.

CONCLUSIONS

AEG patients with gastric tube anastomosis had better a QOL than traditional direct anastomosis patients during the two year follow-up.

Psychosocial factors and their association with reflux oesophagitis, Barrett’s oesophagus and oesophageal adenocarcinoma

AIM: To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma (OAC), as well as the reflux-mediated precursor pathway.

METHODS: An all-Ireland population-based case-control study recruited 230 reflux oesophagitis (RO), 224 Barrett’s oesophagus (BO) and 227 OAC patients and 260 controls. Each case/control group completed measures of stress, depression, self-efficacy, self-esteem, repression and social support. A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.

RESULTS: Compared to controls, OAC patients were almost half as likely to report high stress levels over their lifetime (P = 0.010, OR 0.51; 95%CI: 0.29-0.90) and 36% less likely to report having experienced depression (OR 0.64; 95%CI: 0.42-0.98). RO patients reported significantly higher stress than controls particularly during middle- and senior-years (P for trends < 0.001). RO patients were 37% less likely to report having been highly emotionally repressed (OR 0.63; 95%CI: 0.41-0.95). All case groups (OAC, RO and BO) were more likely than controls to report having had substantial amounts of social support (OR 2.84; 95%CI: 1.63-4.97; OR 1.97; 95%CI: 1.13-3.44 and OR 1.83; 95%CI: 1.03-3.24, respectively).

CONCLUSION: The improved psychological profile of OAC patients may be explained by response shift. The role of psychological factors in the development of OAC requires further investigation.

Knowledge, attitude and practice of smoking in subjects of lung cancer

Lung cancer is the most common cancer in the world since 1988, both in terms of incidence and mortality among both men and women. Approximately half of the cases of lung cancer now occur in developing countries compared to 1980. Tobacco smoking is by far the predominant risk factor for lung cancer. A knowledge, attitude and practice of smoking among 132 cases of lung cancer in this study was undertaken. Amongst 113 ever smokers, out of 132 cases, 91.18% of males and 36.36% of female subjects continued smoking despite knowing the harmful effects of tobacco, displayed over the cigarette or bidi packets. In these group squamous cell carcinoma was the most common type followed by adenocarcinoma. Among the never smokers adenocarcinoma was the commonest type, females accounting for 75% of the cases, though a good number was observed among male ever smokers, signifying the changing histological types of lung cancer today.

Cognitive functions and mood during chronic thyrotropin-suppressive therapy with L-thyroxine in patients with differentiated thyroid carcinoma

BACKGROUND

Subclinical thyroid dysfunctions may cause cognitive deficits and mood disorders. Chronic TSH-suppressive therapy with L-T(4) causing subclinical hyperthyroidism has been widely used in treatment of patients with thyroid differentiated carcinoma. The impact of this therapy on cognitive functions and mood have not been systematically studied. The aim of this study was to asses executive functions, working memory, attention, and depression in patients with subclinical hyperthyroidism in the course of TSH-suppressive therapy.

METHODS

Thirty-one patients with subclinical hyperthyroidism in the course of suppressive treatment with L-T(4) following the total thyroidectomy and radioiodine ablative therapy were included in the study. Cognitive functioning in patients and control group were investigated using the battery of neuropsychological tests [Wisconsin Card Sorting Test (WCST), The Oral Word Association Test (OWAT), Trail Making Test, The Stroop Color-Word Interference test and Digit span]. Psychometric evaluation was performed using 17-items the Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory (BDI).

RESULTS

The performance on tests assessed executive functions, psychomotor speed, and attention was significantly lower in patients group. There was no differences in results of Stroop test and Digit Span forward and backwards between both groups. The intensity of depressive symptoms negatively correlated with a number of completed categories on WCST and results of OWAT. Cognitive deficits were still observed when patients with concomitant general medical conditions and depression were excluded from the analysis.

CONCLUSION

Our findings provide evidence of neuropsychological impairment in patients with differentiated thyroid carcinoma treated with chronic TSH-suppressive therapy.

Impact on quality of life after pancreatoduodenectomy: a prospective study comparing preoperative and postoperative scores

INTRODUCTION

Few studies compare the direct impact of pancreatoduodenectomy (PD) on the patient's quality of life (QOL). The effect of PD in QOL, comparing the preoperative vs. postoperative status, was analyzed.

METHOD

A prospective single-center study was performed. PD patients in a 2-year period were included. A general QOL instrument was applied preoperative, 1, 3, 6, and 12 months after surgery and compared with national norms.

RESULTS

Thirty-seven patients were recruited. Twenty of 37 were female. Ampullary carcinoma 14/37, ductal adenocarcinoma in 9/37, and other malignant neoplasms 14/37 were diagnosed. Mortality was absent; 48.6% had complications, 13.5 % required reoperation. Three (median) and 4 (mode) questionnaires were answered per individual. 85 % answered the last questionnaire. 4/37 had cancer related death before a year. Median follow-up was 29 (3-72) months. QOL diminished a month after surgery, physical function (67 vs 40, p<0.0001) and emotional role (37 vs 17, p<0.032) did so significantly. Three months after surgery QOL improved yet not significantly. Six and 12 months postoperatively, physical role (9 vs 49, p=0.001), physical pain (51 vs 71, p=0.01), social function (52 vs 63, p=0.014), vitality (54 vs 64, p=0.018), and emotional role (41 vs 69, p=0.006) improved significantly.

DISCUSSION

PD has a favorable impact in quality of life as demonstrated by the improvement of most parameters assessed in the postoperative period.

Psychosocial adjustment in colorectal cancer patients undergoing chemotherapy or chemoradiotherapy

BACKGROUND

Psychosocial adaptation is a measurement that represents the patient's adjustment to those changes involved in their illness. We undertook this study to search for individual characteristics and clinical aspects associated with successful psychosocial adjustment in patients with colorectal cancer (CRC) undergoing (CT) chemotherapy or chemoradiotherapy (CRT).

METHODS

Seventy-five patients with CRC treated with CT or CRT in a cancer center were included. Psychosocial Adjustment to Illness Scale Self-Reporting (PAIS-SR) questionnaire was used as a measurement of psychosocial adjustment.

RESULTS

Psychosocial adaptation was successful in 18 patients (24%) and unsuccessful in 57 patients (76%). Young patients, married patients and males showed lower psychosocial adaptation to disease. This is associated with the decrease in sexual relations, economic resources and psychological symptoms. Patients complained that they were unsatisfied due to the lack of disease and treatment information offered by the heath care team.

CONCLUSIONS

In the process of adaptation, clinical features such as tumor location and treatment scheme are considered basic, as well as age, education, marital status. Areas such as sexuality, interpersonal and family relationships, economic status and emotional state of patients affected by the disease and treatments provide a deep complexity in the study of the psychosocial adaptation process in patients with CRC.

Retrospective denial as a coping method

Worldwide, gastric cancer is one of the most common and fatal cancers. The majority of patients present with an advanced stage of disease. Even with use of palliative chemotherapy most patients die within 1 year after diagnosis. Medical psychological attention after a diagnosis of incurable cancer is focused on end of life support. This paper presents the care of a patient treated with palliative intent with chemotherapy for an irresectable histologically confirmed gastric cancer. When, unexpectedly prolonged symptom free survival followed, the reaction of the patient came as a surprise to the attending medical team. In this case history we urge those who care for incurable cancer patients, that the rare patient who survives against all odds may require special psychological care.

[Apathy or depression? Do you have a nose for it? Four case reports of paramedian frontal tumors]

We report four cases of patients with clinically isolated apathy which was mistaken for depression even though they were suffering from voluminous brain tumors. These cases remind us that rigorous clinical analysis is essential: searching for signs of organic origin or psychiatric etiology is fundamental to avoid an incorrect diagnosis. In particular, these four patients displayed anosmia, an uncommon symptom for patients suffering from depression. In addition, brain imaging is important to correctly identify the most prudent medical and/or surgical management strategy. In this short discussion, we propose an algorithm for the clinical diagnosis of apathy.

[Comparison of perception of quality of life in patients with surgical and/or adjuvant in colon cancer and rectal cancer in the Regional Institute of Neoplastic diseases (Trujilo)]

OBJECTIVE

Determine the effectiveness of surgical treatment and / or adjuvant to improve the quality of life in patients with colon cancer compared to rectal cancer.

MATERIAL AND METHODS

Cohort study that evaluated 27 patients diagnosed with colon adenocarcinoma (Group A= 12) and rectum (Group B= 15) resectable treated at the Institute Regional of Neoplastic Diseases of Trujillo since the 1 January 2008 until 31 July 2009.

RESULTS

The overall life quality, as assessed by the QLQ-C 30 at 3 months postoperatively was 67.86 +/- 17.90 points vs. 68.50 +/- 11.94 points respectively for the patients of groups A and B (p = 0.934).The social function was better in patients undergoing surgery for Group A than Group B , (37.50 + 13.36 points vs. 60.00 + 13.69 points, p = 0.018). Body image at 3 months assessed by the QLQ-CR-29 had an average score of 28.12 +/- 6.12 points and 50.00 +/- 25.00 points for Group A y B respectively (p = 0.034). The Group A patients had a mean score at 6 months for sexual function of 33.33 +/- 12.91 points, while Group B patients this average score was 65.00 +/- 22.36 points (p = 0.016).

CONCLUSIONS

Both surgeries for colon and rectal cancer are as effective in improving the overall quality of life of these patients, however the social function, body image, and sexual function is better in colon surgery.

Quality-of-life findings from a randomised phase-III study of XELOX vs FOLFOX-6 in metastatic colorectal cancer

BACKGROUND

A phase-III trial showed the non-inferiority of oral capecitabine plus oxaliplatin (XELOX) vs 5-fluorouracil/leucovorin plus oxaliplatin (FOLFOX-6) in terms of efficacy in first-line treatment of metastatic colorectal cancer. A secondary objective was to compare the quality of life (QoL) and health-care satisfaction of patients.

METHODS

Patients were randomised to receive XELOX (n=156) or FOLFOX-6 (n=150) for 6 months. Quality of life and satisfaction were assessed by the Quality of Life Questionnaire-C30 (QLQ-C30) and Functional Assessment of Chronic Illness Therapy Chemotherapy Convenience and Satisfaction Questionnaire (FACIT-CCSQ), respectively. Patients completed questionnaires at baseline, at Cycle3 (C3) and Cycle (C6) (XELOX) or at C4 and C8 visits (FOLFOX-6) and at their final visit.

RESULTS

A total of 245 and 225 patients were assessed using QLQ-C30 and FACIT-CCSQ, respectively. The completion rates were >80%. Global QoL scores did not differ significantly between groups during the study. According to FACIT-CCSQ, XELOX seemed more convenient (C3/C4, P<0.001; C6/C8, P=0.009) and satisfactory to patients (C6/C8, P=0.003) than FOLFOX-6. At the final visit, XELOX patients spent fewer days on hospital visits (3.3 vs 5.3 days, P=0.045) and lost fewer hours of work/daily activities (10.2 vs 37.1 h lost, P=0.007).

CONCLUSION

XELOX has a similar QoL profile, but seemed to be more convenient in terms of administration at certain time points and reduced time lost for work or other activities compared with FOLFOX-6.

Mucoceles not - Oral cysticercosis and minor salivary gland adenocarcinoma: two case reports

A mucocele is one of the more commonly encountered disorders of the oral mucosa. It develops when a minor salivary duct is injured or blocked, resulting i n the escape of mucus into the adjacent submucosal connective tissue. We present two cases that were clinically diagnosed as mucoceles that were removed because of patient anxiety. However, histological examination revealed dissimilar and medically significant pathologies. Oral cysticercosis and salivary gland adenocarcinoma are rare diseases of the oral mucosa. It is important to consider these and other uncommon diagnoses when evaluating an oral nodule presumed to be a mucocele. We will discuss the natural history and pathogenesis of these disease processes.

Gender differences in pretreatment quality of life in a prospective lung cancer trial

The purpose of this analysis was to assess the impact of pretreatment factors on quality of life (QOL) in patients with locally advanced nonsmall cell lung cancer (NSCLC). In particular, this study focused on the possible interaction between gender-specific baseline health-related QOL and Karnofsky performance score (KPS) in a prospective randomized lung cancer trial. QOL information, using validated instruments (Functional Assessment of Cancer Therapy-Lung [FACT-L], version 2, and Functional Living Index-Cancer [FLIC]), was prospectively collected in patients with locally advanced NSCLC treated on Radiation Therapy Oncology Group (RTOG) trial 89-01. Between April 1990 and April 1994, 70 eligible patients participated in a phase III trial comparing a regimen containing sequential chemotherapy and radiation therapy versus sequential chemotherapy plus surgery. Of these 70 patients, 46 underwent pretreatment FLIC and 49 underwent pretreatment FACT-L. There was a significant interaction between gender and KPS using FLIC (P = 0.009), which also showed a trend toward significance with FACT (P = 0.09). Significant KPS-by-gender interactions were noted for FACT-L in the physical well-being and additional concerns-lung subscales (P = 0.012 and P = 0.0003, respectively). The results of both the FLIC and FACT-L demonstrated significantly lower scores corresponding to lower KPS values (P = 0.009 and P = 0.016, respectively). Results of this randomized study incorporating prospective QOL measurements suggested that in patients with locally advanced NSCLC, analyzing QOL data by either gender or performance status alone may not accurately reflect how these factors depend upon each another. Understanding the interaction between gender and performance status could lead to better prognosticators and potentially could tailor interventions for specific groups of patients with lung cancer.

[Evaluation of the toxicity and quality of life in patients with colorectal cancer treated with chemotherapy]

BACKGROUND

The colorectal cancer is the fourth cause of cancer in Brazil and 5-fluorouracil is the drug most commonly used in the adjuvant or palliative treatment of this disease. AIM - Evaluating in patients with colorectal cancer and chemotherapy, the toxicity and the quality of life.

PATIENTS AND METHODS

From March 2001 and May 2003, 45 patients treated with colorectal cancer treated with 5-fluourouracil and folinic acid were followed closely during six cycles. The gastrointestinal and hematologic toxicity was analysed making use of the chart "Recommendations for the Graduation of Acute and Subacute Toxicity". After the end of each cycle of chemotherapy, the results were registered according to the respectives degrees that vary from 0 to 4. The quality of life was researched through the WHOQOL bref (World Health Organization Quality of Life) questionary that consists of 26 questions and 4 domains: physical, psychological, social relations and environmental, in the beginning, on the 3rd and 6th cycles of treatment.

RESULTS

Among the 45 patients, 28 were male, the average age was 58.4 years old (from 34 to 79 years old). According to the International Union Against Cancer classification, 34 patients (75.6%) had tumors stage II or III and 11 had tumors stage IV (24.4%), 64.4% were in the colon. In 57.7% the chemotherapy was adjuvant and in the others palliative. The toxicities more commonly found were nauseas (42%), diarrhea (38%), and neutropenia (15.7%). There was no significant difference among the degrees of toxicity in the different cycles as well as among the patients in adjuvant or palliative treatment. Significant alterations was found among the quality of life in the physical and psychological domains when the 1st and the 2nd or the 1st and the 3rd application of the test were done. Alterations of the quality of life were also found in the social domain when the first evaluation was compared with the last one. There was no difference between the quality of life and the treatment.

Health-related quality of life among patients cured by surgery for esophageal cancer

BACKGROUND

Little is known regarding the long-term, health-related quality of life (HRQL) of survivors of esophagectomy for cancer.

METHODS

Consecutive patients completed the validated European Organization for Research and Treatment of Cancer general quality-of life-questionnaire (QLQ-C30) and the esophageal-specific module (QLQ-OES18) before surgery and regularly thereafter for at least 3 years. Mean scores with 95% confidence intervals were calculated. The Student t test for paired data was used to determine differences between baseline and 3-year HRQL scores in which scores differed by >or=5 points.

RESULTS

Of 90 patients who underwent surgery, 47 patients (52%) survived for >or=3 years. In this group, most aspects of HRQL recovered to preoperative levels by the 3-year assessment, except that scores for physical function, breathlessness, diarrhea, and reflux were significantly worse than at baseline (P < .01). However, patients reported significantly better emotional function 3 years after surgery than before treatment (P = .0008).

CONCLUSIONS

Even after 3 years, patients who underwent esophagectomy suffered persistent problems with physical function and specific symptoms. These findings may be used to inform patients of the long-term consequences of surgery.

Prevalence, severity, and chronicity of pain and general health-related quality of life in patients with localized prostate cancer

AIMS

To analyze the prevalence and the severity spectrum of pain and its relationships to health-related quality of life and the bio-psycho-social consequences of pain among patients scheduled for radical prostatectomy.

METHODS

Urological inpatients completed an epidemiological pain questionnaire extensively exploring pre-operative acute and chronic pains in 21 body regions. The severity of pain was determined using von Korff's Pain Grading (CPGQ). Pain chronicity was estimated employing the Mainz Pain Staging System (MPSS). Anxiety and depressive symptoms were identified with the HADS and the Habitual Well-Being Questionnaire (FW-7). Health-related quality of life was measured using the SF-12. Comorbidities and comorbidity-related interferences with daily activities were ascertained with the Weighted Illness Checklist (WICL).

RESULTS

Eighty of 115 patients (69.6%) reported about pain during the last 3 months pre-operatively. 28.7% of the pain patients had pain related to urological disease. Severe dysfunctional pain was identified by pain Grades 3 and 4 of the CPGQ in 20% and 13.8%, respectively. Advanced pain chronicity characterized by pain Stages II and III of the MPSS was present in 38.8% and 11.3%. Patients with localized prostate cancer without pain complaints had significantly better health-related quality of life and habitual well-being and lower anxiety and depression scores and fewer comorbidities. Patients with cancer-related and non-cancer pain did not differ in pain chronicity, pain severity, pain intensities, anxiety, comorbidities and physical health (SF12-PCS).

CONCLUSIONS

The high prevalence of severe and chronic pain in cancer patients before scheduled radical prostatectomy--combined with considerable disability effects and markedly reduced quality of life necessitate a short routine screening-analysis of the severity spectrum of pain and psychopathology. Patient self-rated pain chronicity staging and psychological distress analysis will allow a disorder severity-guided treatment and the prevention of suffering and additional new chronic post-surgical pain.

Successful amelioration of oxaliplatin-induced hyperexcitability syndrome with the antiepileptic pregabalin in a patient with pancreatic cancer

BACKGROUND

Oxaliplatin, a platinum derivative used in the treatment of gastrointestinal cancers, has been associated with sensory neuropathies and, more infrequently, a neuromyotonia-like hyperexcitability syndrome. We present a case of hyperexcitability syndrome that developed during the treatment of pancreatic cancer with oxaliplatin and gemcitabine (GEMOX) that was successfully treated with pregabalin.

CASE PRESENTATION

A 54-year-old woman was undergoing chemotherapy with gemcitabine and oxaliplatin (GEMOX) for stage II-B pancreatic adenocarcinoma. On the third day of her fourth cycle, she presented with twitching of eyelids and tremors of hands. This twitching started bilaterally on the eyelids, followed by teeth jittering, hand shaking, and slurring of speech. A thorough neurological exam revealed no abnormalities except increased tone of both hands-she had difficulty opening her hand after closing it for a hand-grip. She was given a dose of 1 g of IV magnesium sulfate and 1 g of IV calcium gluconate, and 50 mg of IV diphenhydramine. In addition to reassurance, pregabalin was prescribed for these myotonic symptoms at a dosage of 50 mg by mouth three times daily. Improvement occurred in these symptoms within 12 h and she was almost asymptomatic within 72 h.

CONCLUSION

Oxaliplatin causes a unique spectrum of acute neurological toxicities that have not been observed in patients receiving either cisplatin or carboplatin. Clinically, sensory alterations are most prominent, particularly cold-induced and perioral paresthesias. Other symptoms, such as cramps, jaw stiffness, voice changes, ptosis, and visual field changes suggest that motor nerves or muscles may also be involved (hyperexcitability). Hyperexcitability syndrome, distinct from cold-induced paresthesias and sensory neuropathy, is a rare complication of oxaliplatin chemotherapy; and up to date no pharmacotherapy has been successful in treating these symptoms. This is the first report of the successful amelioration of this syndrome with the antiepileptic pregabalin.

Mapping FACT-P and EORTC QLQ-C30 to patient health status measured by EQ-5D in metastatic hormone-refractory prostate cancer patients

OBJECTIVES

To construct and validate a prediction model of preference-adjusted health status (EQ-5D) for metastatic hormone-refractory prostate cancer (HRPCA) patients using cancer-specific health-related quality of life (HRQoL) measures.

METHODS

Data were obtained from a multicenter, multinational observational study of metastatic HRPCA patients conducted during 2002 to 2004. In addition to clinical and resource utilization, preference-adjusted health status (EQ-5D) and HRQoL (Functional Assessment of Cancer Therapy-Prostate [FACT-P] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) data were collected. Predictive validity of ordinary least square (OLS) and median regressions of various model specifications were tested using cross-validation samples. The selected specification was then further refined and tested for alternative model specifications and restrictions.

RESULTS

OLS regression with both HRQoL measures as individual components and patient demographics was the best-performing model. It explained 58.2% of the observed EQ-5D variation in the validation sample. A model including only the prostate cancer-specific HRQoL measure, FACT-P, explained 53.5% of the observed EQ-5D variation.

CONCLUSIONS

The models developed have good predictive validity. These algorithms enable researchers to translate cancer-specific HRQoL measures to preference-adjusted health status in metastatic HRPCA patients. The findings will help perform health status adjustments in cost-utility analyses.

Eliciting patient preferences for hormonal therapy options in the treatment of metastatic prostate cancer

Treatment choices for metastatic prostate cancer are complex and can involve men balancing survival versus quality of life. The present study aims to elicit patient preferences with respect to the attributes of treatments for metastatic prostate cancer through a discrete choice experiment (DCE) questionnaire. Men with recently diagnosed localized prostate cancer were asked to envisage that they had metastatic disease when completing a survey. As expected, men with prostate cancer placed considerable importance on gains in survival; however, avoiding side effects of treatment was also clearly important. Survival gains should be considered alongside side effects when discussing treatment options in metastatic disease.

Moderator analyses of participants in the Active for Life after cancer trial: implications for physical activity group intervention studies

BACKGROUND

Prostate cancer patients on hormonal therapy experience significant treatment-related physical and psychological sequelae.

PURPOSE

We examined moderator variables to determine whether certain participants demonstrated quality of life (QOL) benefits from a group-based lifestyle physical activity program compared to a group-based educational support program and standard care.

METHODS

Participants were 134 prostate cancer patients on continuous androgen ablation in a controlled trial that used adaptive allocation.

RESULTS

As reported elsewhere, no significant differences were found between study conditions on primary QOL outcomes following the 6-month interventions. However, in a secondary analysis, several significant interactions indicated that both group programs benefited patients with lower psychosocial functioning at baseline; patients with lower mental health and social support scores had significant improvements in these measures compared with standard care. For those with higher pain, the educational support program resulted in significant improvements compared with the other two conditions. Twelve-month findings indicated lasting effects.

CONCLUSIONS

Consistent with existing research, results indicate that group interventions benefit cancer patients with limitations in psychosocial functioning. Findings underscore the importance of physical activity/exercise studies to employ control conditions that consider the attention and support provided by health educators and group members, particularly when examining psychosocial outcomes and pain.

Laparoscopic radical robotic prostatectomy: a case study

The management of prostate cancer includes observation, hormonal therapy, radical prostate surgery (open, laparoscopic, or laparoscopic robotic), external beam radiation, brachytherapy, or cryotherapy. Laparoscopic radical robotic prostatectomy is the newest technology in minimally invasive surgery. This is a case study of a patient who chose to undergo laparoscopic robotic prostatectomy for his prostate cancer.

Restless legs syndrome induced by citalopram: a psychiatric emergency?

OBJECTIVE

The objective of this case report is to create awareness on restless legs syndrome (RLS) among clinicians working in emergency units.

METHOD

We describe a case reporting important aggravation of RLS associated with citalopram, 60 mg/day, in a 48-year-old woman who was sent to the emergency unit by her general practitioner. Citalopram was replaced by bupropion, 150 mg/day, and sertraline, 50 mg/day.

RESULTS

Three days later, symptoms of RLS started to diminish and, after 3 weeks, clinical symptoms had disappeared entirely. On 6-month follow-up, the patient did not manifest clinically significant RLS. Ignoring RLS could lead to a worsening of symptoms and could increase the risk for iatrogenic conditions. The prevalence of RLS in the general population is 3-9%; nevertheless, this syndrome is frequently underdiagnosed.

CONCLUSION

This case report suggests that RLS could be considered as a possible "dopamine-dependent side effect" of selective serotonin reuptake inhibitors (SSRIs). Bupropion could potentially "correct" dopaminergic dysfunction in RLS, and sertraline appears to be the SSRI that provides the least risk of RLS by blocking dopamine reuptake.

Phase I/II study of weekly docetaxel and vinblastine in the treatment of metastatic hormone-refractory prostate carcinoma

BACKGROUND

Phase II trials have shown that taxanes have clinical activity as single agents as well as in combination with microtubule inhibitors in the treatment of hormone-refractory prostate cancer. Recent phase III trials with docetaxel have reported a survival benefit. Most trials also report significant toxicity, including thromboembolic disease. We conducted a phase I/II study to evaluate the maximum-tolerated dose, response rate, and effects on quality of life of the combination of docetaxel and vinblastine.

METHODS

Twenty men with hormone-refractory prostate cancer were treated after experiencing hormonal failure. Patients were enrolled in cohorts of three and treated with three weekly doses of docetaxel (20, 25, 30, 35, or 40 mg/m2) administered as 30-minute infusion and vinblastine (3 mg/m2) bolus. Treatment cycles were repeated every 28 days. Follow-up assessments included prostate-specific antigen level determinations, computed tomographic scans, bone scans, Brief Pain Inventory, and Functional Assessment of Cancer Therapy-Prostate Instrument (FACT-P). Toxicity was graded by National Cancer Institute common toxicity criteria.

RESULTS

The maximum tolerated dose of docetaxel was 35 mg/m2. Twelve of the 19 patients (63%; 95% CI 38%-84%) evaluable patients achieved a 50% reduction in prostate-specific antigen level that persisted for 24-80 weeks. Four of eight patients with measurable soft tissue disease had a partial response. Median time to disease progression was 50 weeks. Sixteen patients completed the Brief Pain Inventory at least three times. Twelve patients reported moderate-to-severe pain scores (>or=4) at baseline. Of these 12 patients, 11 reported that their worst pain score improved by at least two levels, and five of the 12 reported decreased opioid requirements. Seventeen patients completed the FACT-P at baseline and on at least two additional visits. Nine of these 17 (53%) reported improvement in Trial Outcome Index (sum of physical, functional, prostate subscales) by >or=6 points. Anemia was common; 12/20 patients required epoetin, and two required transfusions. Venous thrombosis developed in four patients during treatment. Only two patients discontinued treatment because of toxicity.

CONCLUSIONS

This combination of weekly docetaxel and vinblastine is effective, well tolerated, and associated with improved quality of life in most of the patients treated. Although estramustine was not given, the risk of thromboembolic disease remains significant.

Discussing quality-of-life issues with a patient newly diagnosed with prostate cancer

BACKGROUND

A 66-year-old man with hypertension, hyperlipidemia, and benign prostatic hyperplasia presented for evaluation of an elevated PSA level of 6.2 ng/ml.

INVESTIGATIONS

Transrectal ultrasound-guided 12-core prostate needle biopsy.

DIAGNOSIS

Clinically localized, clinical stage T1c adenocarcinoma of the prostate.

MANAGEMENT

Following a full discussion of the risks and benefits of his treatment options, including quality-of-life sequelae, the patient opted for radical prostatectomy.

Using the Liverpool Care Pathway for a dying patient

This article describes the experience of staff in one acute hospital in Northern Ireland who adapted the Liverpool Care Pathway (LCP) for the dying patient to suit their organisation. It focuses on one patient's journey, from diagnosis to terminal care. The patient remained on the care pathway for 12 days. This reflection demonstrates that, as long as patients continue to meet the criteria for the LCP, some may be on the care pathway for more than the recognised average of two days.

[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.

Correlation of Patient-Derived Utility Values and Quality of Life after Pancreaticoduodenectomy for Pancreatic Cancer

BACKGROUND

Utility value (UV) represents the "value" that a patient places on a given health state and can be closely associated with quality of life. The purpose of this study was to determine if UV and quality of life are correlated after pancreaticoduodenectomy for pancreatic adenocarcinoma and to assess quality of life after pancreaticoduodenectomy.

STUDY DESIGN

Patients who underwent pancreaticoduodenectomy for pancreatic cancer were interviewed using the 36-item Short Form Health Survey, which measures 8 domains of quality of life. Patients assessed their current health state by rating their present health from 0 (which was equivalent to death) to 100 (which was equivalent to prefect health), and by a time-exchange (TE) method that asked how many years of their present life they would be willing to exchange for perfect health. Statistical analysis consisted of linear regression analysis and Mann-Whitney U test.

RESULTS

Twenty patients were interviewed. The UVs correlated with the TE (p = 0.003, r = -0.63), and 6 of 8 36-item Short Form Health Survey domains: physical functioning (p < 0.00001, r = 0.82), role-physical (p = 0.005, r = 0.61), bodily pain (p = 0.003, r = 0.63), general health (p = 0.00001, r = 0.81), vitality (p = 0.01, r = 0.54), and mental health (p = 0.03, r = 0.5). The TE score correlated with the physical functioning (p = 0.06, r = -0.59) and bodily pain (p = 0.05, r = -0.44) domains. There were significant differences in the UV, TE, physical functioning, role-physical, and role-emotional between patients less than 1 year and more than 1 year postoperative.

CONCLUSIONS

These data imply that patient-perceived health status and quality of life are linked and that quality-of-life scores after pancreaticoduodenectomy are better in patients more than 1 year postoperative.

Effects of depression on the survival of pancreatic adenocarcinoma

OBJECTIVES

Depression frequently predates the diagnosis of pancreatic adenocarcinoma. In other malignancies, depression has been shown to adversely affect survival. The purpose of this study was to assess whether survival after resection for pancreatic cancer is shortened by the pretreatment presence of depression.

METHODS

A database of all patients diagnosed with pancreatic cancer was retrospectively reviewed for depression, resection, and chemotherapy and/or radiation therapy. A total of 258 patients were studied; 21% had depression, 19% had surgical resection of the tumor, and 42% were treated with chemotherapy and/or radiation therapy. Survival data was analyzed using Cox proportional hazard regression and life table analysis.

RESULTS

The median survival time for all depressed patients with pancreatic cancer was 5 months compared with 4 months for all nondepressed patients with pancreatic cancer (P < 0.9). There was no difference in stage, rate of surgical resection, rate of chemotherapy administration, or rate of radiation therapy use between depressed and nondepressed patients.

CONCLUSION

Patients who had undergone surgical resection or chemotherapy and/or radiation therapy had longer survival times than those who did not. Depression, although common among patients with pancreatic cancer, does not affect survival.