How does patient‐clinician information engagement influence self‐reported cancer‐related problems?

BACKGROUND:

Past research has linked patient‐physician communication with improved emotional, physical, and social health. One component of communication, patient‐clinician information engagement (PCIE), predicts improved short‐term patient‐reported outcomes, such as treatment satisfaction, through perceptions of feeling informed. However, to the authors' knowledge, the relation between PCIE and longer term cancer‐related problems has not been examined previously. The authors examined the influence of PCIE on self‐reported problems associated with cancer diagnosis and treatment based on a longitudinal survey among a randomly selected sample from the 2005 Pennsylvania Cancer Registry.

METHODS:

In total, 1293 respondents were surveyed who were diagnosed with colorectal, breast, or prostate cancers during 2006 and 2007. The baseline response rate was 64%, and the retention rate was 65%. The authors predicted an index of cancer‐related problems at 1‐year follow‐up with the baseline cancer‐related problem index and PCIE, controlling for demographic and clinical factors using regression analyses. The mean age of participants was 65 years, approximately 50% were women, and 86% were white.

RESULTS:

Having more cancer‐related problems and PCIE at baseline significantly predicted more cancer‐related problems at follow‐up. In addition, baseline cancer‐related problems and PCIE interacted significantly (P = .01): PCIE was associated with more cancer‐related problems at follow‐up among participants who reported more symptoms rather than fewer symptoms at baseline.

CONCLUSIONS:

If respondents reported engaging more with their physicians at baseline, then they reported experiencing more cancer‐related issues at follow‐up; this pattern was stronger among those who reported more baseline problems. The current results indicated that increased discussion of cancer information with physicians may maintain the salience of these problems in cancer survivors' minds over time. Cancer 2011. © 2011 American Cancer Society.     

Anti‐tumour/metastasis effects of the potassium‐sparing diuretic amiloride: An orally active anti‐cancer drug waiting for its call‐of‐duty?

Amiloride.HCl is clinically used as an oral potassium-sparing diuretic, but multiple studies in biochemical, cellular and animal models have shown that the drug also possesses anti-tumour and anti-metastasis activities. The additional effects appear to arise through inhibition of two discrete targets: (i) the sodium-hydrogen exchanger 1 (NHE1), a membrane protein responsible for the characteristically low extracellular pH of tumours and (ii) the urokinase-type plasminogen activator (uPA), a serine protease mediator of cell migration, invasion and metastasis and well-known marker of poor prognosis in cancer. This mini-review summarises for the first time the reported anti-tumour/metastasis effects of amiloride in experimental models, discusses the putative molecular mechanisms responsible for these effects and concludes by commenting on the pros and cons of trialling amiloride or one of its structural analogues as potential new anti-tumour/metastasis drugs.     

Systemic therapy for early‐stage HER2‐positive breast cancers: Time for a less‐is‐more approach?

Trastuzumab‐based chemotherapy has dramatically improved outcomes for patients with all stages of human epidermal growth factor receptor 2 (HER2)‐positive breast cancer. Additional HER2‐directed agents that have recently been approved are also expected to improve outcomes. Patients with small, lymph node‐negative, HER2‐positive breast cancers who are treated with trastuzumab‐based chemotherapy demonstrate especially favorable responses, with 5‐year recurrence rates of <5%. In this review, recent data regarding response rates among patients with early‐stage HER2‐positive breast cancer treated with trastuzumab‐based chemotherapy are discussed. This review supports future studies of the possible omission of chemotherapy in a subset of patients with HER2‐positive cancers, specifically those that coexpress hormone receptors. Cancer 2015;121:517–526. © 2014 American Cancer Society.     

Are importance–satisfaction discrepancies with regard to ratings of specific health‐related quality‐of‐life aspects valid indicators of disease‐ and treatment‐related distress among patients with endocrine gastrointestinal tumours?

The aims of this study were to investigate: (1) whether ratings of importance of, satisfaction with, and symptom/function of specific health-related quality-of-life (HRQoL) aspects are related, and (2) whether an importance–satisfaction discrepancy with regard to ratings of a specific HRQoL aspect is a valid indicator of distress. Eighty-three patients with endocrine gastrointestinal tumours completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and answered questions about importance of, satisfaction with, and symptom/function of 12 HRQoL aspects. The patients reported a relatively high HRQoL in terms of physical, emotional and social function. Most of the HRQoL aspects were considered as important for a good quality of life. High satisfaction was related to fewer symptoms and a better function. Patients who assigned a higher importance than satisfaction rating to an aspect reported a lower quality of life for the same aspect. The findings suggest that importance–satisfaction discrepancies are valid indicators of patient distress and illustrate the importance of asking patients not only about frequency and level of symptoms, but also about importance of and satisfaction with when assessing patient quality of life.     

Liver resections in over‐75‐year‐old patients: Surgical hazard or current practice?

OBJECTIVES: To assess the safety of hepatic resections in the very old patient by comparing the outcome in patients younger and older than 75 years. METHODS: Thirty-two resections in 31 patients > or =75 years (Over-75 Group) were compared with 164 resections in 162 patients <75 years (Control Group). Indications for resection, concomitant diseases, previous abdominal surgery, type of resection, associated surgical procedures, use/length of portal clamping, intra-operative blood losses and transfusions, and length of operation were preliminarily compared. The outcome was evaluated in terms of post-operative mortality, morbidity, transfusions, and postoperative hospitalization. RESULTS: Mean age was 76.0 +/- 2.3 years (range 75-83) in the Over-75 Group and 58.4 +/- 10.7 years (range 23-74) in the Control Group. The over-75 group included more hepatomas (43.8% vs. 26.8%, P = 0.09), chronic liver disease (31.3% vs. 28.7%, P = 0.03) and concomitant diseases (62.5% vs. 32.9%, P = 0.002). The two groups were comparable (P = n.s.) when evaluated for all other variables. The 30-day mortality rate was 3.6% in the Control Group and none in the Over-75 Group. Postoperative surgical complications occurred in 37 patients (22.6%) in the Control Group and 1 patient (3.1%) in the Over-75 Group, with statistically significant differences (P = 0.01), and incidence of medical complications was 13.4% in the Control Group and 3.1% in the Over-75 Group. Median postoperative hospitalization and transfusions were not statistically different. CONCLUSIONS: Hepatic resections in over-75-year-old patients are not a surgical hazard and may be carried out relatively safely as long as an accurate selection of the patient is performed.     

Do patients with schizophrenia receive state‐of‐the‐art lung cancer therapy? A brief report

Objective: Patients with schizophrenia sometimes receive substandard medical care. This study explored such disparities among lung cancer patients with underlying schizophrenia. Methods: This retrospective study focused on patients with pre‐existing schizophrenia (or in some instances schizoaffective disorder) and a lung cancer diagnosis made between 1980 and 2004. ‘Disparity’ was defined as a patient's having been prescribed less aggressive therapy for a potentially curable cancer based on state‐of‐the‐art treatment standards for the time and for the cancer stage. Qualitative methods were used to assess healthcare providers' decision‐making. Results: 29 patients were included. The median age was 59 years; 38% were men. Twenty‐three had non‐small cell lung cancer and 6 small cell lung cancer; 17 had potentially curable cancers. Five of 17 had a ‘disparity’ in cancer care: (1) no cancer therapy was prescribed because of chronic obstructive pulmonary disease; (2) no cancer therapy was prescribed because of infection; (3) no chemotherapy was prescribed because the patient declined it; radiation was provided; (4) no chemotherapy was prescribed because of the patient's schizophrenia symptoms; radiation was administered; and (5) no surgery was performed because of disorientation from a lobotomy; radiation was prescribed. Comments from healthcare providers suggest reflection and ethical adjudication in decision‐making. Conclusion: Schizophrenia was never the sole reason for no cancer treatment in patients with potentially curable lung cancer. This study provides the impetus for others to begin to assess the effect of schizophrenia on lung cancer management in other healthcare settings. Copyright © 2007 John Wiley & Sons, Ltd.     

End‐of‐life decision making – have we got it right?

There are wide-spread misconceptions about palliative care. Various treatments used in palliative care have a potential to shorten, and at times even prolong life. However, such treatments are used with a view to enhance quality of life and/or death. Withholding and withdrawal of life-prolonging treatments are not equivalent to assisting death. It is important that patients who are approaching death are sensitively encouraged to make informed choices about such treatments. At the same time, there is no obligation on part of a health professional to provide a futile treatment. This personal view of two palliative care physicians aims to explore some of the difficulties surrounding end-of-life care.     

Is self‐efficacy a predictor of short‐term post‐surgical adjustment among Chinese women with breast cancer?

BACKGROUND: High self-efficacy (SE) is regarded as beneficial for cancer patients in facilitating adaptation and therefore desirable. However, this may not always be the case. DESIGN: A longitudinal cohort study of women receiving breast cancer surgery. Path analysis examined impact of high and low baseline SE scores on outcome. Post hoc analysis stratified outcome expectations by SE. METHODS: 405/529 eligible Chinese women aged 28-79 years receiving breast cancer surgery in six regional Hong Kong hospitals were interviewed within 1 week of surgery. After assessing SE, incongruence between expectancy and outcome of surgery (E-OI), and psychological morbidity, 91% of women were followed for 1 month when psychological and social morbidity were assessed (follow-up). RESULTS: After adjustment for demographic and histopathological factors, psychological morbidity was predicted by E-OI. Women with high E-OI had more impairment of sexuality and self-image. Women with high SE had better self-image and relationships with friends, but tended to underestimate the negative consequences of surgery on appearance. This increased E-OI and thereby psychological morbidity. CONCLUSIONS: High post-surgical SE benefits early social adaptation, but also leads to under-estimating the negative impacts of surgery, impairing psychological adjustment. High SE can thereby contribute indirectly and significantly to increased psychological morbidity.     

What is the role of the (1→3)‐β‐d‐glucan assay in the screening of patients undergoing autologous haematopoietic stem‐cell transplantation?

The aim of this study is to determine the clinical contribution of (1→3)‐β‐d ‐glucan (BDG) screening in the case of patients undergoing autologous haematopoietic stem‐cell transplantation (HSCT). The records at our stem‐cell transplantation centre were reviewed to identify the patients who underwent autologous HSCT between April 2009 and December 2010. Patients were classified as having proven invasive aspergillosis (IA), probable IA, or possible IA on the basis of the criteria established by the European Organization for Research and Treatment of Cancer and Mycoses Study Group (independent of the BDG results). During the study period, the patients were screened for BDG twice a week from transplant (day 0) until engraftment. Three patients were diagnosed with probable IA and five were diagnosed with possible IA. A total of 354 serum samples from79 patients who met the study inclusion criteria were used for statistical analysis. At the cut‐off value of 80 pg ml^?1, the sensitivity was 27.2% [95% confidence interval (CI); 7.3–60.6]; specificity, 94.4% (95% CI; 91.3–96.5); positive predictive value, 6.2%; and negative predictive, 93.7%. The clinical contribution of the BDG assay as a screening test was relatively limited in this cohort of patients undergoing autologous HSCT.     

Does routine assessment and real‐time feedback improve cancer patients’ psychosocial well‐being?

This study examined the effectiveness of giving medical oncologists immediate feedback about cancer patients' self-reported psychosocial well-being in reducing those patients' levels of anxiety, depression, perceived needs and physical symptoms. Cancer patients attending one cancer centre for their first visit were allocated to intervention (n = 42) or control (n = 38) groups. All patients completed a computerized survey assessing their psychosocial well-being while waiting to see the oncologist. Intervention patients' responses were immediately scored and summary reports were placed in each patient's file for follow-up. A total of 48 participants (25 intervention and 23 control) completed the survey four times. Intervention patients who reported a debilitating physical symptom at visit 2 were significantly less likely to report a debilitating physical symptom at visit 3 compared with control patients (OR = 2.8, P = 0.04). Reductions in levels of anxiety, depression and perceived needs among intervention patients were not significantly different to control patients. Repeated collection and immediate feedback of patient-reported health information to oncologists has potential to improve patients' symptom control, but has little impact upon emotional well-being, including those at high risk. Future research should consider providing the feedback to other health professionals and patients, and monitor the impact on the process of individual patient care.     

Does ampicillin‐sulbactam cause false positivity of (1,3)‐beta‐D‐glucan assay? A prospective evaluation of 15 patients without invasive fungal infections*

The purpose of this study was to investigate the interaction between intravenous ampicillin‐sulbactam treatment and (1,3)‐beta‐D‐glucan (BDG) assay. Fifteen patients with a median age of 60 (16–81) without known risk factors for invasive fungal infections who received a daily dose of 3 × 2 g ampicillin‐sulbactam monotherapy from different batches were included in the study. Thirteen patients had soft tissue infections. The 5 of 13 patients who went under surgery had surgical dressings. Serum samples were obtained both before and after antibiotic infusion on the first, third, seventh and tenth days of an ampicillin‐sulbactam treatment course. BDG was assayed using the Fungitell kit (Associates of Cape Cod, East Falmouth, MA, USA) according to manufacturers’ specifications. All serum samples were also tested for galactomannan (GM) antigenemia by Platelia Aspergillus ELISA (Bio‐Rad Laboratories, Marnes‐la‐Coquette, France). A total of 37 of 117 serum samples were positive for BDG at a threshold of 80 pg ml^?1. Seven of 37 BDG positive serum samples had a GM index ≥0.5. When a cutoff value of ≥0.5 was used for GM positivity, 16 (13.3%) serum samples were positive. For a cutoff value of ≥0.7, eight (6.6%) serum samples were positive. There were no statistically significant differences in the median BDG levels (P = 0.47) or median GM indices (P = 0.28) of the various sampling times. None of the SAM vials tested positive for BDG or GM. After ruling out fungal infections and all known potential causes of false BDG positivity, environmental contamination remained possible cause of BDG reactivity. We did not observe any significant association of ampicillin‐sulbactam administration and positive assays for BDG or GM.     

Does on‐site adequacy evaluation reduce the nondiagnostic rate in endoscopic ultrasound‐guided fine‐needle aspiration of pancreatic lesions?

BACKGROUND:

This retrospective study compared the nondiagnostic rate for endoscopic ultrasound‐guided (EUS) fine‐needle aspiration (FNA) of pancreatic lesions in 2 settings: 1 with and 1 without on‐site evaluation.

METHODS:

The authors reviewed 381 consecutive cases and divided them into groups with and without on‐site adequacy evaluation. For the group with on‐site evaluation, cytopathology personnel prepared and evaluated Diff‐Quik–stained direct smears and rinsed the remaining material in CytoLyt solution (Cytyc Corporation, Marlborough, Mass). The group without on‐site evaluation was divided into 2 subgroups: the clinical team either prepared an air‐dried smear for each FNA pass and then rinsed the remaining material in CytoLyt, or the entire sample was rinsed in CytoLyt. The cytologic diagnoses were reviewed and the nondiagnostic rates for each group were calculated.

RESULTS:

On‐site evaluation was provided for 167 cases with a nondiagnostic rate of 25.8% (43 of 167 cases). On‐site evaluation was not provided for 214 cases with a nondiagnostic rate of 24.3% (52 of 214 cases). The nondiagnostic rate for the subgroup with air‐dried smears prepared by the clinical team was 25.6% (43 of 168 cases) and that for the subgroup with the entire sample rinsed in CytoLyt was 19.6% (9 of 46 cases). There were no significant statistical differences in nondiagnostic rates noted among the different groups or subgroups.

CONCLUSIONS:

The results of the current study indicate that when experienced operators perform EUS FNA of pancreatic lesions, on‐site adequacy evaluation offers no benefit in reducing the nondiagnostic rate. Optimizing visualization of the sampled material by omitting the preparation of direct smears and rinsing the entire sample in liquid‐based media demonstrated a trend toward improving the diagnostic rate. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.