Individual differences in well-being in older breast cancer survivors

Older women who survive breast cancer may differ significantly in their long-term well-being. Using a risk and protective factors model, we studied predictors of well-being in 127 women age 70 and above with a history of at least 1 year's survival of breast cancer. Mean post-cancer survivorship was 5.1 years. Using life satisfaction, depression and general health perceptions as outcome variables, we assessed whether demographic variables, cancer-related variables, health status and psychosocial resources predicted variability in well-being using correlational and hierarchical regression analyses. Higher age predicted increased depression but was not associated with life satisfaction or general health perceptions. Cancer-related variables, including duration of survival, and type of cancer treatment, were not significantly associated with survivors' well-being. Poorer health status was associated with poorer well-being in all three dependent variables. After controlling for demographics, cancer-related variables, and health status, higher levels of psychosocial resources including optimism, mastery, spirituality and social support predicted better outcome in all three dependent variables. While many older women survive breast cancer without severe sequelae, there is considerable variability in their well-being after survivorship. Successful intervention with older breast cancer survivors might include greater attention not only to cancer-specific concerns, but also attention to geriatric syndromes and functional impairment, and enhancement of protective psychosocial resources.     

WT1 vaccination in AML and MDS: A pilot trial with synthetic analog peptides

Peptide vaccines are capable of eliciting immune responses targeting tumor‐associated antigens such as the Wilms’ Tumor 1 (WT1) antigen, often overexpressed in myeloid malignancies. Here, we assessed the safety, tolerability, and immunogenicity of a polyvalent WT1 peptide vaccine. Individuals with WT1‐positive acute myeloid leukemia (AML) in first (CR1) or second (CR2) remission or with higher‐risk myelodysplastic syndrome (MDS) following at least 1 prior line of therapy were vaccinated with a mixture of peptides derived from the WT1 protein, with sargramostim injections before vaccination to amplify immunogenicity. Six vaccinations were delivered biweekly, continuing then monthly until patients received 12 vaccinations or showed disease relapse or progression. Therapeutic efficacy was evaluated by progression‐free and overall survival. Immune responses were evaluated by delayed‐type hypersensitivity testing and T‐cell IFNγ ELISPOT at specified intervals. In 16 patients who received at least one vaccination, 10 completed the planned course of six vaccinations and six continued for up to six additional monthly vaccinations. Vaccinations were well tolerated, with no patients discontinuing due to toxicity. One of two patients with high‐risk MDS experienced a prolonged decrease in transfusion dependence. Two of 14 AML patients demonstrated relapse‐free survival >1 year. Both patients were in CR2 at time of vaccination, with duration of their remission exceeding duration of their first remission, suggesting a potential benefit. Our WT1 vaccine was well‐tolerated. The clinical benefit that we observed in several patients suggests engagement of a protective immune response, indicating a need for further trials. Am. J. Hematol. 90:602–607, 2015. © 2015 Wiley Periodicals, Inc.     

Anti-TNF-alpha therapies do not increase early postoperative complications in patients with inflammatory bowel disease. An Italian single-center experience

Purpose  

The impact of preoperative use of TNF-alpha inhibitors on postoperative complications in patients with inflammatory bowel disease (IBD) undergoing abdominal surgery is controversial. The aim of this study was to evaluate the 30-day postoperative outcomes for IBD patients treated with these drugs prior to surgery.     

Anemia of aging: the role of chronic inflammation and cancer

Aging is associated with increased incidence and prevalence of anemia, leading to a number of adverse health outcomes. These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. Because of this concern, correction of anemia in elderly individuals with relative EPO insufficiency should not be attempted outside clinical trials.     

The complexity of cancer survivorship: a case for personalized medicine. Report of the 2014 Grandangolo conference

This article reviews the Grandangolo conference on cancer survivorship and highlights the major findings. These include the improvement in survivorship, and the emergence of survivorship related syndromes, such as new neoplasms, cardiomyopathy, neutorpathy fatigue and memory loss. Emotional disorders may include the Lazarus’ Syndrome and the post-traumatic stress disorder. An open question is whether we should have specialists of survivorship or primary care physicians or oncologists could fulfill this role.     

Efficacy of platelet concentrates in bone healing: A systematic review on animal studies – Part B: Large-size animal models

In the presence of large bone defects, delayed bone union, or nonunion and fractures, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates (APCs). Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to enhance bone healing. However, both preclinical and clinical studies produced contrasting results, mainly due to a high heterogeneity in study design, objectives, techniques adopted, and outcomes assessed. The aim of the present systematic review was to evaluate the efficacy of APCs in animal models of bone regeneration, considering the possible factors that might affect the outcome. An electronic search was performed on MEDLINE and Scopus databases. Comparative animal studies with a minimum follow up of 2 weeks, at least five subjects per group and using APCs for regeneration of bone defects were included. Articles underwent risk of bias assessment and quality evaluation. Fifty studies performed on six animal species (rat, rabbit, dog, sheep, goat, mini-pig) were included. The present part of the review considers studies performed on small ruminants, dogs, and mini-pigs (14 articles). The majority of the studies were considered at low risk of bias. In general, APCs’ adjunct positively affected bone regeneration. Animal species, platelet and growth factors concentration, type of bone defect and of platelet concentrate used seemed to influence their efficacy in bone healing. However, sound conclusions were not drawn since too few studies for each large-size animal model were included. In addition, characterization of APCs’ content was performed only in a few studies. Further studies with a standardized protocol including characterization of the final products will provide useful information for translating the results to clinical application of APCs in bone surgery.