Population-based retrospective study to investigate preexisting and new depression diagnosis among head and neck cancer patients

This study aimed to estimate the pre-cancer prevalence and post-cancer incidence of depression in older adult head and neck cancer patients. Using SEER-Medicare files, cancer was identified from SEER data and depression diagnosis was identified using Medicare claims. Of 3533 head and neck cancer patients, 10.6% were diagnosed with depression during the two years prior to cancer diagnosis, and an additional 8.9% developed depression in the year following cancer diagnosis. This study supports the critical need of screening for depression throughout cancer diagnosis and treatment, as well as a preventative approach in depression development in the older head and neck cancer patient population.     

The psychological impact of the Three Mile Island incident

This study examines the psychological impact of the Three Mile Island incident. The results are based on data from a panel study of 403 persons living within five miles of Three Mile Island (TMI), and a telephone survey of 1,506 people living within 55 miles of that area. Active coping strategies were associated with continued high levels of distress. Having more friends was related to reduced distress, but introspection, taking protective actions, being active in organizations, and seeking out others were all related to higher levels of distress. High self-esteem was related to a decrease in symptoms and psychotropic drug use, and avoidance behaviors were related to higher than expected numbers of symptoms. Efforts to profile those who used different coping strategies were relatively unsuccessful. The results emphasize the need to consider the nature of the stressor when developing models of coping and response to stressful situations.     

Neck emphysema in a HNSCC cancer patient undergoing concurrent radiotherapy and cetuximab

BackgroundLung toxicity in patients undergoing cetuximab and radiotherapy (Cetux-RT) for head and neck squamous cell carcinoma (HNSCC) has been reported in literature and represents a serious side effect of concurrent therapies.MethodsWe report a case of a HNSCC patient that developed neck emphysema during the course of Cetux-RT. The patient was an old male (80 years old) in a good performance status, with an oropharyngeal cancer (T4aN3a).ResultsDuring RT, cone-beam computed tomography (CBCT) showed bilateral neck emphysema that was confirmed at restaging CT. We decided to stop the treatment and to treat the neck emphysema with conservative strategies. After one week CT was repeated and the neck emphysema had improved, so we decided to complete the RT treatment.ConclusionsPatients undergoing Cetux-RT must be properly selected, whereas IGRT imaging must be viewed carefully in order to permit an early diagnosis and careful management of the patients.     

Factors associated with Danish cancer patients' return to work. A report from the population-based study 'The Cancer Patient's World'

Purpose: If patients facing difficulties in the process of returning to work after treatment of cancer could be identified, these patients could be assisted in the transition. This might help some patients to stay in work. We therefore assessed demographic and clinical factors associated with returning to work after a cancer diagnosis. Materials and methods: In this cross-sectional survey, 1490 cancer patients who had been in contact with a hospital department during the past 12 months in three Danish counties responded to a mailed questionnaire. Factors associated with employment and return to work (i.e., working more than 0 h in the past month) respectively, were assessed in multivariate ordinal logistic regression models. Results: Of the 598 patients below age 65 who were employed at the time of diagnosis, 75% were still employed when answering the questionnaire at a median of 2.8 years after diagnosis and 63% were working. In multivariate analyses, younger and more recently diagnosed patients were more often employed. Patients diagnosed with lung or head and neck cancer were least likely to be employed and having returned to work. Advanced cancer at diagnosis was associated with loss of employment. Advanced cancer and being in active treatment were associated with not having returned to work. Conclusion: A quarter of the patients had lost their employment probably resulting in economic consequences on the individual as well as at the societal level. The highest risk was observed for older patients and those diagnosed with lung or head and neck cancer.     

Use of tumor markers in the management of head and neck cancer

Serologic tumor markers have been evaluated in the diagnosis, management and follow-up of patients with head and neck cancer. However, to the authors' knowledge no tumor marker has yet been shown to be useful for monitoring the response to chemotherapy in this type of disease, in particular for undifferentiated tumors. The pretreatment levels of CEA, TPA, SCC and ferritin were evaluated in 98 patients with advanced head and neck cancer. Of this group 64 patients were studied sequentially every month during planned chemotherapy and three weeks after treatment using standard commercial kits. The results showed the following sensitivity values: TPA 50%, CEA 36%, SCC 34% and ferritin 19%. The incidence and magnitude of the marker elevations were correlated with the extent of disease. In patients with squamous cell cancer SCC and CEA were elevated (by 68% and 54%, respectively) in tumors with good differentiation (G1), but only by 13% (both markers) in tumors classified as poorly differentiated (G3). CEA, SCC and ferritin serum levels were not correlated with response to chemotherapy, while TPA values correlated with the clinical response to treatment in 100% of patients with undifferentiated cancer and in 75% of those with squamous cell cancer. Our data indicate that in patients with head and neck cancer TPA appears to be a sensitive marker, followed in decreasing order of sensitivity by CEA, SCC and ferritin. However, SCC and CEA seem to be the most suitable markers for squamous cell cancer and in particular for more differentiated tumors (G1). Finally, TPA has proved to be a useful marker for monitoring the response to chemotherapy in patients with head and neck cancer, in particular for undifferentiated tumors.     

功能与分子影像在头颈部肿瘤放射治疗计划和疗效评价中的应用

目前临床普遍采用功能与分子影像检测手段能来评价头颈部肿瘤的放射治疗计划和疗效,可指导个体化治疗从而提高疗效。文章概述了功能与分子影像技术CT,MRI,PET-CT,超声检测技术在头颈部肿瘤放射治疗计划制定和疗效评价中的应用进展。结果显示,不同分子影像检测方法如在检查时机的选择、诊断和鉴别诊断的价值、观察放射治疗后肿瘤的残存和复发、预测放射治疗效果、指导后续治疗等方面均可起到重要作用。采用图像融合技术进行联合应用,如PET-CT和MRI-CT等,可提高检测的准确率。临床医生需在常规影像学手段的基础上,根据头颈部肿瘤患者病情和治疗方法的不同选用正确的功能和分子影像检测手段,更好地指导制定放射治疗计划及综合评价放射治疗后的疗效。     

Cancer during adolescence: negative and positive consequences reported three and four years after diagnosis

Persons diagnosed with cancer during adolescence have reported negative and positive cancer-related consequences two years after diagnosis. The overall aim was to longitudinally describe negative and positive cancer-related consequences reported by the same persons three and four years after diagnosis. A secondary aim was to explore whether reports of using vs. not using certain coping strategies shortly after diagnosis are related to reporting or not reporting certain consequences four years after diagnosis. Thirty-two participants answered questions about coping strategies shortly after diagnosis and negative and positive consequences three and four years after diagnosis. Answers about consequences were analysed with content analysis, potential relations between coping strategies and consequences were analysed by Fisher's exact test. The great majority reported negative and positive consequences three and four years after diagnosis and the findings indicate stability over time with regard to perceived consequences during the extended phase of survival. Findings reveal a potential relation between seeking information shortly after diagnosis and reporting a more positive view of life four years after diagnosis and not using fighting spirit shortly after diagnosis and not reporting good self-esteem and good relations four years after diagnosis. It is concluded that concomitant negative and positive cancer-related consequences appear stable over time in the extended phase of survival and that dialectical forces of negative and positive as well as distress and growth often go hand-in-hand after a trauma such as cancer during adolescence.     

"It's at a Time in Your Life When You Are Most Vulnerable": A Qualitative Exploration of the Financial Impact of a Cancer Diagnosis and Implications for Financial Protection in Health

Although cancer patients may incur a wide range of cancer-related out-of-pocket costs and experience reduced income, the consequences of this financial burden are poorly understood. We investigated: financial adjustments needed to cope with the cancer-related financial burden; financial distress (defined as a reaction to the state of personal finances); and factors that increase risk of financial difficulties. Two sets of semi-structured face-to-face interviews were conducted with 20 patients with breast, lung and prostate cancer and 21 hospital-based oncology social workers (OSWs) in Ireland, which has a mixed public-private healthcare system. Participants were asked about: strategies to cope with the cancer-related financial burden; the impact of the financial burden on the family budget, other aspects of daily life, and wellbeing. OSWs were also asked about patient groups they thought were more likely to experience financial difficulties. The two interview sets were analysed separately using a thematic approach. Financial adjustments included: using savings; borrowing money; relying on family and friends for direct and indirect financial help; and cutting back on household spending. Financial distress was common. Financial difficulties were more likely for patients who were older or younger, working at diagnosis, lacked social support, had dependent children, had low income or had few savings. These issues often interacted with one another. As has been seen in predominantly publically and predominantly privately-funded healthcare settings, a complex mixed public-private healthcare system does not always provide adequate financial protection post-cancer. Our findings highlight the need for a broader set of metrics to measure the financial impact of cancer (and to assess financial protection in health more generally); these should include: out-of-pocket direct medical and non-medical costs; changes in income; financial adjustments (including financial coping strategies and household consumption patterns); and financial distress. In the interim, cancer patients require financial information and advice intermittently post diagnosis.     

Immunotherapy for head and neck cancer

Head and neck cancer represents a challenging disease. Despite recent treatment advances, which have improved functional outcomes, the long-term survival of head and neck cancer patients has remained unchanged for the past 25 years. One of the goals of adjuvant cancer therapy is to eradicate local regional microscopic and micrometastatic disease with minimal toxicity to surrounding normal cells. In this respect, antigen-specific immunotherapy is an attractive therapeutic approach. With the advances in molecular genetics and fundamental immunology, antigen-specific immunotherapy is being actively explored using DNA, bacterial vector, viral vector, peptide, protein, dendritic cell, and tumor-cell based vaccines. Early phase clinical trials have demonstrated the safety and feasibility of these novel therapies and the emphasis is now shifting towards the development of strategies, which can increase the potency of these vaccines. As the field of immunotherapy matures and as our understanding of the complex interaction between tumor and host develops, we get closer to realizing the potential of immunotherapy as an adjunctive method to control head and neck cancer and improve long-term survival in this patient population.     

Coping with abortion

This study evaluated individual differences in coping style in response to an abortion procedure. The 55 subjects displayed a wide range of responses, although the average level of distress was fairly high. These women were quite similar to other stressed populations in their response to the Impact of Event Scale, providing evidence for a generalized stress response syndrome. When divided into groups based on coping style, "avoiders" were found to experience more distress that "nonavoiders," and "approachers" decreased in distress over time while "nonapproachers" did not. The implications of these findings are discussed in the context of the interaction between coping styles and counseling strategies.     

Neoadjuvant chemotherapy in head and neck cancer

BACKGROUND: Neoadjuvant chemotherapy has an increasing role in multimodality treatment of advanced head and neck cancer. In this paper we summarize our first results with this treatment. METHOD: Thirty-five, previously untreated, mostly inoperable head and neck cancer patients were given two cycles of Cisplatin and 5FU chemotherapy. We continued the therapy only in case of regression until four cycles, then the patients received surgical and/or radiotherapy according to their status. After the treatment patients' status was regularly evaluated. RESULTS: We detected 4 complete and 20 partial responses after the chemotherapy. Three patients became eligible for a radical operation. At this moment 10 patients are free of tumor, 8 patients died in consequence of the tumor, we have no data in 3 cases, 3 patients are given palliative therapy because of progression, 4 patients are receiving radiotherapy and 7 patients with partial response are candidates for further active oncotherapy. CONCLUSIONS: Although the number of the patients we treated is too small for a statistical analysis, our results are similar to the conclusion of the large randomized studies: after neoadjuvant chemotherapy of advanced head and neck cancer partial response can improve the result of surgical or radiological treatment. Neoadjuvant chemotherapy does not improve survival in advanced head and neck cancer, but it is of great importance because of better quality of life of patients, especially those who had organ preserving therapy.     

Squamous cell carcinoma antigen and protein-bound sialic acid in the management of head and neck cancer.

Serum squamous cell carcinoma antigen (SCCAg) and protein-bound sialic acid (PBSA) were measured in 43 head and neck cancer patients and 50 controls. SCCAg and PBSA were correlated with clinical stage, histological grade, presence/absence of keratin and disease course. Patients with advanced cancer (stage III and IV) and grade III tumors had higher PBSA levels but no such difference was observed for SCCAg. Head and neck cancer patients were grouped according to the disease status i.e. a) patients who developed recurrence and b) who responded to the adjuvant therapies. There was an excellent correlation between serial serum PBSA changes and the progression of disease or the response to therapy in patients with advanced head and neck cancer.     

Coping with cancer among holocaust survivors in Israel: an exploratory study

The psychosocial coping potential of Israeli cancer patients who are concentration camp survivors was found to be consistently lower than that of similar cancer patients without camp experience. "The survivor's syndrome" is referred to as explaining the lower coping levels of patients for whom cancer diagnosis reactivates past traumas. The need for early identification and treatment of these highly vulnerable patients is emphasized.     

Autogenic training and signs of distress: an experimental study.

The research investigated the autogenic training (AT) effects, analyzing the emotional and somatic distress symptoms of patients during their learning of the AT standard exercises (N = 79). An improvement was observed even before the beginning of the course, thus demonstrating the Balint effect of the drug-doctor phenomenon. The control subjects, entered in a waiting list, showed no further improvements from this phase of the study; the experimental ones, who had begun their AT exercises, continued to show significant improvement.     

Preoperative Radiation in the Treatment of Cancer

In the treatment of advanced cancer of the hypopharynx, preoperative radiation therapy has proven to be of value for the prevention of recurrences in the operative area following radical neck dissection for cancer of the head and neck. Also it has been of value in the planned combined therapy of certain patients with lung, bladder, breast, esophagus, bone, endometrial and rectal cancers.Preoperative radiation therapy should be advantageous in patients who have malignant disease where the possibility exists for the cancer cells to be disseminated during the surgical procedure.     

Effectiveness of peer-led self-management coaching for patients recently diagnosed with Type 2 diabetes mellitus in primary care: a randomized controlled trial

Diabet. Med. 29, e390-e397 (2012) SUMMARY: Aims To study the effectiveness of a peer-led self-management coaching intervention in recently diagnosed patients with Type 2 diabetes. Methods Randomized controlled trial of recently diagnosed patients with Type 2 diabetes from 54 participating general practices. The intervention group received three home visits by an experienced peer (expert patient) who adhered to the recommended treatment and lifestyle guidelines. Together with their expert patient, participants set feasible goals and these were evaluated in the next visit. Participants in the control group received care as usual. At baseline, 3?months and 6?months post-intervention, participants completed a questionnaire measuring changes in self-efficacy, coping, physical activity, dietary habits, psychological well-being, depressive symptoms and diabetes related distress. Results In total, 327 patients were eligible for inclusion in the study of which 133 consented to participate. In participating patients, self-efficacy, coping and saturated fat intake improved significantly over time. Analyses of participants with low self-efficacy at baseline (25th percentile: 44) revealed a significant time?×?group difference, F?=?3.71; P?=?0.03. Participants who reported low psychological well-being at baseline increased substantially throughout the study (F?=?23.84; P?相似文献   

Carcinoma of the thoracic esophagus; a discussion of early diagnosis and surgical treatment

Dysphagia, substernal or epigastric distress, and regurgitation of food are important early symptoms in the diagnosis of carcinoma of the esophagus. Temporary remission in symptoms does not rule out esophageal cancer. The use of thick barium meal and routine thorough examination of the esophagus in upright and supine positions in all upper gastrointestinal roentgen studies, even though the clinical symptoms point to the upper abdomen, are of great importance. The spread of the cancer to both mediastinal and subdiaphragmatic lymph nodes makes transthoracic thoracolaparotomy the one approach which will permit the surgeon to perform a one-stage esophagogastrostomy, and to adequately evaluate and deal with cancerous tissue on both sides of the diaphragm. This one-stage procedure permits the patient to swallow normally after operation, and the costly and time-consuming uncertainties of the many-staged operations are avoided. The comfort which the operation gives to otherwise doomed patients, along with the improving postoperative mortality rate, offers new hope to those who have cancer of the esophagus.     

Simultaneous Integrated Boost Radiotherapy in Unresectable Stage IV (M0) Head and Neck Squamous Cell Cancer Patients: Daily Clinical Practice

AimTo evaluate clinical outcome in locally-advanced stage IV (M0) head and neck cancer patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in daily clinical practice.BackgroundDespite SIB-IMRT has been reported as a feasible and effective advanced head and neck cancer treatment, there are few data about its concurrent use with systemic therapies.Material and MethodsWe reviewed 41 staged IV (M0) head and neck cancer patients treated in two radiotherapy units in the city of Messina (Italy) during the last six years, using intensity modulated techniques-SIB. 22/41 patients had concomitant chemotherapy or cetuximab. Acute and late toxicities, objective response (OR) rate, local control (LC) and overall survival (OS) have been evaluated.Results37/41 patients received the planned doses of radiotherapy, 2 patients died during the therapy. The major acute regional toxicities were skin reaction and mucositis. A case of mandibular osteoradionecrosis was recorded. At completion of treatment, OR was evaluated in 38 patients: 32/38 patients (84.2%) had complete (55.3%) and partial (28.9%) response. The 1- and 5-year LC rates were 73.4% and 69.73%, respectively. The 1-, 3-, and 5-year OS rates were 85.93%, 51.49% and 44.14%, respectively. No statistically significant differences in outcomes have been observed in patients treated with radiotherapy alone vs. irradiation concomitant to chemo/biotherapy. The median OS was 45 months.ConclusionSIB-IMRT is safeand can be used with concomitant chemotherapy/biotherapy in real-life daily clinical practice. SIB-IMRT alone is a valid alternative in patients unfit for systemic therapies.