Family Communication and Coping with Cancer

This study was designed to (1) explore the role of communication in family coping and (2) assess the impact of a weekend intervention designed to enhance communication in families experiencing cancer. Data were collected from 14 families participating in a weekend retreat program (The Massachusetts We Can Weekend). Those families who communicated frequently and used a variety of coping strategies reported less difficulty coping with cancer than did those who used fewer strategies. Although the findings are limited, they suggest that participating in interventions such as the We Can Weekend can enhance family members' ability to cope by increasing their use of communication and social support.     

Epidemiologic differences between women with colorectal cancer and women with ovarian cancer

BACKGROUND AND OBJECTIVES: The difference between the epidemiologic features of women with colorectal cancer and those with ovarian cancer has not been thoroughly studied. The aim of this study is to review the epidemiologic features of women with colorectal cancer and compare them with those of women with ovarian cancer. METHODS: The epidemiologic features of 705 women with colorectal cancer were compared with those of 503 women with primary epithelial ovarian cancer. Both groups included all women with the confirmed respective histologic diagnoses admitted to Roswell Park Cancer Institute between 1982 and 1996 who returned a voluntary self-administered epidemiologic questionnaire. RESULTS: Women with ovarian cancer were significantly younger, had higher education and income, had fewer children, and were more likely to have never been married and nulligravid than those with colorectal cancer. There was a significant difference in the contraceptive history between both groups among women > or = 45 years of age. More women with ovarian cancer had a family history of ovarian cancer and more women with colorectal cancer had a family history of colorectal cancer. CONCLUSIONS: The epidemiologic features of women with colorectal cancer are different from those with ovarian cancer. The difference between both groups might indicate difference in the environmental or genetic etiology of both cancers.     

Psychological Distress Among Adolescents Living with a Parent with Advanced Cancer

The objective of this exploratory study was to evaluate the impact of advanced parental cancer on adolescents’ psychological status. A sample of 28 adolescents, having a parent with advanced cancer, was recruited and compared with a sample from the general population (N = 2,346). Late adolescents (age 15 to 18) experienced significantly more psychological distress than early adolescents (age 12 to 14). Moreover, late adolescents experienced significantly higher psychological distress than the general population for the same age group, which was not the case for early adolescents. Implications for adolescents living in families touched by advanced cancer are discussed.     

Analysis of multiple primary cancers in patients with urologic cancer

Background The study of the clinical features of multiple primary cancers (MPC) may provide insight into the pathogenesis of specific cancers, as well as the issue of treatment-related induction of second tumors. Methods Between 1972 and 1995, 94 of 765 patients with urologic cancer treated at our hospital had MPC. We retrospectively analyzed the clinical features of these patients, and compared them with those of the 671 patients with single primary cancers (SPC). Results The frequency of MPC among all 765 patients was 12.3%. The average age at diagnosis of urologic cancer in the male patients was significantly higher in the MPC group than in the SPC group. In the MPC group, the organs most commonly involved were the bladder and prostate (urologic cancers), and the stomach and lung (nonurologic cancers). Adenocarcinoma was the most common tumor in the MPC group. The interval between the first and second cancer diagnoses was significantly longer in female patients with MPC than in male patients. No significant difference between the MPC and SPC groups was observed in the distribution of ABO blood groups or in the frequency of history of tobacco or alcohol use. Four MPC patients had second cancers considered to have been induced by the treatment for the first cancer. The prognoses were significantly poorer for the patients with MPC. The rate of death due to urologic cancer was much lower in the patients with MPC than in those with SPC. Conclusions We found that more than 10% of the 765 patients with urologic cancer whose cases we reviewed had another primary cancer. Because the number of cases of MPC is increasing, it is important to be aware of the possibility of the development of MPC and to therefore carefully follow up cancer patients.     

Survival of patients with oesophageal and gastric cancers in Europe

The EUROCARE study is a European Union project to collect survival data from population-based cancer registries and analyse them according to standardised procedures. We investigated and compared oesophageal and gastric cancer survival in 17 countries between 1985 and 1989. Time trends in survival over the 1978–1989 period were also investigated in 13 countries. The overall European 1-year relative survival rates were 33% for oesophageal cancer and 40% for gastric cancer. The corresponding 5-year relative survival rates were 10 and 21%, respectively. Important intercountry survival differences exist within Europe for oesophageal and gastric cancer. Taking the European average as the reference, the relative risk (RR) of death at 5 years was at least 30% higher in Denmark, Poland, Estonia and Slovenia for oesophageal cancer and in Denmark, England, Scotland and Poland for gastric cancer. In the other countries survival figures were close to the European average. Gender had little influence on survival, whilst age at diagnosis was inversely related to prognosis. There was a slight improvement between 1978 and 1989 in 5-year overall relative survival rates for both oesophageal cancer (RR=0.80, 95% confidence interval (CI) 0.72–0.90) and gastric cancer (RR=0.88, 95% CI 0.82–0.94). Differences in quality of care and stage at diagnosis can explain in part the differences in survival found in the EUROCARE countries. Significant improvement in prognosis has still to be achieved.     

Cancer incidence in people with AIDS in Italy

People with HIV/AIDS (PWHA) have increased risk of some cancers. The introduction of highly active antiretroviral therapies (HAART) has improved their life expectancy, exposing them to the combined consequences of aging and of a prolonged exposure to cancer risk factors. The aim of this study was to estimate incidence rates (IR) in PWHA in Italy, before and after the introduction of HAART, after adjusting for sex and age through direct standardization. An anonymous record linkage between Italian AIDS Registry (21,951 cases) and Cancer Registries (17.3 million, 30% of Italian population) was performed. In PWHA, crude IR, sex‐ and age‐standardized IR and age‐specific IR were estimated. The standardized IR for Kaposi sarcoma and non‐Hodgkin lymphoma greatly declined in the HAART period. Although the crude IR for all non‐AIDS‐defining cancers increased in the HAART period, standardized IR did not significantly differ in the 2 periods (352 and 379/100,000, respectively). Increases were seen only for cancer of the liver (IR ratio = 4.6, 95% CI: 1.3–17.0) and lung (IR ratio = 1.8, 95% CI: 1.0–3.2). Age‐specific IRs for liver and lung cancers, however, largely overlapped in the 2 periods pointing to the strong influence of the shift in the age distribution of PWHA on the observed upward trends. In conclusion, standardized IRs for non‐AIDS‐defining cancers have not risen in the HAART period, even if crude IRs of these cancers increased. This scenario calls, however, for the intensification of cancer‐prevention strategies, notably smoking cessation and screening programs, in middle‐aged HIV‐patients.     

Variation in survival of adult patients with thyroid cancer in Europe

The survival of patients with thyroid cancer was analysed using population-based EUROCARE II data from 1978–1989 (trends in survival) and 1985–1989 (cross-sectional comparisons between areas). The data consisted of 7504 patients and covered 37 cancer registration areas in 17 European countries. In 90% of the patients the diagnosis was histologically confirmed. The prognosis of patients with thyroid cancer was relatively favourable. The overall 5-year relative survival rate was 72% for men and 80% for women. Substantial variation in this 5-year rate was observed between countries ranging from 59 to 83% in men and from 72 to 84% in women. Higher than average survival rates were observed in Finland, Iceland, The Netherlands and Sweden. Countries with lower than average rates were Denmark, England, Estonia, Slovakia, Slovenia and Poland (women). Elderly patients had lower survival rates than the younger ones. Time trends in survival (which could be analysed only in selected countries with sufficient numbers of cases) were irregular but generally showed slight increases compared with rates in 1978–1980. Different distributions in the histological subtypes of thyroid cancer is one plausible explanation for the variation in the survival rate. Other likely factors contributing to this are differences in the stage distribution and varying efficacy of treatment. The EUROCARE II data did not permit specific analyses of the roles of various prognostic factors.     

Meta-analysis of 16 studies of the association of alcohol with colorectal cancer

Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of 16 studies of CRC to examine the shape of the alcohol–CRC association, investigate potential effect modifiers of the association, and examine differential effects of alcohol consumption by cancer anatomic site and stage. We collected information on alcohol consumption for 14,276 CRC cases and 15,802 controls from 5 case-control and 11 nested case-control studies of CRC. We compared adjusted logistic regression models with linear and restricted cubic splines to select a model that best fit the association between alcohol consumption and CRC. Study-specific results were pooled using fixed-effects meta-analysis. Compared to non-/occasional drinking (≤1 g/day), light/moderate drinking (up to 2 drinks/day) was associated with a decreased risk of CRC (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.88–0.98, p = 0.005), heavy drinking (2–3 drinks/day) was not significantly associated with CRC risk (OR: 1.11, 95% CI: 0.99–1.24, p = 0.08) and very heavy drinking (more than 3 drinks/day) was associated with a significant increased risk (OR: 1.25, 95% CI: 1.11–1.40, p < 0.001). We observed no evidence of interactions with lifestyle risk factors or of differences by cancer site or stage. These results provide further evidence that there is a J-shaped association between alcohol consumption and CRC risk. This overall pattern was not significantly modified by other CRC risk factors and there was no effect heterogeneity by tumor site or stage.     

Factors Associated with “Survivor Identity” in Men with Breast Cancer

Cancer patients vary in their comfort with the label “survivor”. Here, we explore how comfortable males with breast cancer (BC) are about accepting the label cancer “survivor”. Separate univariate logistic regressions were performed to assess whether time since diagnosis, age, treatment status, and cancer stage were associated with comfort with the “survivor” label. Of the 70 males treated for BC who participated in the study, 58% moderately-to-strongly liked the term “survivor”, 26% were neutral, and 16% moderately-to-strongly disliked the term. Of the factors we explored, only a longer time since diagnosis was significantly associated with the men endorsing a survivor identity (OR = 1.02, p = 0.05). We discuss how our findings compare with literature reports on the comfort with the label “survivor” for women with BC and men with prostate cancer. Unlike males with prostate cancer, males with BC identify as “survivors” in line with women with BC. This suggests that survivor identity is more influenced by disease type and treatments received than with sex/gender identities.     

食管贲门癌合并哮喘的外科治疗

目的　为了探讨食管癌贲门癌合并哮喘的最佳治疗方法以提高生存率及生活质量。方法　我院于 1994年 3月～ 1998年 12月共收治此类病人 15例 ,均采用左后外侧开胸 ,食管贲门癌切除 ,胃代食管 ,食管 胃吻合术并附以左肺减容术 ,食管胃颈部吻合 4例 ,弓上吻合 2例 ,弓下吻合 9例 ;减容术 15例 ,左上叶切除 7例 ,肺段切除术 5例 ,楔形切除 3例。分别在术前、术后 ,一周、四周、三月分别测试肺功能、血气、6分钟走。结果　术后出现并发症 6例 (4 0 % )其中肺部感染 1例 ,心律失常 3例 ,支气管胸膜瘘 2例 ,死亡 2例为心肺功能衰竭。术后四周测定 13例病人肺功能、6分钟走、血气等各项指标均比术前不同程度地改善 ,3个月最为明显。FEV1术前 1.15± 0 .0 6 (L) ,术后为 1.43± 0 .12 (L) ;FVC术前 2 .6 5± 0 .2 5 (L) ,术后 3 .0 6± 0 .2 0 (L) ,PaO2 术前 6 9.4± 4(mmHg) ,术后 75± 4(mmHg) ;6分钟走术前 12 0 0±10m ,术后 14 75± 15m。呼吸困难指数术后平均下降 1.5分。结论　早中期食管贲门癌合并哮喘采用一次性肿瘤切除及肺减容术。术后病人生活质量及生存率有不同程度提高 ,是一种有效的治疗方法。     

Improvement in survival of patients with cancer of the kidney in Europe

Survival of adult patients with cancer of the kidney, renal pelvis, ureter and urethra (ICD-9 189) was analysed using data from the EUROCARE II study, a collaborative project of 45 population-based cancer registries in 17 European countries. For the period 1985-1989, more than 24000 patients were included and 5-year relative survival was 48%. Large variations were observed between countries with 5-year relative survival ranging from 57% in France, 53% in Italy and 51% in Spain to 35% in Denmark, 33% in Poland and 30% in Estonia. A number of registries also provided information on previous years and survival was seen to improve with time from 44% in 1978-1980 to 50% in 1987-1989. Age was an important determinant of survival with 5 year survival rates decreasing from 63% in patients aged 15-44 years to 36% in patients aged 75 years and older. Variation in survival rates by country or time is probably related to differences in the distribution of tumour stage at diagnosis. Evidence to confirm this theory is, however, lacking.     

Screen-detected colorectal cancers are associated with an improved outcome compared with stage-matched interval cancers

Background:

Colorectal cancers (CRCs) detected through the NHS Bowel Cancer Screening Programme (BCSP) have been shown to have a more favourable outcome compared to non-screen-detected cancers. The aim was to identify whether this was solely due to the earlier stage shift of these cancers, or whether other factors were involved.

Methods:

A combination of a regional CRC registry (Northern Colorectal Cancer Audit Group) and the BCSP database were used to identify screen-detected and interval cancers (diagnosed after a negative faecal occult blood test, before the next screening round), diagnosed between April 2007 and March 2010, within the North East of England. For each Dukes'' stage, patient demographics, tumour characteristics, and survival rates were compared between these two groups.

Results:

Overall, 322 screen-detected cancers were compared against 192 interval cancers. Screen-detected Dukes'' C and D CRCs had a superior survival rate compared with interval cancers (P=0.014 and P=0.04, respectively). Cox proportional hazards regression showed that Dukes'' stage, tumour location, and diagnostic group (HR 0.45, 95% CI 0.29–0.69, P<0.001 for screen-detected CRCs) were all found to have a significant impact on the survival of patients.

Conclusions:

The improved survival of screen-detected over interval cancers for stages C and D suggest that there may be a biological difference in the cancers in each group. Although lead-time bias may have a role, this may be related to a tumour''s propensity to bleed and therefore may reflect detection through current screening tests.     

胃癌卵巢转移临床病理特点及误诊原因分析

目的探讨胃癌卵巢转移患者的临床病理特点及误诊原因。方法对1990年1月至2004年6月发生的52例胃癌卵巢转移患者的临床资料、病理结果及误诊原因进行回顾性分析。结果胃癌卵巢转移患者平均年龄(40.15±1.28)(22￣64)岁,常以卵巢转移灶为首发表现。B超检查以混合性包块或实质性包块为主要表现,多伴有腹腔积液,双侧卵巢转移瘤占76.9%。血清C A125升高,平均(99.85±14.23)U/m L,但显著低于同期原发性卵巢癌(P<0.05)。术前诊断准确率低(46.1%)。结论胃癌卵巢转移与原发性恶性肿瘤无可靠的鉴别诊断标准,卵巢转移瘤超声、C T等影像检查技术无特异性,术前诊断需行多方面的综合分析。     

Surgical Outcomes of Patients with Stage IA2 Cervical Cancer Treated with Radical Hysterectomy

Background: This study was undertaken to evaluate the surgical outcomes of patients with stage IA2 cervicalcancer treated with radical hysterectomy. Data for 58 patients who underwent modified radical hysterectomyor radical hysterectomy with pelvic lymphadenectomy between January 2003 and December 2012 at ChiangMai University Hospital were retrospectively reviewed. The analysis included clinico-pathological risk factors(nodal metastasis, parametrial involvement), adjuvant treatment, 5-year disease-free survival and 5-year overallsurvival. All pathologic slides were reviewed by a gynecologic pathologist. Follow-up methods included at leastcervical cytology and colposcopy with directed biopsy if indicated. Univariate analysis was performed to identifyfactors associated with median survival. At the median follow up time of 73 months, the 5-year disease-freesurvival and the 5-year overall survival were 97.4% and 97.4%, respectively. Two (3.4%) patients had pelviclymph node metastases. In a univariate analysis, there was no statistically significant association between survivaland prognostic factors such as age, histological cell type, lymph-vascular space invasion, vaginal margin statusand lymph node status. Surgical and survival outcomes of women with stage IA2 cervical cancer are excellent.No parametrial involvement was detected in our study. Patients with stage IA2 cervical cancer may be treatedwith simple or less radical hysterectomy with pelvic lymphadenectomy.     

放疗联合骨肿瘤切除术对不同分期骨癌患者的临床治疗效果评价

目的探讨并分析放疗联合骨肿瘤切除术对不同分期骨癌患者的临床疗效。方法选择60例骨癌患者为研究对象,根据其肿瘤分期及恶性程度分为低恶组和高恶组,两组均采用放疗联合骨肿瘤切除术进行治疗,术后采用VAS评分评估两组患者骨癌痛程度,统计两组治疗后随访6个月内局部肿瘤控制率、复发情况以及并发症发生率,并进行比较。结果①术后3 h,两组患者疼痛程度评分相比差异不具有统计学意义(P>0.05),术后1 d~2 d,低恶组患者放疗联合骨肿瘤切除术后疼痛程度评分均显著低于高恶组(P<0.05);②与低恶组相比,高恶组患者局部肿瘤控制有效率显著降低,生存期显著缩短,差异均具有统计学意义(P<0.05);③低恶组和高恶组复发率相比差异无统计学意义(P>0.05);④两组患者术后并发症相比,低恶组显著低于高恶组(P<0.05)。结论放疗联合骨肿瘤切除术对早期骨癌患者具有较好的治疗效果,术后疼痛程度和并发症降低、肿瘤控制有效率提升,从而使得患者生存期显著延长,推荐用于早期骨癌患者的临床治疗。     

Effects of Tamoxifen on the Cervix and Uterus in Women with Breast Cancer: Experience with Iranian Patients and a Literature Review

Objective: Invasive breast cancer is the most common malignancy in women. Due to the declining mortalityrate that is partly attributable to the use of screening mammography and effective adjuvant therapy, morewomen survive their breast cancers. The aim of this study was to evaluate the effects of tamoxifen on the genitaltract with particular attention to the uterus and cervix. Methods: We investigated the relationship betweentamoxifen and cervical or uterine cancer in Iran, reviewing all the studies performed by the Vali-Asr GynecologyOncology Clinic in Tehran. In addition, the available data on Medline from 1980 until 2009 were reviewed.Results: A total of 182 articles showed associations with gynecologic malignancies. Although as many as 121refered to links between the drug and endometrial abnormalities (polyps or cancers), 55 articles studied therelationship with changes of pap smears, four of which indicated isolated cervical metastasis followed tamoxifenuse in patients with breast cancer. Conclusion: In spite of the significant relationship between tamoxifen andendometrial cancers, cervix is rarely involved in breast cancer patients. However, vaginal bleeding or abnormalvaginal discharge has been reported in all cases before the diagnosis was made. To rule out genital tract malignancy,it is necessary, therefore, to have an annual pelvic exam, pap smear and early endometrial with endocervicalcurettage for tamoxifen users following a breast cancer in those with abnormal uterine bleeding or persistentvaginal discharge.