Palliative and oncologic co-management: symptom management for outpatients with cancer

Purpose

Although outpatient palliative care clinics are increasingly common, evidence for their efficacy remains limited.

Methods

We conducted an observational study at the palliative care clinic of an academic cancer center to assess the association between palliative care co-management and symptoms and quality of life. Two hundred sixty-six adult outpatients were seen for a minimum of two palliative care visits within 120 days. A subset of 142 patients was seen for a third visit within 240 days. Patients completed a questionnaire containing validated symptom, quality of life, and spiritual wellbeing questions at each visit.

Results

The first follow-up visit was on average 41 days after the initial visit; the second follow-up visit was on average 81 days after the initial visit. Between the initial and first follow-up visits, there was significant improvement in pain (p?<?0.001), fatigue (p?<?0.001), depression (p?<?0.001), anxiety (p?<?0.001), quality of life (p?=?0.002), and spiritual wellbeing (p?<?0.001), but not nausea (p?=?0.14). For the subset of patients seen for a second follow-up visit, the improvements in pain, fatigue, depression, anxiety, quality of life, and spiritual wellbeing persisted (p?≤?0.005 for trend of each symptom). Patients had similar improvement regardless of their gender, age, ethnicity, disease stage, disease progression, and concurrent oncologic treatments.

Conclusions

Palliative care was associated with significant improvement in nearly all the symptoms evaluated. A sustained change in symptoms was observed in the subset of patients seen for a second follow-up visit. Members of all subgroups improved.     

Demoralization syndrome among cancer outpatients in Taiwan

Goals

This paper aims to explore characteristics of demoralization syndrome as well as the relationship between demoralization syndrome and psychosocial issues as seen through examinations of cancer outpatients in Taiwan.

Materials and methods

Outpatients with different cancer types were enrolled in this study. The Demoralization Scale Mandarin Version (DS-MV), Patient Health Questionnaire, Beck Hopelessness Scale, and McGill Quality of Life Questionnaire—Taiwan Version were used as instruments. All data were analyzed using SPSS 18.0.

Results

Among the 234 patients studied (97 men and 223 women), the majority had cervical cancer (29.1%), followed by breast cancer (26.5%) and head and neck cancer (24.3%). The mean score of DS-MV was 31.05 (SD 14.87). The results of ANOVA analysis showed a significant effect of occupation F(4.209)?=?7.145 (p?F(7.206)?=?3.795 (p?F(8.206)?=?3.553 (p?Conclusions Demoralization syndrome was found to be related to psychosocial issues, different cancer types, and treatments. Further studies are recommended to better understand causes and impacts of demoralization in the quality of life and care of cancer patients.     

Clinical correlates of endothelial function in chronic heart failure

Objective

There is a close link between heart failure and endothelial dysfunction. Brachial flow-mediated dilation (FMD) is a validated non-invasive measure of endothelial function. The aim of this study was to investigate the clinical correlates of FMD in patients with chronic heart failure (CHF).

Design, setting, patients

We evaluated 60 CHF outpatients (age 62?±?14?years; 49 males, NYHA class 2.2?±?0.7, left ventricular ejection fraction, LVEF, 33?±?8%) taking conventional medical therapy (ACE-inhibitors and/or ARBs 93%, beta-blockers 95%) and in stable clinical conditions.

Main outcome measures

The maximum recovery value of FMD was calculated as the ratio of the change in diameter (maximum-baseline) over the baseline value.

Results

As compared with patients with a higher FMD, those with FMD below the median value (4.3%) were more frequently affected by ischemic cardiopathy (50 vs. 23%; p?=?0.032) and diabetes mellitus (20 vs. 3%; p?=?0.044), had a higher NYHA class (2.5?±?0.5 vs. 1.9?±?0.7; p?<?0.001) and NT-proBNP (2,690?±?3,690 vs. 822?±?1,060; p?=?0.001), lower glomerular filtration rate estimated by Cockcroft-Gault (GFRCG: 63?±?28 vs. 78?±?25; p?=?0.001) and LVEF (29?±?8 vs. 37?±?9; p?=?0.001), as well as more frequently showing a restrictive pattern (40 vs. 7%; p?=?0.002). In a multivariate regression model (R ²?=?0.48; p?<?0.001), FMD remained associated only with the NYHA class (p?=?0.039) and diabetes mellitus (p?=?0.024).

Conclusions

This study demonstrates that a better functional status and absence of diabetes mellitus are associated to higher FMD regardless of the etiology of the cardiac disease.     

Impact of hypoxic hepatitis on mortality in the intensive care unit

Purpose

Hypoxic hepatitis (HH) is a form of hepatic injury following arterial hypoxemia, ischemia, and passive congestion of the liver. We investigated the incidence and the prognostic implications of HH in the medical intensive care unit (ICU).

Methods

A total of 1,066 consecutive ICU admissions at three medical ICUs of a university hospital were included in this prospective cohort study. All patients were screened prospectively for the presence of HH according to established criteria. Independent risk factors of mortality in this cohort of critically ill patients were identified by a multivariate Poisson regression model.

Results

A total of 118 admissions (11%) had HH during their ICU stay. These patients had different baseline characteristics, longer median ICU stay (8 vs. 6?days, p?p?p?p?p?=?0.359).

Conclusions

Hypoxic hepatitis (HH) occurs frequently in the medical ICU. The presence of HH is a strong risk factor for mortality in the ICU in patients requiring vasopressor therapy.     

Tracheal suction by closed system without daily change versus open system

Background

Tracheal suctioning costs are higher with a closed tracheal suction system (CTSS) than with an open system (OTSS), due to the need for complete daily change as recommended by the manufacturer. However, is it necessary to change the closed system daily?

Objective

To evaluate the tracheal suctioning costs and incidence of ventilator-associated pneumonia (VAP) using closed system without daily change vs OTSS.

Design

Prospective and randomised study.

Setting

An Intensive Care Unit in a university hospital.

Patients

Patients requiring mechanical ventilation.

Interventions

Patients were randomly assigned to CTSS without daily change or OTSS. We used a CTSS that allowed partial or complete change.

Measurements and results

There were no significant differences between both groups of patients (236 with CTSS and 221 with OTSS) in gender, age, diagnosis, APACHE-II score, mortality, number of aspirations per day, percentage of patients who developed VAP (13.9 vs 14.1%) or the number of ventilator-associated pneumonia per 1000 days of mechanical ventilation (14.1 vs 14.6). There were not significant differences in tracheal suctioning costs per patient/day between CTSS vs OTSS (2.3?±?3.7 vs 2.4?±?0.5 Euros; p?=?0.96); however, when length of mechanical ventilation was lower than 4?days, the cost was higher with CTSS than with OTSS (7.2?±?4.7 vs 1.9?±?0.6?Euros; p?p?Conclusion CTSS without daily change is the optimal option for patients needing tracheal suction longer than 4?days.     

Syncope: experience at a tertiary care hospital in Karachi, Pakistan

Introduction

Our aim was to determine the characteristics of patients presenting with syncope at a tertiary care hospital in Karachi, Pakistan.

Methods

A review of medical records was conducted retrospectively at the Department of Medicine, Aga Khan University Hospital, Karachi. Patients aged 16 and above, admitted from January 2000 to December 2005 with the diagnosis of syncope made by the attending physician were included.

Results

A total of 269 patients were included (75% males, mean age: 57.4 years). Neurogenic (vasovagal) syncope was the most common cause (47%), followed by cardiogenic syncope (18%) and orthostatic syncope (9%). A total of 24% were discharged undiagnosed. Twenty patients (7.4%) did not have any prodrome. Common prodromal symptoms included dizziness (61%), sweating (25%), palpitations (19%), nausea/vomiting (19%) and visual symptoms (17%). The distribution of symptoms according to cause of syncope revealed only breathlessness to be significantly associated with cardiogenic syncope (p?=?0.002). Most patients with cardiogenic syncope were aged above 40 (98%, p?p?p?Conclusion Despite differences in burden of diseases, our findings were similar to those of published syncope literature. Further studies are needed to develop a protocol to expedite the evaluation and limit the work-up and admission in low-risk patients.     

Surface and intracardiac ECG for discriminating conduction disorders after CoreValve implantation

Background

Transcatheter aortic valve implantation (TAVI) has been developed to minimize operative morbidity and mortality in high-risk symptomatic patients unfit for open surgery. With the proximity of the aortic valve annulus to the conduction system there is, however, an unknown risk of conduction disturbances necessitating monitoring and often cardiac pacing.

Materials and methods

We enrolled 50 consecutive patients from January 2007 to 2008 in our prospective evaluation of conduction disturbances measured by surface and intracardiac ECG recordings. Baseline parameters, procedural characteristics as well as twelve-lead surface ECG and intracardiac conduction times were revealed pre-interventionally, after TAVI and at 7-day follow-up.

Results

TAVI was performed successfully in all patients. During 7?days of follow-up the rate for first-degree AV block raised from 14% at baseline to 44% at day 7 (p?p?p?p?p?p?Conclusion Cardiac conduction disturbances were common in the early experience with CoreValve implantation necessitating close surveillance for at least 1?week.     

Right ventricular function in grown-up patients after correction of congenital right heart disease

Aims

We investigated whether a correlation exists between biomarkers of the neurohumoral system and clinical markers in grown-up patients with congenital heart disease (GUCH) and right ventricular function.

Methods and results

Prospective, cross-sectional, multicenter study of 104 GUCH patients (median) 16?years (range 6?C43?years) after corrective surgery with RV pressure and/or volume overload and 54 healthy controls. Clinical, functional, and laboratory parameters were assessed. Natriuretic peptide levels were significantly increased in GUCH patients (NTproBNP 101 vs. 25?pg/ml, p?<?0.001), but we observed no differences in norepinephrine, aldosterone, angiotensin II and Endothelin-1 levels. NTproBNP correlated significantly with clinical markers such as NYHA classification, prolonged QRS duration and reduced exercise capacity (VO₂ peak) (all p?<?0.001), as well as self-reported quality of life (p?<?0.001). MRI and echocardiography derived RV volumes were elevated and ejection fraction reduced in the patients (both p?<?0.001). Tissue Doppler parameter showed significantly restricted ventricular longitudinal systolic function (longitudinal tricuspid valve movement, 1.7 vs. 2.3?cm, p?<?0.001), suggesting stiffness and reduced RV compliance.

Conclusion

In conclusion, grown-up patients with congenital right heart disease NTproBNP correlates well with various clinical markers of RV failure, such as prolongation of QRS duration, exercise capacity, echocardiography and MRI parameters, and quality of life.     

Vasostatin-I, a chromogranin A-derived peptide, in non-selected critically ill patients: distribution, kinetics, and prognostic significance

Purpose

Chromogranin A (CGA) is released in the plasma during life-threatening illnesses. Its N-terminal 1–76 peptide, vasostatin-I (VS-I), has never been assessed in critically ill patients. Our aim was to examine whether the admission VS-I concentration has prognostic significance without having to specify a primary diagnosis.

Methods

VS-I concentrations were assessed with a new ELISA in 481 consecutive patients and 13 healthy controls. CGA and standard biological tests (including lactate) were performed; the simplified acute physiological score II (SAPS II) was calculated. Mortality was assessed at day 28. In a subgroup of 13 patients with shock, serial VS-I doses were given over 60?h.

Results

Critically ill patients had higher admission VS-I concentrations than controls [4.06 (2.78; 7.61) vs. 2.85 (2.47; 3.22)?ng/ml, p?p?p?p?p?Conclusions Significant amounts of VS-I are detected on admission in critically ill patients. A plasma VS-I concentration above 3.97?ng/ml is associated with poor outcome, and in routine practice simultaneous measurements of the three independent factors VS-I, lactate and age can affect the assessment of severity.     

Predictors of anxiety and depression in people with colorectal cancer

Background

People living with colorectal cancer are at risk of anxiety and depression. We investigated what factors were most highly associated with these.

Methods

Four hundred and ninety-six people with colorectal cancer completed the Hospital Anxiety and Depression Scale (HADS). Data on functioning, symptoms, illness perceptions and social difficulties were collected by questionnaire. Case-note-identified disease, treatment and co-morbidity data were recorded. Multiple logistic regression identified factors independently predictive of anxiety and depression caseness.

Results

Self-reported history of anxiety/depression predicted anxiety but not depression caseness. Depression caseness predicted anxiety caseness (p?=?0.043), as did poorer self-reported cognitive functioning (p?=?0.001), dyspnoea (p?=?0.015) or diarrhoea (p?=?0.021), reporting a high negative life and emotional impact (p?<?0.001) and having difficulties with finance (p?=?0.007). Having neo-adjuvant radiotherapy increased the odds of depression caseness (p?=?0.007), as did poorer physical (p?=?0.007), cognitive (p?<?0.001) and social (p?<?0.001) functioning, having constipation (p?=?0.011), reporting a high negative life and emotional impact (p?<?0.001), having difficulties with personal care (p?=?0.022) and communicating with others (p?=?0.014).

Conclusion

Levels of anxiety caseness were similar to those of non-clinical samples, but depression caseness was higher, particularly in those who had received neo-adjuvant radiotherapy. Most factors associated with possible or probable depression may be modified with appropriate intervention.     

The early discontinuation of palliative chemotherapy in older patients with cancer

Purpose

Older patients with cancer may have an increased risk of early discontinuation of active treatment (ED), which results in poor outcome in curative or adjuvant settings. We aimed to determine the association between survival and ED and to identify predictors of ED in palliative setting.

Methods

Ninety-eight patients older than 65 years of age who received a comprehensive geriatric assessment (CGA) before palliative first-line chemotherapy were analyzed. Clinical information and CGA results were retrieved from electronic medical record. CGA included Charlson’s co-morbidity index, activities of daily living (ADL), instrumental ADL (IADL), Mini-Mental Status Examination, short-form of the geriatric depression scale, timed-get-up-and-go test (TGUG), and mini-nutritional assessment (MNA). ED was defined as no active cancer treatment (radiotherapy and/or chemotherapy) beyond palliative first-line chemotherapy. Predictors of ED were identified using clinical parameters and CGA.

Results

Active treatment was discontinued after first-line chemotherapy in 30 patients during median follow-up period of 15.1 months. ED after first-line chemotherapy was associated with shorter overall survival (OS; median OS?=?3.1 vs. 14.7 months in patients with ED compared with patients without ED, p?<?0.001). Eastern Cooperative Oncology Group performance status, living alone, ADL, IADL, MNA, and TGUG were associated with ED (p?=?0.001, p?=?0.048, p?=?0.001, p?<?0.001, p?<?0.001, p?=?0.002, respectively). In multivariable analysis, malnutrition and dependent IADL were the independent predictive factors for ED (odds ratio?=?5.03; 95 % confidence interval?=?1.50–16.87: odds ratio?=?3.06; confidence interval?=?1.03–9.12, respectively).

Conclusions

ED was associated with shorter OS in older patients with cancer. Malnutrition and dependent IADL were identified as independent predictive factors for ED.     

A pilot study to examine patient awareness and provider discussion of the impact of cancer treatment on fertility in a registry-based sample of African American women with breast cancer

Purpose

Fertility is a concern for many cancer patients diagnosed during their reproductive years. Although African American women are more likely to be diagnosed with early breast cancer (i.e., ≤age 40), little is known about patient awareness of or provider discussion related to fertility in this group. We examined African American women's awareness of the possible impact of cancer treatment on fertility.

Methods

In a cross-sectional survey of African American women with early-onset breast cancer, demographic and clinical variables were compared with patient awareness and physician discussion of potential fertility loss.

Results

For women in our sample (N?=?48), 45.8% reported being aware of the potential impact of cancer treatment on fertility, and 56.3% reported that their providers discussed fertility with them. Bivariate analyses demonstrated that awareness was significantly higher in women diagnosed at age ≤45 (p?p?p?p?p?Conclusion Study results suggest potential health disparities in reproductive health among early-onset breast cancer patients and demonstrate missed clinical opportunities to provide information about fertility that may impact long-term quality of life in early-onset African American breast cancer patients.     

Evaluation of the Semmes–Weinstein filaments and a questionnaire to assess chemotherapy-induced peripheral neuropathy

Objective

This study aims to assess the use of Semmes–Weinstein monofilaments (SWMs) and of the Chemotherapy-Induced Neurotoxicity Questionnaire (CINQ) in the detection of chemotherapy-induced peripheral neuropathy (CIPN).

Method

It is a comparative and cross-sectional study performed in a philanthropic general hospital, located in the state of Minas Gerais, Brazil. One hundred seventeen individuals have participated in this study; they were divided into two groups: patients (n?=?87) treated with oxaliplatin, paclitaxel, or docetaxel and controls (n?=?30) without malignant disease.

Results

There were statistically significant differences between groups for all symptoms assessed by means of the CINQ. Lower limbs were more severely affected. Patients had increased frequency and severity of changes in all points assessed with SWM compared with controls. In the analyses of concordance between CINQ and SWM, kappa?=?0.320 (p?ρ?=?0.357; p?Conclusion CINQ and SWM may be valid tools for diagnosing CIPN in oncology practice. SWM may identify subclinical CIPN.     

Pilot randomised controlled trial of a radiation therapist-led educational intervention for breast cancer patients prior to commencing radiotherapy

Purpose

Although patients receive information prior to commencing radiotherapy, they often experience anxiety and distress. We conducted a pilot randomised controlled trial to determine whether a radiation therapist led psycho-educational intervention for breast cancer patients prior to radiotherapy is likely to be effective in reducing radiotherapy-related concerns, patient anxiety and depression.

Methods

The intervention comprised two face-to-face consultations with a radiation therapist (one prior to radiation planning and the other prior to treatment). Patients completed surveys at baseline, prior to treatment planning and on the first day of treatment. Outcome measures included the Hospital Anxiety and Depression Scale, Radiation Therapy Related Patient Concerns and Radiation Therapy Knowledge Scales.

Results

One hundred and twenty two patients completed baseline measures. Fifty-eight patients received usual care, and 64 received the intervention. After the first consultation, patient anxiety was significantly lower in the intervention group (p?=?0.048), as were concerns about radiotherapy (p?=?0.001). There were no differences between groups for depression. Patient knowledge for the intervention group was higher after the first consultation (p?<?0.001).

Conclusion

This intervention is likely to be effective in reducing patient anxiety and concerns and increasing knowledge. Future research is required to test this intervention with a larger population.     

The impact of radiotherapy on quality of life for cancer patients: a longitudinal study

Purpose

The aim of this study was to assess for changes in quality of life (QOL) among cancer patients who undergo radiotherapy (RT) and to identify factors that influence QOL in this group.

Materials and methods

Three hundred sixty-seven cancer patients who received curative RT were investigated using the EORTC QLQ-C30 questionnaire at the start of RT, end of RT, and 1 and 6 months post-RT.

Results

The patients were 49 % women, 51 % men, and median age at diagnosis was 57 years (range, 16–86 years). Compared to pre-RT, at the end of RT, the global health status score (p?<?0.001), nausea/vomiting (p?<?0.001), and apetite loss scores (p?<?0.001) were significantly poorer. Compared to the end of RT, at 1 and 6 months post-RT, global health status, all functional, and all symptom scores were significantly improved (p?<?0.001). Patient sex influenced scores for pain (p?=?0.036), appetite loss (p?=?0.027), and financial difficulty (p?=?0.003). Performance status influenced scores for global health status (p?=?0.006), physical functioning (p?<?0.001), cognitive functioning (p?=?0.001), and role functioning (p?=?0.021). Comorbidity influenced fatigue score (p?<?0.001). Cancer stage influenced scores for physical functioning (p?=?0.001), role functioning (p?=?0.010), and fatigue (p?<?0.001). Treatment modality (chemoRT vs. RT alone) influenced scores for physical functioning (p?=?0.016), fatigue (p?<?0.001), nausea/vomiting (p?=?0.009), and appetite loss (p?<?0.001); and RT field influenced scores for nausea/vomiting (p?=?0.001), appetite loss (p?=?0.003), and diarrhea (p?=?0.037). Radiotherapy dose functioning (p?<?0.001), cognitive functioning (p?<?0.001), social functioning (p?<?0.001), fatigue (p?<?0.001), and pain (<60 vs ≥60 Gy) had an effect on scores for physical functioning (p?<?0.001), role functioning (p?<?0.001), emotional (p?<?0.001), insomnia (p?<?0.001), constipation (p?<?0.001).

Conclusion

While RT negatively affects cancer patients’ QOL, restoration tends to be rapid and patients report significant improvement by 1 month post-RT. Various patient- and disease-specific factors and RT modality affect QOL in this patient group. We advocate measuring cancer patients’ QOL regularly as part of routine patient management.     

Appraising the impact of left ventricular ejection fraction on outcomes of percutaneous drug-eluting stenting for unprotected left main disease: insights from a multicenter registry of 975 patients

Background

Despite the well-known prognostic impact of systolic dysfunction in unselected patients undergoing percutaneous coronary intervention (PCI), limited data are available on its current predictive role after PCI for unprotected left main disease (ULM). We thus appraised the prognostic role of left ventricular ejection fraction (LVEF) in patients undergoing PCI for ULM with drug-eluting stents (DES).

Methods

Consecutive eligible subjects were retrospectively enrolled in a national registry. Patients were divided into three groups: LVEF?<?30%, LVEF 30?C45%, and LVEF?>?45%. Relevant baseline and outcome data were compared with bivariate and multivariable tests.

Results

A total of 975 subjects was included (LVEF?<?30%: 46, LVEF 30?C45%: 208, LVEF?>?45%: 721). Patients with LVEF?<?30% had several other unfavorable clinical features, including older age and higher EuroSCORE. Adverse event rates were different already at 7?days (p?=?0.012 for all-cause death and p?=?0.015 for major adverse cardiac events [MACE]), with even more significant trends up to 30?days and at long-term (p?<?0.001 for death, and p?<?0.001 for MACE). After a median of 18?months, risk of death totaled 39 versus 13 versus 8% (p?<?0.001) and risk of MACE 44 versus 24 versus 22% (p?=?0.003). Multivariable analyses showed however that reduced LVEF was not an independent predictor of adverse events at any time-point.

Conclusions

Whereas reduced LVEF is apparently a significant predictor of adverse events after PCI with DES for ULM, its prognostic impact is mostly due to clustering with other adverse features.     

Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients

Purpose

Oral mucositis (OM) is a side effect of intensive chemotherapy and radiation and has been reported to affect 75–100 % of hematopoietic stem cell transplantation (HSCT) recipients. The purpose of this study was to compare the incidence of OM in patients conditioned with myeloablative conditioning (MAC) to reduced-intensity conditioning (RIC) and to determine the effect of a new oral care protocol.

Methods

The study involved 171 HSCT recipients, with hematological malignancies transplanted between 2007 and 2011. Median age of the patients was 50 years (range 12–71). Ninety-nine (58 %) received RIC and 72 received MAC. Clinical features of OM were recorded from day ?3 before to day +25 after HSCT using the World Health Organization (WHO) scoring system and the oral mucositis assessment score (OMAS).

Results

Overall, 87 % of the patients developed OM of any severity, which peaked on days 10–11. The mean WHO score was 1.7. In multivariate analysis, the severity of OM was associated with MAC (relative hazard (RH) 1.57, 95 % confidence interval (CI) 1.37–1.80, p?<?0.001), all donor-recipient gender combinations except female-to-male (RH?=?1.26, 95 % CI 1.10–1.4, p?=?0.001), and early year of HSCT (RH?=?0.84, 95%CI 0.7–0.96, p?=?0.013). There was a correlation between long hospitalization and OM (day 15, r?=?0.31, p?<?0.001). There was a good correlation between the WHO and OMAS scoring systems for OM (r?=?0.74, p?<?0.001).

Conclusions

Oral mucositis was reduced in patients treated with RIC and in patients treated during recent years, when oral care was intensified. Increased scores of OM prolonged hospitalization.     

Longitudinal heterogeneity of coronary artery distensibility in plaques related to acute coronary syndrome

Background

How coronary distensibility contributes to stable or unstable clinical manifestations remains obscure. We postulated that the heterogeneous plaque distensibility is associated with unstable clinical presentations in patients with acute coronary syndrome (ACS).

Methods and results

Seventeen and 19 ACS-related and -unrelated lesions, respectively, were visualized using intravascular ultrasound imaging with simultaneous intracoronary pressure recording. Systolic and diastolic lumen cross-sectional areas were measured at the lesion site and at five evenly spaced sites between the proximal and distal reference sites. The coronary distensibility index and stiffness index β were calculated for each site and averaged for each coronary segment. Maximal distensibility index, standard deviation and the difference between maximal and minimal distensibility indices within each segment were significantly higher in the ACS-related than -unrelated plaques (5.6?±?2.3 vs. 3.7?±?1.8, p?p?p?p?=?0.022) than that in ACS-unrelated plaques.

Conclusions

Coronary artery distensibility is longitudinally more heterogeneous in ACS-related than-unrelated plaques, especially between the lesion and the immediate proximal site.     

Resilience in patients after allogeneic stem cell transplantation

Purpose

After undergoing allogeneic stem cell transplantation (alloSCT), patients adapt in very different ways to their taxing situation. Some patients cope very well; others almost seem to fail. Psychosocial variables are important factors for successful reintegration. Besides quality of life, resilience may help to understand the variance in individual differences in adaptation after alloSCT.

Methods

A pilot study at the University Hospital Muenster, Germany, assessed resilience in patients after alloSCT. The sample included 75 patients (leukemia, lymphoma, myeloma, aplastic anemia) aged 20–76 years. The instruments Resilience Scale RS-25, Hospital Anxiety and Depression Scale, General Self-efficacy Scale, and EORTC QLQ-C30 were used.

Results

Resilience is positively correlated with quality of life (Spearman’s rho 0.587) and social functioning (0.472), negatively with anxiety (?0.491) and depression (?0.577). Dividing the sample at the median resilience score of 144 reveals that high-resilience patients report less anxiety (p?=?0.008) and depression (p?<?0.001); higher physical (p?=?0.041), emotional (p?=?0.030), and social functioning (p?=?0.003); and a better quality of life (p?<?0.001) than low-resilience patients. No effects on resilience were found for age, gender, and primary disease entity. The high correlation of resilience and self-efficacy (r?=?0.698) shows the strong relationship between the two concepts. Our results indicate a potential influence of the time span from alloSCT on patients’ resilience.

Conclusions

Resilience should be considered as a protective psychosocial factor for patients after alloSCT. A high degree of resilience can help patients to adapt to their situation and to resume their everyday life.