Impact of a walking intervention on cardiorespiratory fitness,self‐reported physical function,and pain in patients undergoing treatment for solid tumors

BACKGROUND:

Cancer treatment is associated with decline in measured and self‐reported physical function and increased pain. In the current study, the authors evaluated the impact of a walking intervention on these outcomes during chemotherapy/radiation.

METHODS:

Patients with breast, prostate, and other cancers (N=126) were randomized to a home‐based walking intervention (exercise) or usual care (control). Exercise dose during the intervention was assessed using a 5‐item Physical Activity Questionnaire. Outcome measures were cardiorespiratory fitness, expressed as peak oxygen uptake (VO₂) measured during treadmill testing (n = 85) or estimated by 12‐minute walk (n = 27), and self‐reported physical function, role limitations, and pain derived from Medical Outcomes Study Short Form 36. Linear regression was used to evaluate pre‐to‐post intervention change outcomes between groups.

RESULTS:

The mean (standard deviation) age of the patients was 60.2 (10.6) years. Diagnoses included prostate (55.6%) and breast (32.5%) cancer. Treatment included external beam radiotherapy (52.3%) and chemotherapy (34.9%). Exercise patients reported worsening Medical Outcomes Study physical function role limitations by the end of cancer treatment (P = .037). Younger age was associated with improved Medical Outcomes Study physical function (P = .048). In all patients, increased exercise dose was associated with decreased Medical Outcomes Study pain (P = .046), regardless of diagnosis. The percent change of VO₂ between prostate and nonprostate cancer patients when adjusted for baseline VO₂ and Physical Activity Questionnaire values was 17.45% (P = .008), with better VO₂ maintenance in the prostate group.

CONCLUSIONS:

Exercise during cancer treatment improves cardiorespiratory fitness and self‐reported physical function in prostate cancer patients and in younger patients, regardless of diagnosis, and may attenuate loss of those capacities in patients undergoing chemotherapy. Exercise also reduces the pain experience. Cancer 2009. © 2009 American Cancer Society.     

Music as a therapeutic intervention for anxiety in patients receiving radiation therapy.

PURPOSE/OBJECTIVES: To determine whether music moderates the level of anxiety that patients experience during radiation therapy. DESIGN: Experimental, longitudinal, random assignment to music or no music therapy. SETTING: Urban radiation oncology center in a Department of Veterans Affairs hospital in the southeastern United States. SAMPLE: Forty-two men (19 in the experimental group, 23 in the control group) aged 39-80 years (74% white, 12% African American, 12% Hispanic, and 2% other) receiving definitive external beam radiation therapy for pelvic or abdominal malignancies. METHODS: Patients in the experimental group listened to music of their choice provided via audiotapes and headphones before and during their simulation and daily treatments for the duration of the planned course of therapy. The control group received standard care. The State-Trait Anxiety Inventory was administered initially to participants in both groups at the time of evaluation (time 1), post-simulation (time 2), at the end of the first week (time 3), at the end of the third week (time 4), and at the end of the fifth week or end of radiation therapy (time 5). MAIN RESEARCH VARIABLE: State anxiety. FINDINGS: No significant difference existed between the two groups to suggest that music moderated the level of anxiety during radiotherapy. However, post-hoc analyses identified changes and trends in state anxiety scores, suggesting a possible benefit of music therapy during radiotherapy. CONCLUSIONS: Despite a lack of group differences, early intervention with music therapy for patients with high levels of anxiety may be beneficial. IMPLICATIONS FOR NURSING PRACTICE: Nurses and other clinicians may administer state anxiety scales at the initial visit or prior to pretreatment radiation planning (simulation). Individuals who have high state anxiety scores may receive nursing interventions tailored to reduce anxiety during simulation and the early part of radiotherapy.     

Cancer Treatment Survey (CaTS): development and validation of a new instrument to measure patients' preparation for chemotherapy and radiotherapy

Objective: Cancer patients experience high levels of pre‐treatment anxiety. Chemotherapy and radiotherapy are threatening medical procedures. Preparation for these procedures should include the provision of sensory and procedural information, and addressing fears. The aim of this study was to develop a cancer treatment survey (CaTS) to assess the preparation for chemotherapy and radiotherapy in cancer patients. Methods: Drawing on evidence for how to prepare patients for threatening procedures, items were generated by psychosocial/clinical experts and pilot tested with cancer patients. The 36‐item draft CaTS was administered to 192 cancer patients commencing chemotherapy for lymphoma, breast or colon cancer. Participants also completed the Hospital Anxiety and Depression Scale (HADS) and basic medical and demographic information was recorded. Results: A systematic process of item selection removed 11 items. Factor analysis indicated a two‐factor solution, with 11 items representing sensory/psychological concerns and 14 items representing procedural concerns. The two subscales demonstrated excellent internal reliability with Cronbach's alpha both over 0.90 and the average inter‐item correlation for each scale exceeded 0.30. Divergent validity was established for both CaTS subscales with the HADS‐A and‐T (all r<0.30). Younger participants (under 65 years of age) had significantly greater procedural concerns (p = 0.001; medium effect). Conclusions: The CaTS is a two factor, 25‐item measure that assesses sensory/psychological concerns and procedural concerns relating to cancer treatment. The instrument provides a reliable and valid outcome measure for interventions to prepare cancer patients for chemotherapy and radiotherapy. Copyright © 2010 John Wiley & Sons, Ltd.     

Caregivers' anxiety and self‐efficacy in palliative care

MYSTAKIDOU K., PARPA E., PANAGIOTOU I., TSILIKA E., GALANOS A. & GOULIAMOS A. (2012) European Journal of Cancer Care 22 , 188–195 Caregivers' anxiety and self‐efficacy in palliative care This study examined the relationship between caregivers' anxiety supporting a patient with advanced cancer and self‐efficacy and their socio‐demographic characteristics, and then whether these variables could influence their self‐efficacy. One hundred and seven caregivers of advanced cancer patients participated in the study and completed the Greek versions of the State–Trait Anxiety Inventory (STAI) and the General Perceived Self‐efficacy Scale (GSE). Significant comparisons were found between State anxiety and female gender (P= 0.009), cohabitation (P= 0.002) and relationship with the patient (P= 0.004); statistically significant associations were found between State, Trait anxiety and self‐efficacy scores of caregivers (P < 0.0005 respectively). A multiple regression model (enter method) showed women (P= 0.005), spouses (P= 0.01) and self‐efficacy (P= 0.02) as the significant predictors of State anxiety. Furthermore, self‐efficacy seemed to be the strongest contributor of trait anxiety (P < 0.0005). Female caregivers and spouses of advanced cancer patients experience more state anxiety levels than men and other caregivers respectively. In addition, caregivers with low self‐efficacy are more likely to have elevated anxiety scores than self‐efficacious caregivers. These findings can help healthcare professionals focus on some problems common to caregivers of cancer patients and plan appropriate interventions.     

High‐dose chemotherapy and autologous hematopoietic progenitor cell rescue in children with recurrent medulloblastoma and supratentorial primitive neuroectodermal tumors

BACKGROUND:

The role of myeloablative chemotherapy in children with recurrent medulloblastoma and supratentorial primitive neuroectodermal tumors (MB/ST‐PNET) is controversial, in particular in patients who develop recurrent disease after craniospinal radiotherapy.

METHODS:

In this retrospective analysis, the authors investigated the outcome of children with recurrent MB/ST‐PNET who were referred for myeloablative chemotherapy and autologous hematopoietic progenitor cell rescue at Childrens Hospital Los Angeles.

RESULTS:

Thirty‐three children were referred for myeloablative chemotherapy: Fourteen of those children were never transplanted because of pre‐transplant adverse events, and 19, including 6 without and 13 with previous irradiation, underwent transplant. Conditioning regimens included a backbone of thiotepa, which was given either in a single cycle or in multiple sequential cycles. The 3‐year post‐transplant event‐free survival rate in unirradiated versus previously irradiated children was 83% ± 15% versus 20% ± 12%, respectively (P = .04). One child who had never been exposed to radiotherapy died of toxicity; the other children received post‐transplant radiotherapy and remained disease free. Nine previously irradiated children experienced 4 toxic deaths and 6 tumor recurrences (1 patient had both): An interval of <1 year between initial radiotherapy and myeloablative chemotherapy predicted a greater risk of toxic death (P = .02), whereas a history of meningeal metastases at diagnosis and a poor response to the initial rescue therapy predicted a greater risk of post‐transplant recurrence (P = .03 and P = .08, respectively).

CONCLUSIONS:

Myeloablative doses of thiotepa‐based chemotherapy and radiotherapy were able to cure most children who had radiotherapy‐naive, chemoresponsive recurrences. Children who developed recurrences after craniospinal radiotherapy had poorer outcomes; however, cure was possible in those who had good prognostic features at presentation, chemoresponsive recurrences, and a long interval between initial radiotherapy and myeloablative chemotherapy. Cancer 2009. © 2009 American Cancer Society.     

Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy

BACKGROUND:

Success rates with salvage radiotherapy (SRT) in men who have a postprostatectomy biochemical relapse are suboptimal. One treatment‐intensification strategy includes elective irradiation of the pelvic lymph nodes with whole pelvis radiotherapy (WPRT).

METHODS:

An inter‐institutional retrospective cohort study compared outcomes for patients who received SRT at 2 separate academic institutions with disparate treatment paradigms: almost exclusively favoring WPRT (n = 112) versus limiting treatment to the prostate bed (PBRT) (n = 135). Patients were excluded if they had lymph node involvement or if they received androgen‐deprivation therapy. The Cox proportional hazards model was used to adjust for potential confounders.

RESULTS:

In total, 247 patients were analyzed with a median follow‐up of 4 years. The pre‐SRT prostate‐specific antigen (PSA) level (adjusted hazard ratio [HR], 1.58; P < .0001) and a Gleason score of 8 to 10 (adjusted HR, 3.21; P < .0001) were identified as independent predictors of increased risk of biochemical PSA progression after SRT. However, WPRT was not independently associated with biochemical progression‐free survival in the multivariate model (adjusted HR, 0.79; P = .20). Neither low‐risk patients nor high‐risk patients (defined a priori by a preoperative PSA level ≥20 ng/mL, a pathologic Gleason score between 8 and 10, or pathologic T3 tumor classification) benefited from WPRT. Overall survival was similar between treatment groups. When restricting the analysis to patients with pre‐SRT PSA levels ≥0.4 ng/mL (n = 139), WPRT was independently associated with a 53% reduction in the risk of biochemical progression (adjusted HR, 0.47; P = .031).

CONCLUSIONS:

WPRT did not improve outcomes among the entire group but was independently associated with improved biochemical control among patients with pre‐SRT PSA levels ≥0.4 ng/mL. Cancer 2013. © 2012 American Cancer Society.     

Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact?

A better understanding of the role of psychosocial resources and factors associated with participating in patient support groups appears to be important for the development and implementation of cancer survivorship care plans. We therefore investigated the frequency of participation in and satisfaction with patient support groups after completion of a rehabilitation programme and aimed to examine differences in demographic, medical and psychosocial characteristics between group participants and non‐participants. We further aimed to identify predictors of participation in patient support groups. A total of 1281 eligible patients (75.5% participation rate) were recruited on average 11 months post diagnosis and assessed at the beginning (t₁), at the end (t₂) and 12 months after rehabilitation (t₃). Study participants completed self‐report measures assessing support‐group participation and satisfaction, psychosocial distress (anxiety, fear of cancer recurrence, depression), social support, coping, quality of life, pain and treatment‐related characteristics. Sixty‐seven patients (7.6%) participated in a patient self‐help group. Being unemployed, undergoing an increased number of overall treatments, and a higher active emotion‐oriented coping style significantly predicted self‐help group participation; the predictive power of the multivariate logistic regression model was rather weak (Nagelkerke's R² = 0.07). Our data provide evidence that self‐help group participation in cancer patients may be largely related to other factors than medical or psychosocial distress.     

Limited Impact of Music Therapy on Patient Anxiety with the Large Loop Excision of Transformation Zone Procedure - a Randomized Controlled Trial

Background: Many studies have pointed to strategies to cope with patient anxiety in colposcopy. Evidence shows that patients experienced considerable distress with the large loop excision of transformation zone (LLETZ) procedure and suitable interventions should be introduced to reduce anxiety. This study aimed to investigate the effects of music therapy in patients undergoing LLETZ. Materials and Methods: A randomized controlled trial was conducted with patients undergoing LLETZ performed under local anesthesia in an out patient setting at Ramathibodi Hospital, Bangkok, Thailand, from February 2015 to January 2016. After informed consent and demographic data were obtained, we assessed the anxiety level using State Anxiety Inventory pre and post procedures. Music group patients listened to classical songs through headphones, while the control group received the standard care. Pain score was evaluated with a visual analog scale (VAS). Statistical analysis was conducted using Pearson Chi-square, Fisher’s Exact test and T-Test and p-values less than 0.05 were considered statistically significant. Results: A total of 73 patients were enrolled and randomized, resulting in 36 women in the music group and 37 women in the non-music control group. The preoperative mean anxiety score was higher in the music group (46.8 VS 45.8 points). The postoperative mean anxiety scores in the music and the non-music groups were 38.7 and 41.3 points, respectively. VAS was lower in music group (2.55 VS 3.33). The percent change of anxiety was greater in the music group, although there was no significant difference between two groups. Conclusions: Music therapy did not significantly reduce anxiety in patients undergoing the LLETZ procedure. However, different interventions should be developed to ease the patients’ apprehension during this procedure.     

Disruption to radiation therapy sessions due to anxiety among patients receiving radiation therapy to the head and neck area can be predicted using patient self-report measures

Objective: This analysis sought to determine whether patient self‐report measures were associated with disruption to radiation therapy sessions due to anxiety among cancer patients undergoing radiation therapy to the head and neck region. Method: A cohort of patients undergoing radiation therapy to the head and neck region at a major regional radiation oncology treatment centre (ROTC) in Australia completed self‐report measures of anxiety, history of panic and fears relevant to use of an immobilising mask. The treating Radiation Therapist (RT) rated the level of session disruption due to patient anxiety during the Computerised Tomography/Simulation (CT/Sim) (baseline) session and first treatment session. Results: Complete data were obtained for 90 patients. RTs rated 11 and 24% of patients as having some level of session disruption session due to anxiety at baseline and Treatment 1, respectively. Five factors were significantly associated with session disruption at baseline in bivariate analyses: currently taking psycho‐active medication (p=0.008); fear of enclosed spaces (p=0.006); fear of face being covered up (p=0.006); fear of movement restriction (p=0.041) and ever had an anxiety attack (p=0.034). Sensitivity ranged from 0.57 to 0.75 and specificity ranged from 0.68 to 0.90. Only session disruption at baseline predicted disruption at Treatment 1 (p<0.01). Conclusions: This study offers some preliminary insights into the prevalence of patient anxiety severe enough to cause session disruption and patient self‐report measures which might be used to flag patients for prophylactic treatment. Further development and replication in a larger sample is warranted before introduction of these measures into routine practice. Copyright © 2010 John Wiley & Sons, Ltd.     

Effects of complementary therapies on clinical outcomes in patients being treated with radiation therapy for prostate cancer

BACKGROUND.

This pilot randomized controlled trial (RCT) examined the clinical effects of 2 complementary (CAM) therapies, relaxation response therapy (RRT) and Reiki therapy, in men being treated with external beam radiotherapy (EBRx) for prostate cancer.

METHODS.

Study participants were randomly assigned to weekly RRT, Reiki therapy twice weekly, or wait‐list control. Well‐validated instruments measured anxiety (STAI), depression (CES‐D), and quality of life in cancer patients (FACT‐G) at randomization and 3 subsequent time points.

RESULTS.

Fifty‐four men were randomized, and 16 of 18 (89%) of RRT and 15 of 18 (83%) of Reiki patients completed the intervention protocol. No statistically significant difference was found between the RRT, Reiki, and control groups on total scores for the STAI, CES‐D, or FACT‐G instruments at any time point. However, at the end of the intervention, significant improvement was found on the emotional well‐being subscale of the FACT‐G quality of life scale in the RRT group compared with the Reiki and control groups (P = .01). In participants who were classified as “anxious” at baseline, statistically significant improvement occurred in the RRT group (P = .02), and a positive trend was found in the Reiki group (P = .10).

CONCLUSIONS.

This pilot study documented the feasibility of conducting a RCT of CAM therapies in men undergoing EBRx for prostate cancer. Relaxation response therapy improved emotional well being and eased anxiety in participants. Reiki therapy also had a positive effect in anxious patients. A larger study to verify and better define the benefits of these therapies in men with prostate cancer is warranted. Cancer 2011. © 2010 American Cancer Society.     

鼻咽癌患者心理状态与免疫功能的关系

目的 探讨鼻咽癌患者在放疗期间的心理状态与免疫功能的关系.方法 分别应用焦虑自评量表(SAS)和抑郁自评量表(SDS)调查60例首诊鼻咽癌患者在放疗开始和放疗结束时的焦虑和抑郁状况,同时测定患者的血液白细胞及总淋巴细胞水平.结果 治疗前后患者焦虑状况、抑郁状况、白细胞水平及总淋巴细胞水平比较差异均有统计学意义(P＜0....     

Relationship of stress management skill to psychological distress and quality of life in adults with cancer

Background: Distress is common among cancer patients, especially those undergoing chemotherapy. Although skill in stress management is often the target of intervention efforts, its relationship to distress and quality of life in patients about to begin cancer treatment has not been examined. Objective: To examine the relationship of pre‐treatment skill in stress management to patient distress and quality of life. Methods: One hundred and ten adults diagnosed with stage I–IV cancer and ECOG?2 provided data on perceived stress management skill, anxiety, depression, and health‐related quality of life prior to their initial chemotherapy infusion. Results: As predicted, greater skill in stress management was associated with lower levels of anxiety and depression and better overall mental quality of life. These relationships were generally independent of demographic and clinical variables also found to be associated with distress and quality of life. Conclusions: Findings confirm that skill in stress management is related to pre‐chemotherapy distress and quality of life and suggest the importance of assessing this variable as part of efforts to link distressed patients to appropriate psychosocial services. Findings also raise the possibility that assessing extant stress management skills could be used to match patients to the type of intervention most likely to benefit them. Copyright © 2009 John Wiley & Sons, Ltd.     

Self-reported cognitive functioning in postmenopausal breast cancer patients before and during endocrine treatment: findings from the neuropsychological TEAM side-study

Objective: This study aimed to evaluate self‐reported cognitive functioning of postmenopausal breast cancer patients before and during endocrine treatment compared with healthy female controls, and to investigate associations between self‐reported cognitive functioning, cognitive test performance and anxiety/depression, fatigue, and menopausal complaints. Methods: Self‐reported cognitive functioning, anxiety/depression, fatigue, menopausal complaints, and cognitive tests performance were assessed before (T1) and after 1 year (T2) of adjuvant endocrine treatment in postmenopausal chemotherapy‐naïve breast cancer patients. Self‐reported cognitive functioning was assessed by the cognitive failures questionnaire and interview questions concerning cognitive complaints. Patients participated in the TEAM‐trial, a prospective randomized study investigating tamoxifen versus exemestane as adjuvant therapy for hormone‐sensitive breast cancer. Identical information was obtained from healthy postmenopausal volunteers. Results: Two measures for self‐reported cognitive functioning provided the distinctive results. At T1 and T2, healthy controls reported a higher frequency of cognitive failures than patients; change over time did not differ between groups. The prevalence of cognitive complaints did not differ between the groups at T1, but change over time regarding attention/concentration complaints differed between groups, due to an increased prevalence in tamoxifen users. Self‐reported cognitive functioning showed moderate associations with anxiety/depression, fatigue, and menopausal complaints. Cognitive test performance was not associated with self‐reported cognitive functioning, but weakly with anxiety/depression and fatigue. Conclusion: Adjuvant therapy with tamoxifen and exemestane did not influence the self‐reported frequency of cognitive failures. Increased attention/concentration complaints were observed in tamoxifen users, but not in exemestane users. This latter finding should be confirmed with better validated instruments. Copyright © 2011 John Wiley & Sons, Ltd.     

Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment

BackgroundFatigue is a relevant problem of cancer patients during and after treatment. Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy. However, there is a lack of information about the effects of this intervention on persistent cancer-related fatigue. Therefore, we assessed the effects of an exercise program on cancer-related fatigue after treatment.Patients and methodsA consecutive series of 32 cancer patients with mild to severe persistent fatigue [scores on the Brief Fatigue Inventory (BFI) > 25] participated in a 3-week exercise program consisting of endurance (30 min walking on a treadmill) and resistance/coordination exercises for the major muscle groups. Fatigue, mood, and anxiety were assessed with questionnaires and physical performance with a stress test before and after the program.ResultsAt the end of the program, we observed a significant increase of physical performance (workload at the anaerobic threshold pre 61 ± 26 W, post 78 ± 31 W, P < 0.0001) and reduction of global fatigue (Functional Assessment of Cancer Therapy: pre 45.7 ± 13.4, post 52.6 ± 12.4, P < 0.0001; BFI: pre 37.9 ± 18.3, post 31.2 ±17.1, P < 0.001). However, no significant improvement of cognitive fatigue or reduction of anxiety was observed.ConclusionsA 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment. However, this intervention does not affect depression, anxiety, or cognitive fatigue.     

Individualised mindfulness‐based stress reduction for head and neck cancer patients undergoing radiotherapy of curative intent: a descriptive pilot study

People with head and neck cancer (HNC) experience elevated symptom toxicity and co‐morbidity as a result of treatment, which is associated with poorer psychosocial and quality‐of‐life (QoL) outcomes. This Phase I study examined whether an individualised mindfulness‐based stress reduction (IMBSR) programme could be successfully used with HNC patients undergoing curative treatment. Primary aims were to explore feasibility, compliance, acceptability and fidelity. Secondary aims were to determine whether (1) participation in the intervention was associated with changes in post‐intervention mindfulness and (2) post‐intervention mindfulness was associated with post‐intervention distress and QoL. Nineteen HNC patients participated in a seven‐session IMBSR programme with pre‐ and post‐test outcome measures of psychological distress, depression, anxiety and QoL. Primary aims were assessed by therapists or participants. Mindfulness, distress and QoL were assessed using self‐report questionnaires at pre‐ and post‐intervention. Longer time spent meditating daily was associated with higher post‐intervention mindfulness. After controlling for pre‐intervention mindfulness, there was an association between higher post‐intervention mindfulness and lower psychological distress and higher total, social and emotional QoL. This study offers important preliminary evidence than an IMBSR intervention can be administered to HNC patients during active cancer treatment. A randomised controlled trial is warranted to confirm these findings.     

The value of local treatment in patients with primary,disseminated, multifocal Ewing sarcoma (PDMES)

BACKGROUND:

The value of local treatment in patients with primary, disseminated, multifocal Ewing sarcoma (PDMES) was investigated.

METHODS:

We analyzed 120 patients registered into the European Ewing Tumor Working Initiative of National Groups (EURO‐E.W.I.N.G. 99) trial at the trial center of Muenster from 1998 to 2006. Median age was 16.2 years. Local treatment of the primary tumor was surgery in 26 of 120 patients, surgery and radiotherapy in 21 patients, and definitive radiotherapy in 40 patients. For treatment of metastases, 6 of 120 patients received surgery; 9 patients, surgery and radiotherapy; and 33 patients, definitive radiotherapy. Forty‐seven (39%) patients had local treatment of both the primary tumor and metastases, 41 (34%) patients of either the primary tumor or metastases, and 32 (27%) received no local therapy.

RESULTS:

Event‐free survival (EFS) at 3 years was 0.24 (95% CI, 0.16‐0.33). Univariate analyses demonstrated the impact of local therapy given to the primary tumor: 3‐year EFS was 0.25 with surgery, 0.47 with surgery and radiotherapy, 0.23 with radiotherapy, and 0.13 when no local therapy was administered (P < .001). Three‐year EFS in PDMES was also influenced by the local treatment: surgery, 0.33; surgery and radiotherapy, 0.56; radiotherapy, 0.35; no local therapy, 0.16 (P = .003). Three‐year EFS was 0.39 in patients who received local treatment of both primary tumor and PDMES, compared with 0.17 in patients with any local treatment of either primary tumor or PDMES and 0.14 in patients with no local therapy (P < .001). Multivariate analysis showed absence of local treatment to be the major risk factor (HR = 2.21; P = .027; n = 20).

CONCLUSIONS:

Local therapy of involved sites is important for patients with PDMES and should complement systemic treatment whenever possible. Cancer 2010. © 2010 American Cancer Society.     

Significant improvement in quality of life of patients with incurable cancer after designation to a palliative homecare team

MELIN‐JOHANSSON C., AXELSSON B., GASTON‐JOHANSSON F. & DANIELSON E. (2010) European Journal of Cancer Care 19 , 243–250
Significant improvement in quality of life of patients with incurable cancer after designation to a palliative homecare team The aims of this study were to describe and compare quality of life before and after designation to a palliative homecare team in patients with different cancer diagnoses and to identify pre‐designation predictors of post‐designation global quality of life. We measured patients’ quality of life 1 week before designation and 11 days (median time) after with the Assessment of Quality of life at the End of Life ( Axelsson & Sjödén 1999 ). Of 163 eligible patients 63 participated without attrition. Patients’ quality of life improved in the physical, psychological, medical and global areas. Six items significantly improved: hours recumbent during the day (P = 0.009), nausea (P = 0.008), anxiety (P = 0.007), getting hold of staff (P = 0.000), received care (P = 0.003) and global quality of life (P = 0.023). Depression/low in mood (r = 0.55) and meaningfulness (r = 0.70) associated to global quality of life. Furthermore, pain (P = 0.028) and meaningfulness (P = 0.028) predicted global quality of life. In the existential area, it is important to further explore how meaningfulness is associated to and predicts global quality of life.     

Time for reappraisal of extracranial treatment options?

BACKGROUND.

The optimal treatment of the primary tumor in patients with brain metastases (BM) from newly diagnosed nonsmall cell lung cancer (NSCLC) remains unclear. The authors aimed to identify patient groups with synchronous BM for whom radical treatment of the primary site may be appropriate.

METHODS.

The medical records of 167 patients treated at our center between November 2000 and June 2009 for newly diagnosed NSCLC and synchronous BM were reviewed. All patients underwent surgery/radiosurgery (n = 86) or whole‐brain radiotherapy (WBRT; n = 81) for BM. Univariate and multivariate analyses assessed prognostic factors significant for overall survival (OS).

RESULTS.

Median OS of patients undergoing surgery/radiosurgery for BM was 12.1 months. Those undergoing “radical” thoracic treatment (n = 24) had a longer median OS (28.4 months) than those undergoing chemotherapy (n = 74; 12.1 months) or supportive therapy (n = 69; 5.6 months, P < .01). Patients with stage I thoracic disease (n = 23) had a longer median OS (18.5 months) than those with stage III (n = 43; 9.4 months) or with intra/extra‐thoracic metastases other than BM (stage IV; n = 20; 2.7 months, P < .01). Median OS of WBRT patients was 3.7 months. One patient underwent radical thoracic treatment. Patients undergoing chemotherapy (n = 42) had a longer median OS (5.7 months) than patients undergoing supportive therapy only (n = 38; 1.6 months, P < .01). Performance status and age were also associated with OS.

CONCLUSIONS.

Radical thoracic treatments may be justified in selected patients <65‐years‐old, eligible to undergo surgery/radiosurgery for synchronous BM from NSCLC, even when stage III thoracic disease is present. Cancer 2011. © 2010 American Cancer Society     

Music therapy as a non‐pharmacological anxiolytic for paediatric radiotherapy patients

Outpatient radiotherapy treatment in the paediatric cancer patient can be a traumatic and an anxiety‐provoking experience for both the patient and the family. Music therapy has been widely reported to have psychosocial, educational and physical benefits for the paediatric cancer patient. Using individual case reports, this paper shows the successful use of music therapy as a non‐pharmacological anxiolytic in the paediatric radiotherapy, outpatient waiting room setting, by providing the patient and the family with a means of communication, self‐expression and creativity.