Study themes common to the debate of possible burdensome treatment at the end of life (see Table 1) frequently neglect the patients’ perspective. This study provides valuable information about patients’ perceptions and what stuck in their memory. So, this study should not be seen as a description of actual practice, but as a description of how patients experienced the palliative phase of cancer in the context of chemotherapy. We interviewed advancedcancerpatients with chemotherapy responsive tumors (breast- and colorectal cancer) in different stages of the treatment course to be able to offer insight into patients’ ideas and experiences in the broadest sense. Our study also has limitations. We only included patients with advanced colorectal- and breast cancer who had undergone one or more previous lines of chemotherapy. Possibly, patients with malignancies with worse prognosis (e.g. non-small cell lung cancer, pancreatic cancer) have different views with respect to death and dying and (continuation) of chemotherapy than other patients. However, we were primarily interested in the ideas and decisions of patients who had already started chemo- therapy because stopping is considered to be more difficult than withholding treatment [19,22].
Prognostication is a critical medical task for the adequacy of treatment and management of priorities and expectations of patients and families. In 2005, the European Association of Palliative Care (EAPC) published recommendations on the formulation of vital prognosis in advancedcancerpatients. The aim of this study is to analyze the literature subsequent to this review and to update the presented rec- ommendations. Using the same strategy of the EAPC group, we performed a systematic literature search in the electronic databases PubMed and Scopus, which included original studies in adults with advancedcancer, without tumor-directed treatment, with a median survival of less than 90 days. The articles were analyzed and classified according to the level of evidence by two independent review- ers. The 41 articles analyzed allowed to keep grade A recommendations for clinical estimation of survival and Palliative Prognostic score and now also for Palliative Prognostic Index, performance status, dyspnea, lymphopenia and lactate dehydrogenase. Recom- mendations regarding the use of C-reactive protein, leukocytosis, azotemia, hypoalbuminemia and male gender as predictors reached grade B. To formulate the vital prognosis and to communicate it properly to the patient and family are core competencies of physicians, particularly of those who deal with end of life patients. The clinical impression combined with scientific evidence allows us to estimate more accurately the survival, allowing prioritizing and managing more appropriately the existing resources.
The second most common cluster in our study, NPM (44%), has also been found in several other studies, in which its presence was either partially or totally repre- sented [11, 12, 24, 32–34]. Among four of these studies, which were conducted in patients with advancedcancer, one of them identified a cluster with 4 of the NPM symptoms that were identified in our current study; another identified 2 of our study’s NPM symptom clus- ter; the other two studies grouped the symptoms of depression and anxiety with sleep problems to comprise a distinct symptom cluster in their studies [11, 12]. The combination anorexia- tiredness is also described as an anorexia- cachexia cluster in other studies [11, 12]. This anorexia- tiredness syndromal combination may be associ- ated with among other factors, cytokine release, such as C- RP, interleukin- 6, and tumor necrosis factor- alpha [34, 35]. Meanwhile, given previously published data, the asso- ciation of anorexia- cachexia with anxiety and depression was not a surprise. In a large prevalence study of advancedcancerpatients with different cancers, the factors poor PS, anorexia, and anxiety were independent predictors of depression, fatigue, and pain in multivariate analysis . However, the exact mechanism for this association is unknown and whether the psychological component is a cause or consequence of physical deterioration is not completely known.
DS might be required as part of the management of bulky upper abdominal disease in order to achieve complete re- section, the goal of ovarian surgery. Few articles are specif- ically devoted to this procedure in this context ( Table 5 ). This is a retrospective study, but it concerns a continuous analysis in which none of the patients requiring DS for ovarian malignancies were excluded. In addition, this series included a large number of patients undergoing DS (the second largest series published to date) and treated during a short study period (4 years) with the same team of sur- geons. The largest series previously published involved 69 patients treated during a study period of 9 years. 12
Increased NF-κB signaling in cancer cells is known to block apoptosis . NF-κB pathway inhibition has been shown to sensitize cells to the pro-apoptotic effect of TNFα . We specu- late that the high potency of SAHA in synergy assay is a result of the pro-apoptotic activity of histone deacetylase inhibitors . The lack of apoptosis induction by docetaxel and the poor performance of this agent in this synergy study provide further evidence supporting this hypothesis. However, a detailed experimental investigation of the role of apoptosis in the drug/ NF-κB pathway inhibition synergy is beyond the scope of this focused project. The SAHA effect potentiation by NF-κB pathway inhibition may be of clinical interest. However, the enthusiasm is diminished by the fact that this effect was observed in only one out of three in vitro thyroid cancer models (and the mechanisms responsible for this selectivity are unclear). In addition, SAHA monotherapy was not effective in a phase II trial of patients with metastatic radioiodine-refractory thyroid carcinoma .
All samples used in this study were obtained from a tissue bank at Department of Thoracic Medical Oncology, Peking University Cancer Hospital, which was established in June 1999 and have possessed around 1900 patients with tissues samples which had been genotyped for EGFR mutation status using routine methods (DHPLC). We selected patients from tissue bank in accordance with the following criteria: 1) histologically confirmed stage IIIa-IV NSCLC (pathology report); 2) had received palliative operational resection; 3) could provide sufficient primary tissue samples for microdissection and molecular analysis. The exclusive criteria included: 1) had tissues but was metastatic site samples; 2) the tumor cell content was too low to analysis. The palliative operational resections were defined as the operation performed in the patients with advanced NSCLC who had small intra- pulmonary nodules, solitary metastasis in single organ or pre- operative unidentified metastatic disease.
INTRODUCTION: Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. Objective: To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. Material and methods: 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. Results: Of the 183 patients, only 47 (25.7%) were able to answer the ques- tionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. Con- clusion: There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).
In a previous study we demonstrated that the incidence of fibroblast colony-forming units (CFU-F) was very low in bone marrow primary cultures from the majority of untreated advanced non-small lung cancerpatients (LCP) compared to normal controls (NC). For this reason, we studied the ability of bone marrow stromal cells to achieve confluence in primary cultures and their proliferative capacity follow- ing four continuous subcultures in consecutive untreated LCP and NC. We also evaluated the production of interleukin-1ß (IL-1ß) and prostaglandin E2 (PGE2) by pure fibroblasts. Bone marrow was obtained from 20 LCP and 20 NC. A CFU-F assay was used to investigate the proliferative and confluence capacity. Levels of IL-1ß and PGE2 in conditioned medium (CM) of pure fibroblast cultures were measured with an ELISA kit and RIA kit, respectively. Only fibroblasts from 6/13 (46%) LCP confluent primary cultures had the capacity to proliferate following four subcultures (NC = 100%). Levels of spontaneously released IL-1ß were below 10 pg/ml in the CM of LCP, while NC had a mean value of 1,217 ± 74 pg/ml. In contrast, levels of PGE2 in these CM of LCP were higher (77.5 ± 23.6 pg/ml) compared to NC (18.5 ± 0.9 pg/ml). In conclusion, bone marrow fibroblasts from LCP presented a defective proliferative and confluence capacity, and this deficiency may be associated with the alteration of IL-1ß and PGE2 production.
OS was five percentage points higher for colon cancerpatients (65.6%) than for rectal cancerpatients (60.6%), consistent with prior studies reporting a poorer prognosis for rectal cancer than colon cancer (6,12-13,20) . In addition, our findings suggest that this lower of survival may be associated with the percentage of patients who began treatment more than 60 days after diagnosis (21.5% for colon cancer versus 40.9% for rectal cancer). As the treatment of rectal cancer is more complex than colon cancer, involving more exams for staging as well as the need of multimodality treatment, maybe these patients are more susceptible for delaying the start of treatment.
Confirming the findings of a previous study (23) , our results showed that baseline BF and MTT are different between responders and nonresponders, being respectively significantly higher and significantly lower in poorly respond- ing patients. This can be theoretically explained by the pres- ence of intratumoral arteriovenous shunts with a high perfusion rate and low exchange of oxygen (30) . Such arterio- venous shunts were shown to account for up to 30% of total tumor flow of blood (31–33) and in an animal study it was demonstrated that tumoral areas of high BF in perfusion CT images corresponded to sites of shunting of blood flow (20) . These shunts have low resistance to flow, resulting in increased BF and shorter MTT. BV, although not significantly different, is also higher in poor responders. It seems therefore logical that high perfusion values, which suggest a high rate of angio- genesis within the tumor, may point toward a poor therapy response and/or a worse prognosis. High perfusion could also be a result of intrinsic high angiogenic activity of tumor
The first description of the technique for implanting a gastrostomy tube through alternative paths other than the oral cavity dates from 1967 and was performed by Jascalevich 16 in dogs. In 1979 Sacks et al. 26 did the same procedure in a patient and in 1981 Preshaw reported on a series of 11 patients. These three authors did the gas- trostomy percutaneously using radioscopy. Since then, in specially trained centers and with experts in interventional radioscopy some authors have performed this procedure in patients with tumors of the head and neck 2,6 . These authors advocate the advantage of the reduced risk of tumoral implantation in the surgical wound, as well as the reduced risk of postoperative infection, thus making antibiotic prophylaxis unnecessary.
Conclusion: the prevalence of psychological morbidity was slightly higher in males and older age group, and also high psychological morbidity was seen in recently diagnosed cancerpatients. A good counseling, stress relaxation and life style modification program is required to make such patients live their life in a positive and better way.
and quality of life benefits, but overall 2- year survival rates for this group remain <15% . Newer chemotherapy combinations showed a response rate of 19- 32% and a me- dian survival time of 7,9 to 11,3 months . The differ- ence in outcome among patients with the same clinical stage of the disease suggests that advanced NSCLC is a hetero- geneous disease. Additionally, some patients experience weight loss and some have a significant number of co- morbidities. This wide spectrum of clinical features of pa- tients with advanced NSCLC probably contributes to dis- parities in outcomes seen in different chemotherapy regi- mens and the survival depends of some patients and tumor characteristics . These patients’s heterogeneity leading to the need for the identification of prognostic factors for survival. The analysis of these factors may define a sub- group of NSCLC patients with similar survival potential. They will be helpful advising individuals, choosing treat- ment, understanding the disease and optimizing the results of chemotherapy. Prognostic factors are a variables, as- sessed before any treatment, correlated to an evaluation cri- terion (i.e. survival), that are useful in estimating the pa- tient’s future, independently of the treatment that will be applied .
The frequent complaints of patients experiencing cognitive impairment during or after cancer treatment called the researchers and health professionals’ attention to understand the possible relation between perception of cognitive deficits and objective cognitive measures (161, 162); however, most of studies did not show an association between them (88, 104, 105, 158, 163, 164). A review of 2010 reported that 21% to 90% of the patients reported subjective cognitive impairment and suggests that subjective cognitive dysfunction may be more indicative of emotional distress instead of objective cognitive decline (165). Other recent review evaluated 24 articles showing that only eight of these studies, mainly with breast cancerpatients, found a significant relationship between objective and subjective measures of cognitive performance, with memory as the more important cognitive domain involved. Thus, perceived impairment may be an indicator of psychological distress rather than cognitive impairment (166). This lack of consistent findings regarding the association between subjective complaints and objective cognitive tests could be explained by variations in assessment methods or the definition of impairment. Despite these discrepancies, patients' perceptions of impairment are important due to its significant impact on daily life functionality. This divergence between mostly subtle neuropsychological deficits and often dramatic subjective cognitive complaints as well as the lack of association between both in the majority of studies present one more unsolved puzzle in this field of research.
However, our study tends to indicate that hsa-miR-21, hsa-miR-23a and hsa-miR-23b are present in the saliva of patients with pancreatitis, while hsa-miR-210 is detected in the saliva of a fraction of patients with PDAC. In addition, hsa-miR-23a and hsa-miR-23b are present in the saliva of patients with IPMN. This could be easily explained as pancreatitis and IPMN are two-well characterized PDAC precursor lesions, indicating that PDAC positive for hsa-miR- 210, or hsa-miR-23a and hsa-miR-23b, may have derived from pancreatitis or IPMN, respec- tively. On the contrary, patients diagnosed with pancreatitis and elevated salivary hsa-miR-21, hsa-miR-23a and hsa-miR-23b, or patients diagnosed with IPMN and elevated salivary hsa- miR-23a and hsa-miR-23b may be at-risk of developing PDAC and may require careful clinical follow-up. We are aware that the present study suffers from small sample sizing and requires an external validation population. Consequently, we have recently constituted the first clini- cally annotated cohort of pancreatic cancerpatients’ samples from different institutes (the BACAP initiative, http://www.chu-toulouse.fr/-projet-bacap-). Such cohort will be immensely informative for further validation and future clinical application of our method, because it represents a unique source of PDAC samples, but also because it’s recapitulate the “natural his- tory” of this disease. Such cohort may help to establish salivary miRNAs, together with addi- tional clinical variables, as novel biomarkers for pancreatic cancerpatients’ management. In addition, we have yet to perform comparative studies between different cancerpatients to jus- tify that the biomarkers we identified herein are specific for pancreatic cancer.
A diagnosis of cancer no longer places an individual into a collectively understood stigmatized category. Rather, the potential stigmatization of cancer depends largely on whether a patient’s identity is threatened by the diagnosis. Stigma-induced identity threat can be understood as the extent to which one’s membership in a potentially stigma- tized group is internalized to affect one’s sense of self. A modern understanding of cancer as a stigma should focus on the “targets’ understanding of how others view them, their interpretations of social contexts, and their motives and goals” (Major and O’Brien, 2005: 397). In other words, while past research focused on the disease itself as a stigma that affected all individuals the same way, it is now much more appropriate to examine factors surrounding cancer, such as type, visibility, and the likelihood that the disease will interfere with each individual’s ability to achieve per- sonal goals or function in social contexts. For many, but not all, cancerpatients, stigma is a central force in perceptions of the self (Fife and Wright, 2000) and is often based on distinguishing characteristics that vary by the type of cancer.
From a philosophical point of view, many face suicide in an oncolog- ical setting, especially in advanced phases of disease, as rational (Karlsson, Milberg, & Strang, 2011; Rietjens, van Tol, Schermer, & van der Heide, 2009). Such a desire would prevail as a legitimate form of escape from a painful and relentless disease, through a somehow merciful death. However, from a psychiatric perspective, the desire for death in cancerpatients is the key construct of a set of phenomena that includes suicidal ideation—active or passive, a desire for assisted suicide or euthanasia, suicide attempts, and con- summated suicide (Brown, Henteleff, Barakat, & Rowe, 1986). All of them are common in the oncologic setting, where suicidal ideas frequently work as an escape valve, a way of ventilating hard-to-integrate emotions, like the patient who says to the attending physician, “If things get too bad, I’ll al- ways have an exit” (Breitbart, 1990), somehow maintaining some grip on a potentially painful and uncontrollable situation. Those are usually transient thoughts verbalized in the context of a trust-based relationship that become persistent only in a depressive state.
The meaning attributed to cancer, when passing the patient-family boundary is, in some degree, also shared between health professionals, which can have effect on the professionals’ performance and influence the opinions of users about health services. The focus of this work is the analysis of social representations about patients with cancer, in a population of nurse students, professional nurses working with cancerpatients, and professional nurses not working with cancerpatients, of both sexes. Our main goal is to know their conceptions towards oncologic patients. The methodological option was the social representations theory. The data was retrieved by questionnaire using the free word association technique. Several Factorial Correspondence Analysis where made to identify the different dimensions (or dependent variables). In general, all professional groups represent oncologic patients by their physical alterations. Nurse students decipher cancer in a distant perspective, as the unknown and something that causes discomfort and eventually… death. In fact, patients with cancer are strongly associated to situations of pain, involving suffering, and death. Women show a more positive perception of cancer, supported in treatment and hoping for a healing possibility. Men demonstrate a greater difficulty in dissociating the patients with cancer of people who soon will die. There is still a long way to walk before cancerpatients are no longer associated to a death sign.
intravenously, every 3 weeks). The results showed that in the intention-to-treat population, the median OS was longer in the atezolizumab group compared with the docetaxel group (12.6 versus 9.7 months; HR 0.73, 95% CI 0.53–0.99; P=0.040). In addition, patients with the highest PD-L1 expression on their TCs or ICs showed the largest improve- ment. Unexpected AEs did not occur in either study. The results from both studies indicate that the selection of patients according to PD-L1 expression could enable the identifica- tion of those who are likely to benefit from atezolizumab treatment. 47 Currently, the aim of several ongoing trials is
Abstract: Cancer is generally perceived as a life-threatening disease, so patients often develop spiritual needs after diagnosis. Spirituality affects the quality of life of the patient and provides the context in which hope and meaning can be obtained to deal with the disease. Objectives: To present an overview of the impacts of spirituality and religiosity (S/R) on the health of the cancer patient in facing the disease. Methodology: It is a qualitative study, which used the technique of narrative revision as a methodological contribution. For the data collection, the keywords "spirituality", "RELIGIOSITY", "coping" and "cancer" were used in indexed databases such as LILACS, SciELO, BVS and MEDLINE. 41 articles were selected, considering the scientific relevance, originality, hypotheses confirmation and adequacy to the theme of this review. Results: Spirituality and religiosity were associated with better coping with the difficulties related to cancer with less severity of symptoms. In addition, they are used as support to help overcome pain and suffering, it also contributes to psychic balance, reducing the desire for accelerated death. Despite this, spiritual care remains small in the medical context, although patients, especially at the end of life, would like their spiritual needs to be addressed as part of overall care. Conclusion: The care of cancerpatients goes beyond caring for the person's body. The S/R needs can be considered in the interventions and adapted to the needs of the patient.