Meeting the support and information needs of women with advanced breast cancer: a randomised controlled trial

Addressing psychosocial and quality of life needs is central to provision of excellent care for people with advanced cancer. This study tested a brief nurse-delivered intervention to address the needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Australia. One hundred and five women with advanced breast cancer were recruited and randomised to receive the intervention or usual care, then asked to complete the European Organisation of Research and Treatment of Quality of life Q-C30 version (2.0) (EORTC Q-C30) (version 2) and Supportive Care Needs Survey (SCNS) at 1 month and 3 months postrecruitment. No significant differences were detected between intervention and usual care groups in the SCNS or the EORTC Q-C30 subscale scores. However, when the groups were divided into high needs (score of above 50) and low baseline needs (score of 50 or below) for each SCNS subscale, a significant difference between intervention and usual care groups was found in the psychological/emotional subscale among women with high baseline needs. In conclusions, this study demonstrated that a face-to-face session and follow-up phone call with a breast care nurse significantly reduced the psychological and emotional needs of those with high initial needs. There was no evidence of the intervention influencing the quality of life; or perceived needs of women with low initial psychological/emotional needs or perceived needs in other domains. Possibly, the intervention was not sufficiently intense to achieve an effect.     

Information needs of patients with cancer: results from a large study in UK cancer centres

As part of a multi-centred study evaluating a communication skills training model for clinicians, we collected information preferences using an adaptation of Cassileth's Information Needs questionnaire from a heterogeneous sample of 2331 patients. Results showed that 87% (2027) wanted all possible information, both good and bad news and 98% (2203) preferred to know whether or not their illness was cancer. Cross tabulation of responses revealed no significant differences in information preferences for tumour site or treatment aims but did show an effect of age and sex. The few 58/440 (13.2%) patients who stated that in general they preferred to leave disclosure of details up to the doctor, tended to be older patients more than 70 years of age (chi square = 26.01, df = 2, P< 0.0001), although paradoxically they still wanted to know certain specific details. In comparison to men women preferred to know the specific name of the illness (chi square = 4.9, df = 1, P< 0.02) and what were all the possible treatments (chi square = 8.26, df = 1, P< 0.004). The results from this very large sample provide conclusive evidence that the vast majority of patients with cancer want a great deal of specific information concerning their illness and treatment. Failure to disclose such information on the grounds that significant numbers of patients prefer not to know is untenable.     

Mapping the quality of life and unmet needs of urban women with metastatic breast cancer

Enhancing quality of life and reducing the unmet needs of women are central to the successful management of advanced breast cancer. The objective of this study was to investigate the quality of life and support and information needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Melbourne, Australia. A consecutive sample of 105 women with advanced breast cancer completed a questionnaire that contained the European Organization of Research and Treatment of Cancer Quality of Life Q-C30 and the Supportive Care Needs Survey. Between one quarter and a third of the women reported difficulties with their physical, role and social functioning, and a little over a quarter of the women reported poor global health status. Fatigue was a problem for most women. The highest unmet needs were in the psychological and health information domains. Almost no differences in unmet needs were detected when comparing different demographic and disease characteristics of women. Health care providers should routinely monitor the quality of life and needs of women with advanced breast cancer to ensure that appropriate treatment, information or supportive services are made available.     

尊严疗法在晚期癌症患者中的研究进展

“尊严”是指一种被尊重、重视及公平对待的权利,这种权利与生俱来,体现着生命的价值和意义。“ 尊严疗法”主要探讨的是“临终尊严”,涉及对患者的症状控制、确保患者的身体完整性、自主权与隐私权、保障患者被尊重、个人事务的妥当处理及平和地面对死亡等诸多方面。尊严疗法是一种个体化的心理干预方法,旨在减轻患者的悲伤情绪,提升其人生目的、意义、价值感,降低精神和心理负担,总体改善患者的生命质量。      

D -二聚体对晚期结直肠癌患者预后的影响

目的：探讨首次化疗前 D -二聚体水平对晚期结直肠癌患者预后的影响。方法：检测62例复发或转移性结直肠癌患者化疗前 D -二聚体水平,分析其与临床因素、化疗疗效、总生存期的相关性。结果：D -二聚体低水平组与高水平组在各临床因素间、化疗疗效间的比较均无统计学意义（P >0.05）,多因素生存分析显示 CEA 水平、D -二聚体水平是总生存期的独立预后因素（HR =3.454,95% CI =1.151~10.369, P =0.027;HR =2.380,95% CI =1.082~5.253,P =0.031）。结论：D -二聚体水平可作为晚期结直肠癌患者总生存期的预后因素,但不足以预测化疗疗效。     

Phase II study of mitoxantrone, 5-fluorouracil,and levo-leucovorin (MLF) in elderly advanced breast cancer patients

Summary We have carried out a phase II trial to evaluate the efficacy and toxicity of a combination therapy consisting of mitoxantrone 10 mg/sqm i.v. on day 1, levo-leucovorin 250 mg/sqm administered over 2 hours and 5-fluorouracil 500 mg/sqm i.v. push after the first hour of levo-leucovorin infusion, on days 15–16 (MFL) in patients aged more than 65 years. 24 patients with advanced breast cancer entered the study: 16 aged 65–70 yrs, 4 patients 70–75 yrs, and 4 > 75 yrs. Median PS was 1 (range 0–2); sites of metastases were: bone 14 patients, viscera 14 patients, soft tissue 11 patients, and CNS 1 patient. A median number of 6 cycles (range 3–9) was administered. All patients were evaluable for response and toxicity; partial response was obtained in 12 (50%) patients (95% C.I 30–70), stable disease was observed in 9 patients (37.5%), while 3 patients (12.5%) progressed. Median progression-free survival and survival were 9 months (range 2–14) and 14 months (range 5–36), respectively. Toxicity was generally mild and the most frequently observed side-effects were WHO gr. 1–2 leukopenia in 6/24 (25%) patients and gr. 1–2 emesis in 10/24 (41.6%) pts. 1 patient pretreated with doxorubicin cumulative dose of 240 mg/sqm showed clinical signs of congestive heart failure (NYHA grade 1) after the fifth cycle of treatment. MFL is a well tolerated regimen and could represent a safe and effective treatment in older advanced breast cancer patients.     

Assessment of hospitalised cancer patients' needs by the Needs Evaluation Questionnaire

Background:Cancer disease modifies the order and the nature ofneeds connected with the state of health. The aim of this study was toevaluate the informative, psychological, social and practical needs ofhospitalised cancer patients by means of the Needs Evaluation Questionnaire(NEQ), an instrument designed concisely for the convenience of patients andmedical staff. Patients and methods:Different samples of consecutivehospitalised cancer patients were involved in the various phases of designingthe instrument: 30 patients for items identification, 101 patients forcompleteness and acceptability evaluation, 423 patients for construct validityand prevalence of needs; content and reliability analysis were performed on2 subsamples of, respectively, 60 and 88 of the patients from the last sample. Results:The validation analysis showed rather good reliability,structure validity and internal consistency of the questionnaire. Theprevalence analysis showed that the most common needs were: 'more informationabout my future conditions' (74%); 'more information about mydiagnosis' (56%); 'more information about the exams I am undergoing'(52%); 'more explanations on treatments' (51%); 'to have abetter dialogue with clinicians' (57%); 'better services from thehospital' (bathrooms, meals, cleaning) (56%). Conclusions:The NEQ, self-completed by patients, has proven tobe a useful clinical tool for obtaining a systematic and undistorted overviewof the principal needs with respect to the state of health of patients. Thisinstrument, which can also be administered by persons not belonging to thehealth care system such as volunteers, and inserted into the patients'hospital charts, could be used by the medical staff to identify the real needsof patients at an early stage.     

Validation of the needs assessment for advanced lung cancer patients (NA-ALCP)

Objective: The Needs Assessment for Advanced Cancer Patients (NA‐ACP) is a 132‐item self‐report questionnaire designed to assess the seven needs domains of patients with advanced, incurable cancer. This study aimed to evaluate the short derivative form of that questionnaire with advanced lung cancer patients. Methods: Item factor loadings, item test–retest data and response distributions were used to retain or reject items from the original NA‐ACP scale. This resulted in 38 items being maintained, preserving the original subscales. The response scale was simplified following feedback from patients. 108 people with advanced lung cancer completed the shortened NA‐ALCP along with measures of psychological distress (HADS, DT) and quality of life (EORTC QLQ‐C30). A‐priori predictions were made for divergent and convergent validity. Results: Internal consistency coefficients were satisfactory for six of seven subscales, range 0.71–0.95. Correlations between NA‐ALCP and HADS, DT and EORTC‐QLQ‐C30 provided support for 11 of the 22 divergent (r = 0.13–0.27) and convergent predictions (r = 0.45–0.71). Conclusions: Subscales of the NA‐ALCP demonstrated internal reliability consistent with the original scale. Results provided supporting evidence for divergent and convergent validity. This study indicates that the NA‐ALCP is psychometrically robust, easily understood and one‐quarter the length of the original version. Copyright © 2011 John Wiley & Sons, Ltd.     

Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients

Fifty-seven patients treated by radical gastric resections were retrospectively studied to understand the clinicopathologic characteristics of advanced gastric cancer without serosal invasion (the depth of tumor invasion limited to the muscularis propria or subserosal layer) in young and old age persons. There were 36 patients in the old age group (age > 60 years) and 21 in the young age group (age ≤ 40 years). The clinical and pathologic parameters for this study included sex, gross type, location, maximum tumor size, depth of invasion, lymph node metastasis, tumor stage, histologic type, and rate of curative resection. The old patients had a higher percentage of small tumors, subserosal invasion and lymph node metastasis, but these parameters were not significantly different from those of the young patients, nor did the sex ratio, gross type, location, and rate of curative resection show significant differences. The histologic feature was the only statistically significant parameter, determined by univariate and multivariate analyses. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were detected in 10 (47.6%) and 4 (19.0%) of the 21 younger patients, respectively, while there were 4 (11.1%) and 2 (5.6%) in the old age group. Although the gastric cancer in young patients had more aggressive histologic characteristics than it did in elderly patients, survival rates between the two groups did not differ to any great degree. Our findings indicate that the prognosis for younger patients with advanced gastric cancer without serosal invasion was favorable when curative resection was performed. © 1996 Wiley-Liss, Inc.     

吉非替尼一线治疗老年晚期非小细胞肺癌临床观察

目的：观察表皮生长因子受体酪氨酸激酶抑制剂吉非替尼单药一线治疗老年晚期非小细胞肺癌的疗效和不良反应。方法：2006年2月至2008年12月36例65岁以上晚期非小细胞肺癌患者进入研究,所有患者均为Ⅲ-Ⅳ期。口服吉非替尼250mg/d,至病情进展或者不能耐受不良反应。结果：36例均可评价疗效和不良反应。治疗后2个月进行评价,RR为41.67%（15/36）、DCR86.11%（31/36）。用药后最常见的不良反应为Ⅰ、Ⅱ度皮疹25例（52.78%）,腹泻11例（30.56%）,皮肤瘙痒5例（13.89%）,皮肤干燥5例（13.89%）,肝功异常2例（5.56%）。TTP为3.5-23.8个月,中位TTP8.2个月。结论：吉非替尼单药治疗老年晚期非小细胞肺癌疗效肯定,不良反应相对较小,患者耐受性好。可以作为该特殊人群的一线治疗。     

多西他赛单药治疗老年性晚期非小细胞肺癌的临床观察(英文)

Objective:The aim of our study was to evaluate the clinical efficacy and side effects of docetaxel as single chemotherapy for elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: Forty-two elderly patients with advanced NSCLC who were chemotherapy-naive were enrolled in this study. Docetaxel at the doses of 70 mg/m2 was administrated intravenously every 21 days as a cycle, each patient received 2-4 cycles. All patients were followed up until disease progressed or patients died. Result...     

The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure)

BACKGROUND: Many cancer survivors experience ongoing morbidity over the survivorship continuum and their supportive care needs have yet to be comprehensively assessed. METHODS: This study aimed to develop and empirically evaluate a self-report measure of cancer survivors' supportive care needs. In Phase I, questionnaire items were generated based upon previous qualitative research that identified both unique and shared needs in survivors and their partners; items were constructed into the Cancer Survivors' Unmet Needs measure (CaSUN). In Phase 2, the CaSUN was completed by 353 cancer survivors who had been diagnosed with cancer between 1 and 15 years earlier and were currently disease-free. RESULTS: After modification, the CaSUN included 35 unmet need items, 6 positive change items and an open-ended question. Good acceptability, internal consistency and validity were demonstrated, although test-retest reliability was low. Maximum likelihood factor analysis identified five discrete factors: Existential Survivorship, Comprehensive Care, Information, Quality of Life and Relationships. CONCLUSIONS: Preliminary data indicates that the CaSUN meets the majority of psychometric criteria for assessment measures, although its low test-retest reliability awaits further investigation. The CaSUN will facilitate the evaluation of supportive care services and generation of service delivery recommendations for cancer survivors.     

Quality of life and functional status in patients with advanced cancer admitted to hospice home care in Malaysia: a cross-sectional study

Cancer patients more than often experience poor quality of life after diagnosis and treatment of cancer. As the disease progresses quality of life issues become important. This cross-sectional study assessed various features of quality of life among 61 (33 women and 28 men) patients with advanced cancer cared by selected hospices in Peninsular Malaysia. The Hospice Quality of Life Index was used to assess quality of life. The mean total Hospice Quality of Life Index score for all subjects was 189.9 ± 51.7. The possible scores range from 0 to 280. The most problem areas in these patients were in the domain of functional well-being, followed by psychophysiological and social/spiritual domain. Patients with advanced cancer have a diminished quality of life. These findings suggest that there is a need for improving quality of life in terminally ill cancer patients in hospice care.     

Assessing the unmet supportive care needs of newly diagnosed patients with cancer

Adequate monitoring in cancer control needs to include measures of psychosocial outcomes so as to take account of the totality of the felt cancer experience. There is a need to know whether the experience of cancer is changing, as well as a need for tools to identify where supportive care interventions or services could be targeted to good effect. The aim of this study was to investigate the utility of using a telephone-administered survey to identify the unmet needs of cancer patients. Participants were identified from a statewide population-based cancer registry following an episode of hospitalized care in Victoria (Australia). Of the 506 eligible patients, 236 completed a telephone adaptation of the Supportive Care Needs Survey-Short Form (SCNS-SF31). Sampling from the cancer registry was shown to provide timely contact with patients. Results from the survey indicated that perceived needs for this newly diagnosed group of cancer patients were mostly in the area of information provision. Results also showed that some socio-demographic and disease-specific variables affected the level of perceived unmet needs. Overall, this study indicated that registry-based sampling was practical and the telephone adaptation of the SCNS-SF31 provided a reliable method to explore the unmet needs of newly diagnosed patients with cancer.     

Hope in advanced cancer patients

Individuals diagnosed with advanced cancer frequently experience physical and psychological distress. Hope has been identified as an essential resource in the lives of people with cancer, helping them to cope during times of suffering and uncertainty. Therefore, in order to help bolster hope, health care providers require an understanding of its meaning from the perspective of advanced cancer patients and an awareness of those interventions demonstrated empirically to foster hope in this patient population. This paper summarises salient evidence pertaining to hope in advanced cancer patients and their families or informal caregivers. We examine the challenging issue of how to define hope, discuss the issue of measuring hope and review the state of evidence addressing interventions that may enhance or bolster hope in the face of advanced disease.