Relationship between weakness and phase angle in advanced cancer patients with fatigue

Objective

This study aims to determine the relationship between weakness and bioimpedance analysis (BIA)-derived phase angle in a population of untreated cancer patients with fatigue.

Methods

We prospectively evaluated 41 treatment-naive cancer patients of several origins that presented with performance status 1–2, weight loss >5 % in the last 6 months, and Fatigue Numeral Scale score >4. Weakness was considered a physical component of the multidimensional fatigue syndrome and was evaluated through several parameters utilizing hand grip strength technique by dinamometry. The same assessment was also performed on a healthy control population (n?=?20). BIA-derived phase angle was also determined by BIA.

Results

Compared to healthy controls, cancer patients exhibited significant differences in all the parameters: median fatigue was 6 (range 5–9), evaluated maximal strength mean was 27?±?10.71 vs. 42?±?10.74 kg (p?<?0.0001 for patients vs. control, respectively), and muscle strength difference (max–min muscle strength) was also statistically different (p?<?0.0001). We also determined parameter associations within the patient population. We found statistical significant correlations between median phase angle score and endurance muscle with percentage of weight loss (r?=?0.43, p?=?0.03) for head and neck cancer patients, and in non-small cell lung cancer patients, grip work correlated significantly with normal or decreased phase angle (r?=?0.85), p?=?0.006 (Spearman Rank Correlation).

Conclusions

Weakness could be correlated with normal or decreased phase angle in a population with ambulatory advanced cancer with fatigue naive of treatment. We also found a significant relationship between median phase angle score and endurance muscle with percentage of weight loss in the subpopulation of patients with head and neck carcinoma.     

食管癌患者家庭关怀度与自我感受负担的相关性研究

目的：调查食管癌患者家庭关怀度及自我感受负担,并分析其相关性。方法：采用一般资料和疾病资料调查表、家庭关怀指数问卷、癌症患者自我感受负担量表对136例食管癌患者进行问卷调查。结果：136例食管癌患者家庭关怀度总分为（7.37±1.72）分,属于家庭功能中度障碍;自我感受负担总分为（71.42±19.21）分,处于重度负担水平;食管癌患者家庭关怀度与自我感受负担呈负相关（P<0.05）。结论：食管癌患者的家庭关怀度与自我感受负担均有待于进一步提高,护理人员应给予重点关注,并提供个性化的健康指导。     

Changes in circulating immunosuppressive cytokine levels of cancer patients after high intensity focused ultrasound treatment

Immunosuppression in a patient with malignant tumor is a major obstacle in cancer treatment. In this study, we investigated changes in the circulating level of all measured immunosuppressive cytokines in patients with malignancy before and after high intensity focused ultrasound (HIFU) treatment. Fifteen patients with solid malignancy were enrolled in this study and an enzyme-linked immunoabsorbent assay (ELISA) method was used to measure serum level of vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGF-beta1), transforming growth factor-beta2 (TGF-beta2), interleukin 6 (IL-6) and interleukin 10 (IL-10), respectively before and 1 wk after HIFU treatment. Among them, seven patients had distant metastasis and the remaining eight had no metastasis. All patients received one-session HIFU treatment for primary cancer, including complete ablation in eight patients without metastasis, and partial ablation in seven patients with metastases. The results showed that serum immunosuppressive cytokine levels decreased after HIFU treatment, and there were significant decreases of VEGF, TGF-beta1, and TGF-beta2 before and after HIFU treatment. Compared with the values in the metastatic patients, serum levels of immunosuppressive cytokines were significantly lower in the nonmetastatic patients after HIFU treatment. It is concluded that HIFU can decrease tumor-secreted immunosuppressive cytokine production in addition to its direct tumor destruction. This change may lessen tumor-induced immunosuppression and renew antitumor immunity after HIFU in cancer patients.     

Relationship between alcohol use disorders,cortisol concentrations,and cytokine levels in patients with sepsis

Introduction  

Patients with alcohol use disorders (AUD) are at increased risk of developing sepsis and have higher mortality. AUD are associated with higher cortisol and anti-inflammatory cytokine profile. Higher cortisol increases risk of death in septic patients. The relationship between AUD and cortisol in septic patients is unknown. We aimed to study this relationship and postulated that AUD would be associated with higher cortisol and anti-inflammatory cytokine profile.     

Effects of nutritional and psychological status of the patients with advanced stomach cancer on physical performance status

Goals of the work  

The aim of this study was to assess the associations between coping mode, nutritional status, and psychological status and performance status of the patients with advanced stomach cancer.     

Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy

The aim of this study was to examine the relationship of changes in hemoglobin levels to changes in fatigue and cognitive functioning in cancer patients undergoing chemotherapy treatment. Seventy-seven (77) patients completed a self-administered measure of fatigue and a battery of psychometrician-administered measures of cognitive performance before the start of chemotherapy and again before the start of the fourth treatment cycle. Hemoglobin levels were measured at corresponding timepoints. Findings partially supported the hypothesis that greater declines in hemoglobin over the course of repeated chemotherapy administrations would be accompanied by greater increases in fatigue and greater declines in cognitive performance over the same interval. Among the subset of 49 patients who demonstrated a decline in hemoglobin to a final value < or =12 g/dL, greater declines in hemoglobin were significantly (P<0.05) related to greater increases in fatigue duration and disruptiveness and more negative changes in performance on three cognitive tasks. These findings suggest that, in addition to previously reported relationships with fatigue, declines in hemoglobin levels during chemotherapy treatment are associated with adverse changes in cognitive functioning.     

老年人肺癌与血清胆固醇水平关系分析

目的　探讨老年人肺癌与血清胆固醇水平的关系。方法　收集 1996～ 2 0 0 1年间老年肺癌住院患者 79例 ,对血清胆固醇水平等临床资料进行分析 ,并与肺部良性疾病进行比较。结果　老年肺癌组患者血清胆固醇浓度显著低于肺部良性疾病组 (P <0 0 1)。老年肺癌组胆固醇浓度随着病情恶化逐渐降低 (P <0 0 1)。死亡前 1个月内 10 0 %低于肺部良性疾病组平均值。结论　老年肺癌组患者血清胆固醇浓度比肺部良性疾病组显著降低 ,以死亡前 1个月内更为明显 ,这种变化可能对老年肺癌患者的生存时间有预测意义。     

Symptomatology and loss of physical functioning among geriatric patients with lung cancer

In this study of 129 geriatric patients with lung cancer, we investigated how symptom severity varied according to treatment type, stage of disease, and gender; how change in physical functioning (prediagnosis versus post-hospital discharge) was predicted by symptomatology, prior physical functioning, comorbidity, and age; and whether differences exist according to stage of disease, treatment status, or gender. Data were gathered through patient interviews and audits of patient records. Analysis of variance (ANOVA) techniques revealed that there were no significant differences in average symptom severity scores by gender, treatment categories, or stages of disease. Significant predictors of loss of physical functioning were symptom severity, prior physical functioning and patient age. Characteristics of a profile for elderly lung cancer patients at high risk of suffering substantial losses in physical functioning include higher prior levels of physical functioning, higher levels of current symptomatology, and lower age.     

A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer

Depression is a common symptom in patients with advanced cancer and patients who are depressed may also have physical symptoms which are difficult to palliate and which improve as their depression is appropriately treated. This study was carried out to determine if there was an association between depression and physical symptoms in patients with advanced cancer and to establish whether a seven-item verbal rating scale asking patients to verbally rate the severity of physical symptoms together with low mood could be used to screen for depression. The scale was validated against a semi-structured clinical interview according to DSM IV criteria. Seventy-four patients participated with an age range of 28-92 years. All patients had an ECOG performance status of two or three. The prevalence of major depression in this study was found to be 27% (95% C.I. 17-37%). The mean score on the verbal rating scale was 28.77 (median score 29.5) (95% C.I., 26.23 - 31.31; range 0-65). A cut-off of > or = 30 gave a sensitivity of 65% and specificity of 59%, with positive and negative predictive values of 37% and 82% respectively. The verbal mood item alone had an optimal cut-off point of 3, with a sensitivity of 80% and specificity of 43%. Patients diagnosed as being depressed according to psychiatric interview rated each symptom higher than nondepressed patients. The verbal mood item and total verbal rating score correlated with a high significance (rs = 0.607, P < 0.01), implying a relationship between a patient's subjective mood state and other symptoms. Both using the verbal scale and asking patients to verbally rate their mood alone had poor efficacy as a screening tool. However, there is a close association between physical symptoms and the presence of depression in palliative care patients.     

Readiness to self-manage pain is associated with coping and with psychological and physical functioning among patients with chronic pain

A patient's readiness to adopt a self-management approach to pain has been suggested as a construct that may explain differences among patients in coping, adjustment, and response to multidisciplinary pain treatment. The pain stages of change questionnaire (PSOCQ; Pain, 72 (1997) 227) was designed to assess four components of this construct. The current study tested the following two hypotheses in two different samples of persons with chronic pain. PSOCQ scales are associated with (1) coping strategies used to manage pain and (2) patient disability and depression. The findings supported the first hypothesis and provided mixed support for the second. The implications of the findings for understanding the readiness to self-manage pain construct and the validity of the PSOCQ for assessing this construct are discussed.     

血清血管生成素-2水平与进展期胃癌术后复发及预后的关系

目的 探讨进展期胃癌患者血清血管生成素-2(Ang-2)水平与术后复发及预后的关系.方法 采用ELISA 法检测85 例进展期胃癌患者根治术前、术后1 个月及30 位健康对照者血清Ang-2 水平;术后随访3 年,胃癌复发患者及未复发患者复查血清Ang-2 水平.分析影响术前血清Ang-2 水平升高的因素,探讨血清Ang-2 水平变化与术后复发及预后的关系.结果 进展期胃癌组术前血清Ang-2 水平显著高于正常对照组[(345.3 ±141.8)μg/L vs.(187.4 ±32.7)μg/L,P ＜0.01],术后1 个月血清Ang-2 水平显著降低(P ＜0.01).术后复发组血清Ang-2 水平显著高于术后1 个月组和未复发组[(288.7 ±97.8)μg/L vs.(210.5 ±63.4)μg/L,(231.1 ±68.2)μg/L,P ＜0.01].单因素分析显示术前血清Ang-2 水平升高与肿瘤大小、Borrmann 分型、分化程度、淋巴结转移率、浸润深度相关(P ＜0.05),而与肿瘤组织类型无关(P ＞0.05).Logistic 多因素回归分析显示肿瘤大小、分化程度、淋巴结转移、浸润深度是影响进展期胃癌术前血清Ang-2 水平升高的独立危险因素.术前高血清Ang-2 水平负面影响术后生存率和复发率.结论 进展期胃癌术前血清Ang-2 水平升高与多种重要肿瘤病理特征相关,可能是影响预后的重要因素,有助预后评价;术后血清Ang-2 水平变化有助监测术后复发.     

局部晚期非小细胞肺癌患者心脏受照射剂量与预后的关系

目的探讨心脏放射剂量与局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的关系。方法回顾性分析2015年8月至2018年9月于河北省唐山市人民医院接受放射治疗的180例局部晚期NSCLC患者的临床数据和心脏剂量参数,采用K-M分析心脏剂量参数与总生存率的关系,通过多因素COX回归识别NSCLC患者预后的相关因子。结果NSCLC患者的中位生存时间为33.4个月。单因素分析提示计划靶区剂量≥56 Gy(HR1.54,95%CI1.28~2.86,P=0.011)、高血压(HR1.42,95%CI1.34~1.89,P=0.012)、平均心脏剂量≥13.9 Gy(HR1.12,95%CI1.05~2.61,P=0.031)、V5≥70%(HR1.08,95%CI1.01~2.16,P=0.044)、V30≥40%(HR1.16,95%CI1.04~3.01,P=0.041)、V50≥20%(HR1.23,95%CI1.11~2.81,P<0.001)和V60≥5%(HR1.03,95%CI1.00~1.89,P=0.037)是NSCLC患者预后的相关因素。经过多因素调整之后,化疗是NSCLC患者预后的有利因素(HR0.711,95%CI0.35~0.89,P=0.005);患有高血压是预后不良的相关因素(HR1.641,95%CI1.56~1.86,P=0.034);心脏剂量中的V50≥20%(HR1.161,95%CI1.13~3.82,P=0.002)是NSCLC患者预后不良的相关因素。结论心脏剂量中V50是晚期NSCLC患者预后的独立预测因子,心脏照射剂量的增加,可以增加潜在的死亡风险,临床实践中可以通过减少心脏放射剂量来改善患者预后。     

Family functioning and psychological distress among Japanese breast cancer patients and families

Goals of work The purpose of this study was to develop a typology of family functioning in the families of breast cancer patients.Patients and methods Seventy-four families (189 individuals: 74 patients, 54 spouses, 46 offspring, and 15 other relatives) completed self-report questionnaires. Perception of family functioning was assessed using the family relationship index (FRI) and its three dimensions (cohesiveness, expressiveness, and conflict) and was classified into groups by a cluster analytic approach. Psychological distress was assessed using the Zung self-rating depression scale (SDS) and the Zung self-rating anxiety scale (SAS).Main results Cluster analysis yielded three groups of patients and their family members: one cluster with high cohesiveness, high expressiveness, and low conflict (supportive type: n=64); a second group with low cohesiveness, low expressiveness, and high conflict (conflictive type: n=65); and a third group with limited cohesiveness, limited expressiveness, and low conflict (intermediate type: n=60). Analysis of variance revealed that conflictive families manifested the highest level of depression and anxiety among these clusters.Conclusions Typology of family functioning can identify psychologically at-risk families. A family-focused approach can help to reduce psychological distress, especially in conflictive families.     

Association between race and physical functioning limitations among breast cancer survivors

Purpose

The goal of this study was to examine differences in physical functioning limitations among African-American and white breast cancer survivors.

Methods

Data were analyzed from 115 African-American and 712 white breast cancer survivors who responded to a hospital registry-based survey. Physical functioning limitations were assessed using a series of eight questions in which individuals were asked about their ability to perform a physical task such as walking a quarter of a mile. A four-category summary score, representing overall severity of limitation, was created using participant responses to the eight questions. Ordinal logistic regression was used to estimate the odds ratio (OR) and 95 % confidence interval (CI) for the association between race and physical functioning limitation adjusted for potential confounders.

Results

In the unadjusted model, the African-American breast cancer survivors were more than twice as likely to have a greater degree of physical functioning limitation compared to their white counterparts (OR 2.31; 95 % CI 1.59, 3.38). After adjustment for covariates, including body mass index (BMI), the race OR was attenuated and no longer statistically significant (OR 1.44; 95 % CI 0.92, 2.27).

Conclusions

Findings from this study showed that African-American breast cancer survivors were more likely to have worse physical functioning limitations than their white counterparts; however, much of this disparity was due to racial differences in other variables such as BMI. Future research should focus on effective interventions targeting modifiable risk factors of physical functioning limitations among breast cancer survivors with the goal of improving quality of life.     

癌症患者身心健康状况与其临床决策倾向性的相关性

目的了解癌症患者身心健康状况与临床决策中对医生、患者及家属意见倾向性的相关性。方法选取2008年9月至12月在北京市某三级甲等肿瘤专科医院内科住院治疗的120例癌症患者进行问卷调查。结果经非参数检验,血常规结果不同,癌症患者的临床决策倾向性不同(P0.05);经Spearman相关分析,病程、欧洲五维健康量表得分、欧洲五维直观式健康量表得分和卡氏评分与癌症患者的临床决策倾向性有关。心理健康状况与临床决策倾向性不相关(P0.05)。结论癌症患者身体健康状况与临床决策倾向性相关,但未发现心理健康状况与临床决策倾向性的相关性。     

Factors influencing constipation in advanced cancer patients: a prospective study of opioid dose,dantron dose and physical functioning

The relationship between opioid dose, dantron dose, bowel function and physical functioning (measured with the modified Barthel Index) was determined in a sample of 50 inpatients with advanced cancer. Data were collected prospectively from chart review and patient interviews one week after admission to allow for protocol-driven management of constipation to be established. Bowel scores were significantly reduced in 35 patients treated with opioids compared with 15 patients not treated with opioids. Within the opioid group, however, there was no relationship between opioid dose, bowel score, dantron dose or Barthel Index. Higher doses of dantron were associated with better physical functioning (but not opioid dose) suggesting that for any given dose of opioid, fitter patients were treated with larger doses of laxatives. Factors other than opioid dose and physical functioning may be more important in contributing to constipation in this group of patients. Less potent opioid drugs, such as codeine, are just as likely to cause constipation as more potent opioids.