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Data regarding the palliative needs of pediatric patients with central nervous system (CNS) cancer are scarce. We aimed to describe the attention provided by a pediatric palliative care (PPC) team to patients with CNS cancer and the differences in care compared to patients who did not receive PPC.
This retrospective study was based on the clinical records of deceased patients with CNS cancer attended by a PPC team over 10 years, analyzing their trajectory and provision of PPC, including medical, psychological, social, and nursing interventions. Furthermore, we compared the last month of life care of deceased patients with CNS cancer in the same institution, based on whether they were attended by the PPC team.
Of 71 patients, 59 received PPC, with a median of 1.6 months (Interquartile range: 0.6–5.2) from referral to death. Home hospitalization was provided to 84.8%, nursing interventions were registered in 89.8%, psychological characteristics in 84.7%, and social interventions in 88.1%. The most common symptoms were pain, dyspnea, and constipation. When comparing patients from the same hospital who received PPC (n = 36) with those who did not (n = 12), the former spent fewer days in the hospital in their last month and last week (p < 0.01) and were more likely to die at home (50% vs. 0%; p < 0.01).
Significance of results
Patients with CNS cancer show various medical, social, and psychological needs during end-of-life care. Providing specific PPC interventions decreased the number of days spent at the hospital and increased the rate of death at home.
The mutual influence between end-of-life cancer patients and their family caregivers is widely endorsed. The present study aimed to explore the relationship between end-of-life cancer patients’ dignity-related distress and the distress of their caregivers.
A cross-sectional approach was used. The sample consisted of 128 patients with a Karnofsky Performance Status (KPS) below 50 and a life expectancy of a few weeks, and their family caregivers. Personal and clinical data were collected and validated rating scales were administered: Patient Dignity Inventory (PDI) to terminal cancer patients; Hospital Anxiety and Depression Scale (HADS), Demoralization Scale (DS), Herth Hope Index (HHI), Caregiver Reaction Assessment (CRA), Short Form Health Survey 36 (SF-36), and Distress Thermometer (DT) to caregivers.
Findings highlighted significant correlations between patients’ scores on the Psychological Distress PDI subscale and the PDI Total Score and caregivers’ Emotional Role. Patients’ Psychological Distress, PDI Total Score, and Loss of Purpose and Meaning were associated with caregivers’ Disrupted Schedule. Finally, patients’ Physical Symptoms and Dependency, Loss of Purpose and Meaning, and PDI Total Score were correlated with caregivers’ Disheartenment.
Significance of results
The results highlighted the key role of dignity as a relational dimension during the end-of-life phase. Therefore, because of caregivers’ distress could affect patients’ dignity-related distress by influencing the interpersonal aspects of patients’ autonomy, it would be important to relieve caregivers’ distress in order to promote patients’ autonomy and minimize their fear of being a burden.
Cancer is one of the leading causes of mortality and morbidity in the developed world. Age is a primary risk factor for developing cancer, and geriatric oncology is a rapidly emerging field that aims to address the specific needs of older patients with cancer. All clinicians who treat elderly patients should have knowledge of cancer risks, screening, and management principles. This chapter will review the principles of geriatric oncology, including geriatric assessment in the oncology population. We will then discuss the four most common solid tumors encountered in elderly patients: breast, prostate, colorectal, and lung cancer. Each section will include risk factors, screening and prevention, presentation, staging, prognosis, and multidisciplinary management of early- and late-stage disease.
A new therapy that uses the patient's own blood to cure blood cancers (leukaemias) is the focus of this chapter. The history of its detection and diagnosis is related, along with the long and arduous search for effective treatment, arriving at successful employment of bone marrow transplantation in the later twentieth century. More recent developments in chemotherapy are reviewed, leading to a contemporary account of the encouraging progress with T-cell therapies.
This Element explores approaches to locating and examining social identity in corpora with and without the aid of demographic metadata. This is a key concern in corpus-aided studies of language and identity, and this Element sets out to explore the main challenges and affordances associated with either approach and to discern what either approach can (and cannot) show. It describes two case studies which each compare two approaches to social identity variables – sex and age – in a corpus of 14-million words of patient comments about NHS cancer services in England. The first approach utilises demographic tags to group comments according to patients' sex/age while the second involves categorising cases where patients disclose their sex/age in their comments. This Element compares the findings from either approach, with the approaches themselves being critically discussed in terms of their implications for corpus-aided studies of language and identity.
This book will enable practitioners to understand the many complex intricacies of immunohistochemistry (IHC) and make best use of this powerful analytical tool. Providing a thorough grounding in the fundamentals of immunohistochemistry, the book includes several chapters on robotics and automation technology, giving key information on the design of machines and tips to maximise workflow efficiencies. The relationship between IHC and molecular pathology is explained clearly, demonstrating the increasing impact on personalized medicine and targeted therapies for cancer patients. The staining protocol is deconstructed, allowing the reader to adapt it for a variety of diagnostic and research applications. Written by experts at the forefront of hospital immunohistochemistry, there is a strong emphasis on practical guidance on a range of techniques as well as troubleshooting of common problems driven by the authors' experiences. Extensively illustrated with high-quality colour images, this is an invaluable resource to all pathology practitioners utilising the technique.
This study is aimed to evaluate the validity and reliability of the Cancer Stigma Scale for the Turkish population (CASS-T).
The sample of the study consisted of 412 students of a foundation university located in Ankara, Turkey. The reliability of the CASS was evaluated using the Cronbach alpha reliability coefficient and item-total score correlations. Exploratory factor analyses were applied to examine the factor structure of the scale and its construct validity. To test the time invariance of the scale, the relationships between the scores obtained from the first and second applications were examined using the intraclass correlation coefficient (ICC).
The Cronbach's alpha coefficient of CASS-T was 0.83. In the factor analysis, it was confirmed that the scale has a six-dimensional structure in parallel to original version, namely Avoidance, Severity, Responsibility, Policy opposition, Awkwardness, and Discrimination. The ICC values all remained in the range that indicates the reliability of the 0.63–0.71 to be substantial. The contribution of the six factors of the CASS-T scale to the variance is 57.8.
Significance in results
The Turkish version of the CASS was confirmed to have good reliability and validity for evaluating stigma toward cancer in Turkish society.
There is increasing evidence that glioblastoma, a highly aggressive brain tumour, originates from a neural stem cell (NSC) located in the subventricular zone (SVZ) of the lateral cerebral ventricle. Using the most advanced in vivo imaging techniques, Gengatharan and colleagues recently identified a day/night difference in the adult SVZ-NSC division. They reported that the circadian melatonin rhythm and its receptor control the day/night difference in NSC division with high mitotic activity during the day and low activity at night. Expression of melatonin and its receptor diminishes during ageing, which eliminates the regulatory effect of melatonin on NSC mitosis. Moreover, the circadian melatonin rhythm is dampened by light-at-night with the potential of altering the circadian mitotic cycle of NSC in the SVZ. Also, men with a lower melatonin amplitude than women exhibit a 60% higher rate of glioblastoma incidence. Given that ageing contributes significantly to glioblastoma initiation and progression, we suggest that the decline in circadian melatonin synthesis and release as well as its receptors in the SVZ, which also diminish with an ageing act in concert with other factors to facilitate glioblastoma initiation and growth.
One of the side effects of opioid administration is opioid-induced constipation (OIC). To address this side effect, the oral peripheral μ opioid receptor antagonist naldemedine was developed. As this drug does not cross the blood–brain barrier, it is thought that it does not lead to opioid withdrawal syndrome (OWS) with central nervous system symptoms.
Here, we report a cancer patient who presented with symptoms centered round anxiety and irritation 4 months after administration of naldemedine for OIC and who was diagnosed with OWS after close investigation.
The patient was a 65-year-old female who had surgery for stage IB endometrial cancer 4 years previously, but experienced recurrence involving the pelvis 2 years later. Medical narcotics were used to control pain, but naldemedine was started to control subsequent constipation. When naldemedine-related OWS was suspected and the administration of naldemedine discontinued, the above symptoms disappeared within two days, and no recurrence was observed thereafter.
Significance of the results
For patients receiving naldemedine, it is necessary to consider the possibility of OWS regardless of the period of administration in order to maintain patient quality of life.
Mathematical models may be used to optimize the decision of when to screen for cancer and how invasive a test to use, for example a biopsy or a biomarker. Partially observable Markov decision process (POMDP) models may be used to optimize screening decisions based on a patient's belief state, which is calculated using Bayesian updating and comprises a patient's complete history of biomarker test results. POMDPs can be used to determine how, if at all, biomarkers should be used for cancer screening in order to maximize quality-adjusted life years, a population health measure of disease burden that incorporates both the quality and quantity of life.
The current COVID-19 pandemic contributed by the SARS-CoV-2 has put in place an urgent need for new and promising antiviral therapeutics. The viral RNA-dependent RNA polymerase (RdRp) enzyme plays a vital role in viral replication for all RNA viruses, including SARS-CoV-2, thereby making it a prime and promising candidate for novel antiviral targeting. Interestingly, the human telomerase reverse transcriptase (hTERT), a common catalytic subunit of the telomerase enzyme in many cancers, has also been identified with structural and functional similarities to the viral RdRp. Therefore, it becomes essential to evaluate and consider anticancer drugs that target hTERT towards antiviral RdRp activity, and vice versa. For instance, Floxuridine, an hTERT inhibitor, and VX-222, a hepatitis C virus RdRp inhibitor, are now gaining recognition as a potential antiviral against SARS-CoV-2 and anti-hTERT for cancer, simultaneously. While limited studies on hTERT inhibitors for use as viral RdRp, and anti-RdRp inhibitors as hTERT inhibitors are available, in this review, we aim at bringing to light this close structural and functional relationship between both these enzymes. We punctuate this idea with specific examples on how potential anticancer inhibitors can effectively be brought to use as inhibitors against the SARS-CoV-2 virus, a relatively new pathogen, compared to the very well-studied field of cancer research.
The pandemic caused by severe acute respiratory syndrome coronavirus 2 is sweeping the world, threatening millions of lives and drastically altering our ways of living. According to current studies, failure to either activate or eliminate inflammatory responses timely and properly at certain stages could result in the progression of the disease. In other words, robust immune responses to coronavirus disease 2019 (COVID-19) are critical. However, they do not theoretically present in some special groups of people, including the young, the aged, patients with autoimmunity or cancer. Differences also do occur between men and women. Our immune system evolves to ensure delicate coordination at different stages of life. The innate immune cells mainly consisted of myeloid lineage cells, including neutrophils, basophils, eosinophils, dendritic cells and mast cells; they possess phagocytic capacity to different degrees at different stages of life. They are firstly recruited upon infection and may activate the adaptive immunity when needed. The adaptive immune cells, on the other way, are comprised mainly of lymphoid lineages. As one grows up, the adaptive immunity matures and expands its memory repertoire, accompanied by an adjustment in quantity and quality. In this review, we would summarise and analyse the immunological characteristics of these groups from the perspective of the immune system ‘evolution’ as well as ‘revolution’ that has been studied and speculated so far, which would aid the comprehensive understanding of COVID-19 and personalised-treatment strategy.
This study investigated the possible correlation between emotional distress linked to dignity and dysfunctional temporal orientations in the oncological context.
We conducted an exploratory study between December 2020 and February 2021, referring to a sample of 107 patients in active treatment for solid tumors belonging to the Oncology Department of the Fondazione Poliambulanza (Brescia, Italy). We administered two self-report questionnaires: the Patient Dignity Inventory (PDI-IT) (Italian version, Grassi L, Costantini A, Caruso R, et al. (2017) Dignity and psychosocial-related variables in advanced and nonadvanced cancer patients by using the patient dignity inventory-Italian version. Journal of Pain and Symptom Management 53(2), 279–287), as a measure of perceived level of dignity, and the Italian version of the Zimbardo Time Perspective Inventory scale (ZTPI) (Zimbardo PG and Boyd JN (2009) Il paradosso del tempo. La nuova psicologia del tempo che cambierà la tua vita. Milano: Mondadori), as a measure of the experiential dimensions of time, such as past, present, and future.
From the PDI-IT emerged that our sample reported high levels of physical and psychological distress. Furthermore, we founded higher distress in patients under 55 years (p = 0.04) and lower distress in retired patients (p = 0.01). The ZTPI showed in our patients prevailing orientations to the past-positive (39.3%) and the future (37.4%). We noticed a gender difference: men were mainly oriented to the future while women to the past-positive. Moreover, married subjects reported a prevalent orientation to past-positive and the future. Finally, data analysis found moderate positive correlation between the “Negative Past” dimension of ZTPI and high levels of physical (r = 0.203, p = 0.03) and psychological distress (r = 236, p = 0.01).
Significance of results
In our experience in oncology, dignity and time perspective play a central role as indicators of the quality of care. Our study shows the importance of a treatment path that integrates the constructs of Dignity and Time Perspective to favor a better psychological adaptation.
En France, la loi Kouchner (2002) a permis de repenser les droits des patients et a introduit la notion de démocratie sanitaire. En cancérologie, les associations de patients et (ex-)malades ont commencé progressivement à jouer plusieurs rôles (soutien et informations aux malades, représentation dans les institutions de soins et les agences d’État, enseignement auprès des soignants et participation à la recherche). Certains patients choisissent même d'en faire leur métier : c'est cette professionnalisation qui nous intéresse. Nous proposons ici de discuter des premiers résultats de deux recherches en cours sur le sujet.
Boron neutron capture therapy (BNCT) is a tumour selective particle radiotherapy, based on the administration of boron carriers incorporated preferentially by tumour cells, followed by irradiation with a thermal or epithermal neutron beam. BNCT clinical results to date show therapeutic efficacy, associated with an improvement in patient quality of life and prolonged survival. Translational research in adequate experimental models is necessary to optimise BNCT for different pathologies. This review recapitulates some examples of BNCT radiobiological studies for different pathologies and clinical scenarios, strategies to optimise boron targeting, enhance BNCT therapeutic effect and minimise radiotoxicity. It also describes the radiobiological mechanisms induced by BNCT, and the importance of the detection of biomarkers to monitor and predict the therapeutic efficacy and toxicity of BNCT alone or combined with other strategies. Besides, there is a brief comment on the introduction of accelerator-based neutron sources in BNCT. These sources would expand the clinical BNCT services to more patients, and would help to make BNCT a standard treatment modality for various types of cancer. Radiobiological BNCT studies have been of utmost importance to make progress in BNCT, being essential to design novel, safe and effective clinical BNCT protocols.
Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment.
This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants.
Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = −3.79, 95% CI = −7.42, −0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability, and receiving social support.
Significance of results
Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems.
Sexual self-concept has an influence on the sexual behaviors of women with breast cancer. Supportive programs for these women have demonstrable empirical efficacy; however, their effectiveness has not been examined. The aim of this study was to investigate the effect of a supportive program based on social networks on the sexual self-concept of women with breast cancer.
In this randomized controlled single-blind trial, 60 women were assigned to the intervention (n = 30) and control (n = 30) groups using permuted block randomization. Overall, eight 45-min intervention sessions were held (twice a week). The primary outcome was sexual self-concept, and the secondary outcomes were women's sexual quality of life and participants’ satisfaction. The questionnaires were completed by patients before the intervention and immediately and 1 month after the intervention.
The generalized equation estimation test showed that the positive sexual self-concept score of the intervention group versus the control group had increased by 15.67 points (P < 0.001, effect size = 2.00) 1 month after the intervention. The negative sexual self-concept score had decreased by 2.65 points (P < 0.001, effect size = 0.74), and the situational sexual self-concept score had upturned by 6.82 points (P < 0.001, effect size = 2.08) in the intervention group at the same period. Also, the sexual quality of life score in the intervention group compared to the control group generally increased by 13.82 points (P < 0.001, Effect size = 2.08) 1 month following the intervention.
Significance of the results
A social networking support program can be a promising approach to improve the sexual self-concept of women with breast cancer.
Clinical trials.gov identifier
Iranian Clinical Trial Register, IRCT20150608022609N8. Registered on 2 July 2020.
This scoping review aimed to identify published meta-analyses of the associations of dietary soya intakes with cardiovascular, cancer and diabetes II diseases and the best relative risk estimates. A published novel assessment process combining the well-validated Cochrane Review measures, the AMSTAR 2 checklist and a published algorithm specifically designed for conducting a scoping review of similar meta-analyses was employed. This scoping review identified and evaluated twenty-eight meta-analysis reports, published between 2000 and 2021, on the associations of soya intakes with cardiovascular, cancer and diabetes II diseases. It identified eighteen significantly negatively associated risk–disease pairs for total soya intakes, four significantly negatively associated risk–disease pairs for unfermented soya intakes and four significantly negatively associated risk–disease pairs for fermented soya intakes when compared high against low intakes. The largest significant risk decrease found was gastric cancer mortalities with relative risk (RR) 0·49 (95 % CI: 0·35, 0·68); followed by colorectal cancer mortalities RR 0·59 (95 % CI: 0·41, 0·84); ovarian cancer RR 0·52 (95 % CI: 0·42, 0·66) and endocrine-related gynaecological cancer RR 0·61 (95 % CI: 0·53, 0·72). The fermented soya intake and gastric cancer risk–disease pair were identified to be significantly positively associated, RR 1·22 (95 % CI: 1·02, 1·44) when compared high against low intakes. Four significantly negatively associated risk–disease dose–responses were also identified. Being the products with lower greenhouse gas emission intensities, soya products could be the better dietary alternatives to animal products for reducing cardiovascular, cancer and diabetes II diseases and helping combat climate change.
Current studies on inhibitory effects of n-3 PUFA on pro-inflammatory cytokines have inconsistent results. Thus, a meta-analysis of randomised controlled trials was conducted to identify the effects of n-3 PUFA administration on circulating IL-6 and TNF in patients with cancer. Studies that examined the effects of n-3 PUFA administration on circulating IL-6 and TNF in patients with cancer were identified by searching PubMed and EMBASE from January 1975 to February 2021. Differences in n-3 PUFA administration and control conditions were determined by calculating standardised mean differences (SMD) with 95 % CI. Twenty studies involving 971 patients met the inclusion criteria. The overall SMD were 0·485 (95 % CI 0·087, 0·883) for IL-6 and 0·712 (95 % CI 0·461, 0·962) for TNF between n-3 PUFA administration and control conditions. Sources of heterogeneity were not found through subgroup and meta-regression analyses. Publication bias was observed in TNF with a slight contribution to the effect size. n-3 PUFA can reduce circulating IL-6 and TNF levels in patients with cancer. Results supported the recommendation of n-3 PUFA as adjuvant therapy for patients with cancer, possibly excluding head and neck cancer, owing to their anti-inflammatory properties.
Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic.
The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution’s radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied.
Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24–94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1–18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029).
Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population.