Bewältigungsstrategien in der Onkologie

Background

Coping with cancer is a great challenge for patients and their relatives. The initial shock of the diagnosis is followed by different coping strategies and phases of adaptation and processing of the situation.

Methods

This article is based on a selective literature search in PubMed on the topic of coping with disease and cancer.

Results and discussion

Psychosocial resources and factors of resilience can heIp patients to find positive perspectives apart from all the negative aspects associated with cancer. Coping with denial requires a sensitive handling by professionals bearing in mind the protective character of this coping strategy for the mental state of patients. Confrontation with reality is only a realistic option if denial results in damaging effects. Aggression and depression are antagonists in disease processing and coping strategies and are often in danger of becoming unbalanced. It must be taken into consideration that a reactive depressive mood might be an adequate state, whereas a depressive episode should be differentiated as a mental comorbidity that needs to be treated.

     

Vitamin B12 and Folate Status in Head and Neck Cancer

Deficiency of vitamin B12 and folate is associated with causation of certain precancerous conditions and cancer.The present study was carried out on 56 controls, 167 patients with oral precancerous conditions (OPC) and 214head and neck cancer patients, to evaluate the plasma vitamin B12 and folate levels to determine their associationwith tobacco habits and vegetarianism and several sociodemographic factors. The subjects were interviewed using ahealth habit and diet questionnaire at the time of blood collection. Simultaneous estimations of plasma vitamin B12and folate were done by Dual Count Radioassay. It was found that the habit of tobacco consumption, lower educationand low income were among the risk factors. A decrease in the plasma vitamin B12 and folate levels with respect totobacco habits, disease progression, and vegetarian diet was also observed. The individuals in the ower quartile forvitamin B12 and folate were at a higher risk of developing OPC, as compared to those in higher quartiles. Similarly,the patients with OPC in lower quartiles were found to be at a higher risk of developing cancer than their counterparts.There was a significant positive correlation between vitamin B12 and folate levels in the subjects consuming tobacco,and more so in patients with OPC (r=0.4330, p=0.000). Folate levels were significantly lower in patients with advancedas compared with early disease (ANOVA p=0.006 and Spearman’s Rho = -0.211 and p=0.01). The results suggest,potential significance of plasma vitamin B12 and folate levels in head and neck malignancies which needs to beconfirmed by further studies on a large population.     

Progress in the Management of Malignant Pleural Mesothelioma in 2017

Malignant pleural mesothelioma (MPM) is an uncommon, almost universally fatal, asbestos-induced malignancy. New and effective strategies for diagnosis, prognostication, and treatment are urgently needed. Herein we review the advances in MPM achieved in 2017. Whereas recent epidemiological data demonstrated that the incidence of MPM-related death continued to increase in United States between 2009 and 2015, new insight into the molecular pathogenesis and the immunological tumor microenvironment of MPM, for example, regarding the role of BRCA1 associated protein 1 and the expression programmed death receptor ligand 1, are highlighting new potential therapeutic strategies. Furthermore, there continues to be an ever-expanding number of clinical studies investigating systemic therapies for MPM. These trials are primarily focused on immunotherapy using immune checkpoint inhibitors alone or in combination with other immunotherapies and nonimmunotherapies. In addition, other promising targeted therapies, including pegylated adenosine deiminase (ADI-PEG20), which focuses on argininosuccinate synthase 1–deficient tumors, and tazemetostat, an enhancer of zeste 2 polycomb repressive complex 2 subunit inhibitor of BRCA1 associated protein 1 gene (BAP1)-deficient tumors, are currently being explored.     

A Retrospective Study of Double-hit Lymphomas in Elderly Patients (Aged > 70 Years): Overall Outcomes

Background

Double-hit lymphomas (DHLs) are high-grade diffuse large B-cell lymphomas with concurrent translocations involving myc and bcl-2 and/or bcl-6. A patient with DHL often has advanced disease at presentation and typically responds poorly to standard therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). More intensive treatment regimens have been studied; however, few data are available on the outcomes in elderly patients (aged > 70 years) treated with these therapies. We retrospectively studied the efficacy and tolerability of chemotherapy regimens in elderly patients within the Advocate Healthcare System.

Characteristics of Colorectal Mucinous Adenocarcinoma in Iran

Aims and Background: Mucinous adenocarcinoma (MA) colorectal cancer accounts for 10 to 15% of colorectalcarcinoma. It is generally thought that patients with MA present at a more advanced stage of disease and havea poorer prognosis than those with other types of carcinoma The purpose of the present study was to clarifythe clinicopathological characteristics of mucinous colorectal carcinoma in the Iranian population. Methods:Between January 2002 and March 2008, Of the 1283 colorectal cancer patients, 110 patients were consideredto have mucinous tumors according to pathology report. Patients evaluated on the basis of sex, age, location oftumor, stage, differentiation of tumor and family history of cancer. Kaplan-Meier curves and log-rank tests wereused for survival analysis. Results: The median age of these patients at diagnosis was 50.07 years. More than50% of patients were younger than aged 50 years. 34.5% of patients had a family history of colorectal cancerin their first-degree relatives. Most tumors were presented in right colon. 54.3% of MA patients had advancedStage lesions. The Kaplan-Meier method indicated that, the 1, 3 and 5years survival rates are 92.6, 80.1 and41.3 percent, respectively. Survival of the patients was related to disease stage (P = 0.023). Conclusion: Oursuggests that genetic factors may be play an important role in the development of this disease in our countryand screening programs, especially genetic screening programs, should be considered as a main measure forprevention and control of colorectal cancer in Iran.     

Nitric oxide (NO) enhances pemetrexed cytotoxicity via NO‑cGMP signaling in lung adenocarcinoma cells in vitro and in vivo

Pemetrexed (PEM) is a novel, multitargeted, antifolate, antineoplastic agent for the treatment of non-small cell lung cancer and malignant pleural mesothelioma. Additional effects of nitric oxide (NO) donors on the chemosensitivity of cancers have been reported. However, the effects of an NO donor on PEM-induced cytotoxicity remain unknown. In this study, we investigated the effects of the NO donors, NOC-18 on the cytotoxicity in A549 cells in vitro and of nitroglycerin (GTN), on the tumor growth of Lewis lung carcinoma cells in a murine syngraft model treated with PEM. The effects of NO donors on the expression of proteins associated with PEM metabolism, including thymidylate synthase (TS), reduced folate carrier 1 (RFC1), folylpolyglutamate synthase (FPGS), γ-glutamyl hydrolase (GGH) and multidrug resistance-related protein (MRP)5, and the effects of cyclic guanosine mono-phosphate (cGMP) signaling on these proteins were examined in A549 cells. Treatment with 100 nM NOC-18 for 3 days significantly enhanced PEM-induced cytotoxicity and increased the expression of RFC1 and FPGS in A549 cells. Treatment with 10 nM 8-bromo-cGMP (8-Br-cGMP) for 3 days also increased the expression of RFC1 and FPGS in A549 cells. 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) (10 μm) significantly reversed the increase in RFC1 and FPGS expression induced by 100 nM NOC-18 in A549 cells. Combination therapy with GTN and PEM significantly reduced tumor growth compared with PEM alone in the syngraft model. The enhanced antitumor effect of GTN plus PEM was significantly reversed by the concomitant addition of ODQ. These findings suggest that NO donors, such as NOC-18 and GTN, enhance the anticancer effects of PEM by increasing the RFC1 and FPGS expression and stimulating cGMP signaling pathways in cancer cells.     

Retention of paclitaxel in cancer cells for 1 week in vivo and in vitro

Purpose: Clinically, the administration of paclitaxel for ovarian cancer on a dose-dense weekly schedule, rather than the conventional every-3-week schedule, might demonstrate greater tumor-cell death. Here, we investigate the pharmacokinetics and the pharmacodynamics of weekly paclitaxel in cancer cells in vivo and in vitro. Experimental design: Paclitaxel concentrations were measured by HPLC, and apoptotic cells were detected by TUNEL assay in paclitaxel-pretreated cervical cancer cells treated with paclitaxel (10 ng/ml) and in the tissues of cervical cancer patients treated with weekly paclitaxel (60 mg/m²/week). Polymerized tubulin was detected with a tubulin polymerization assay, and the BrdU cell proliferation assay was used to assess the effect of paclitaxel. Results: Paclitaxel remained in the cancer tissues of six patients for 6 days after the last medication. In vitro, paclitaxel was retained in all cell lines for 24 h after its removal from the medium, and paclitaxel was still detectable in CaSki cells on day 7. Simultaneous treatment with depolymerizing drugs inhibited the retention of paclitaxel in cells and paclitaxel-induced polymerization of tubulin. After paclitaxel treatment, apoptotic cells were detected in cancer tissues and CaSki cells for 1 week. Under high magnification, apoptotic cells on day 7 after paclitaxel treatment showed multinucleation. Conclusions: Paclitaxel is unusual in that it accumulates especially in cancer cells and induces apoptosis for 1 week in vivo and in vitro. On the other hand, paclitaxel could not be detected in cancer tissues after 2 weeks. The administration of paclitaxel on a weekly schedule, rather than the standard every-3-week schedule, might produce greater tumor-cell death.     

Cardiospermum halicacabum inhibits Cyclophosphamide Induced Immunosupression and Oxidative Stress in Mice and also Regulates iNOS and COX-2 Gene Expression in LPS Stimulated Macrophages

The effect of a methanolic extract of Cardiospermum halicacabum L was studied against cyclophosphamide(CTX)-induced toxicity in mice. Administration of CTX (25 mg/kg b.wt, i.p.) for 10 days produced significantmyelosuppression as evidenced by a decreased WBC count and bone marrow cellularity. Co-treatment withCardiospermum significantly increased the total WBC count, bone marrow cellularity and α-esterase positivecells, and the relative organ weights of spleen as well as thymus compared to the CTX alone treated group.Cardiospermum further reduced the enhanced levels of ALP, GPT, LPO, and proinflammatory cytokine TNF-α,and also significantly increased the glutathione (GSH) level in CTX treated animals. The lowered levels ofother cytokines like IFN-γ, IL-2, GM-CSF, after CTX treatment were also found to be increased by extractadministration. Histopathological analysis of small intestine also suggested reduction of CTX-induced intestinaldamage. Moreover the extract down-regulated the inducible nitric oxide synthase (iNOS) and cyclo-oxygenase-2(COX-2) mRNA expression in LPS stimulated macrophages. These studies indicate that C. halicacabum couldreduce cyclophosphamide induced oxidative stress and immunosupression through enhancing the antioxidantstatus and immunomodulation by stem cell proliferation.     

Vitamin C in der komplementären Onkologie

The antioxidant perhaps most widely used in complementary oncology is Vitamin C, particularly by intravenous injection. Preclinical data show synergistic as well as antagonistic effects with chemotherapy and small molecules. As single agent, ascorbic acid (AA) seems to inhibit tumour growth dependent on dose or concentration in experimental animal studies. As dehydroascorbic acid (DHA) it can enhance tumour growth. Inhibition seems to be selective for tumour cells, so that we can hope to achieve a therapy without serious side effects. Current data should be verified in clinical studies.     

Knowledge about Oral Cancer in Adults Attending a Dental Hospital in India

The incidence of oral cancer in India is on the rise due to increasing consumption of alcohol and tobaccoproducts. The study was conducted with the aim to assess the associated knowledge in adults attending a dentalcollege. Specific objectives were to: 1) assess the knowledge of risk factors for oral cancer 2) assess the knowledgeof signs of oral cancer; 3) determine factors influencing level of knowledge. All adult patients visiting the dentalcollege were randomly selected to participate in a questionnaire survey, printed both in English and the locallanguage - Kannada. Some 69.8% (n=166) and 37.8% (n=90) respectively were able to correctly identify tobaccoand alcohol as risk factors for oral cancer. Only 20.2% (n=48) and 18.1% (n=43) respectively were able tocorrectly identify a white lesion and a red lesion as early signs of oral cancer. Respondents who were younger,those who had >12yrs of education were more likely to be more knowledgeable of risk factors for oral cancer.Those with higher knowledge of risk factor scores were 4.5 times more likely to obtain ≥1 knowledge of signsscore. (p< 0.0000). Knowledge of risk factors and signs of oral cancer was low and misinformation was high,hence there is a need to focus on educational interventions in a hospital based setting to improve knowledge.     

Tanshinone IIA induces growth inhibition and apoptosis in gastric cancer in vitro and in vivo

As a phytochemical derived from the roots of Salvia miltiorrhiza Bunge, Tanshinone?IIA has been reported to possess anti-inflammatory and antioxidant activity. Studies in breast, colon, prostate and lung cancer indicate that Tanshinone?IIA may exhibit a promising antitumor activity. However, systemic studies of the cytotoxic effects of Tanshinone?IIA on gastric cancer have not been described. The present study offers a comprehensive evaluation of the antitumor effects of Tanshinone?IIA in gastric cancer cells in?vitro and in a mouse xenograft model. Cell viability and apoptosis in?vitro were evaluated through the MTT assay and flow cytometry analysis. The results indicate that Tanshinone?IIA can induce gastric cancer cell growth inhibition and apoptosis in a time- and concentration-dependent manner. Furthermore, we investigated the mechanism of the apoptotic effects induced by Tanshinone?IIA. We found that Tanshinone?IIA can not only cause cell cycle arrest in the G2/M phase, but also trigger the intrinsic apoptotic signaling pathway. The results suggest that Tanshinone?IIA may serve as an effective adjunctive reagent in the treatment of gastric cancer.     

The Prognostic Effect of Changes in Tumor Stage and Nodal Status After Neoadjuvant Chemotherapy in Each Primary Breast Cancer Subtype

Background

Although the prognostic value of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) depends on the intrinsic subtype of breast cancer, it is not clear whether chemosensitivity itself, shown by a decreasing tumor burden after NAC, contributes to improved prognosis in primary breast cancer patients, especially in patients with non-pCR. The aim of this study was to assess the prognostic effect of changes in tumor stage or nodal status after NAC in each primary breast cancer subtype.

Erythrocyte Catalase and Carbonic Anhydrase Activities in Lung Cancer

Aim: To study the relationship between the pathogenesis of lung cancer and antioxidant status and acidicmedia by measuring the activities of erythrocyte catalase (CAT) and carbonic anhydrase (CA). Methods: A totalof 26 patients with lung cancer and 15 healthy individuals were included in the study. The CAT and CA activitiesof erythrocytes were defined. The catalase (CAT) activity of erythrocytes was measured using Aebi`s method.Carbonic anhydrase (CA) activity was analyzed by CO2 hydration. Results: It was found that erythrocyte CAand CAT activities were significantly lower in patients with lung cancer compared to controls (p<0.05). Of the 26patients with lung cancer, seven (26.9%) had metastasis, and the CA and CAT levels in patients with metastasiswere significantly decreased (p=0,0001). Conclusions: Development of oxidative stress due to lung cancer maybe related to the balance between prooxidant and antioxidant reactions. Catalase may have a preventive effectfor malignant lung cancers and the gene of the antioxidant enzymes may be one of the anti-oncogenes, andinactivation of one of these genes in the process of carcinogenesis may lead to tumor development. This maybe an explanation for the very low levels of antioxidant CAT in patients with lung cancer compared to healthyindividuals. Carbonic anhydrase (CA) in tumor cells may be an indicator of the acid-base balance in lung cancer.Decreased levels of CA in patients with lung cancer may provide a convenient media for tumor development,growth and metastasis by creating an acidic media.     

Factors Influencing Late Consultation Among Patients with Rectal Bleeding in University Kebangsaan Malaysia Medical Centre

Background: Patients’ delay in the presentation with rectal bleeding had been identified as a factor for latediagnosis of colorectal cancer. This study was conducted to determine the prevalence of delay in consulting amedical practitioner and identifying associated factors. Materials and Methods: A cross-sectional study of 80patients with rectal bleeding, aged 40 and above, was conducted between December 2008 and June 2009 inthe endoscopy unit, University Kebangsaan Malaysia Medical Centre. The self-administered questionnaireincluded data on sociodemographic, concern of rectal bleeding, whether patients sought initial advice, any selftreatment prior to medical consultation and patients’ opinion on causes of their own rectal bleeding. Results:The prevalence of delay in the presentation of rectal bleeding was 60%. Patients who were less worried (OR 9.6;95% CI 3.3-27.5), who did not seek anyone’s advice (OR 11.8; 95% CI 3.8-36.8) and took some treatment beforeseeking medical consultation (OR 5.0; 95% CI 1.0-24.1) were significantly more likely to delay. Multiple logisticregression revealed that less worry of rectal bleeding and not seeking anyone’s advice were important predictors(p < 0.05). The majority of patients attributed their bleeding to benign causes. Conclusion: A high proportion ofpatients with rectal bleeding in the high risk group delayed in seeking medical advice. Public education needsto focus on interventions to reduce the delay in presenting and diagnosis of colorectal carcinoma.