Definitive chemoradiation for oesophageal cancer--a standard of care in patients with non-metastatic oesophageal cancer

Aims

A retrospective analysis was carried out of 291 cases of oesophageal cancer treated with definitive chemoradiotherapy (dCRT) at a single UK cancer centre between 1995 and 2009. Our protocol consisted of two cycles of neoadjuvant platinum-based chemotherapy followed by two further cycles given concurrently with 50 Gy of external beam radiotherapy delivered in 25 fractions over 5 weeks.

Materials and methods

Demographic, patient and outcome data were recorded prospectively through an electronic health record and retrospectively analysed, using appropriate statistical tools.

Results

Data on 266 patients were available for analysis. The median age was 66.6 years, 53% were adenocarcinomas. dCRT was used instead of surgery because of age/co-morbidity in 44% and disease extent in 39%. Ninety-three per cent of patients completed treatment according to protocol. Grade 3 and 4 toxicities were seen in 42 and 7%, respectively. Median survival was 20.6 months; 2, 3 and 5 year survival rates were 43.6, 32.9 and 19.5%, respectively. Advanced disease was associated with a worse outcome. Shorter disease length was associated with a better median survival, but some patients with disease >10 cm had long-term disease control. The effect of other patient- and disease-related factors was also analysed.

Conclusion

We present data showing that dCRT is well tolerated and should be considered as an alternative to surgery for all patients with locally advanced oesophageal cancer, not only those with co-morbidity. Furthermore, the benefits of dCRT are not confined to carcinomas with squamous histology.     

Family Functioning and Relationship Quality for Adolescents in Family‐based Treatment with Severe Anorexia Nervosa Compared with Non‐clinical Adolescents

This longitudinal study explored family functioning and relationship quality for adolescents with severe anorexia nervosa (AN). An important outcome given healthy family functioning supports effective adolescent development. Fifty‐four female adolescents and their parents, treated with family‐based treatment after inpatient admission, and 49 non‐clinical age‐matched adolescents and their parents were compared at assessment and 6 months after session 20. At baseline, AN group mothers and fathers reported poorer family function. AN adolescents were notably similar to controls, reporting poorer function in only one domain. There were no changes for adolescents, an improvement for mothers in the AN group, but an increase in perceived impairment for fathers in both groups, with AN fathers more affected. The similarity in adolescent reports and the increase for fathers over time may indicate that normal adolescent family processes occur even in the midst of serious illness. There is a need to provide intervention to ameliorate the impact of treatment on parents. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Acceptance of a potential HIV/AIDS vaccine among minority women

PURPOSE: To explore the attitudes, opinions and concerns of minority women regarding acceptance of a potential HIV/ AIDS vaccine. METHODS: In-depth interviews were conducted with high-risk minority women (> or =18 years of age) attending an urban Atlanta health clinic specializing in sexually transmitted diseases, including HIV/AIDS prevention and treatment. Interviews were transcribed and content analyzed to identify common factors related to acceptance of an HIV/AIDS vaccine. RESULTS: Nine major themes were identified. These were general acceptance of an HIV/AIDS vaccine, concerns about the vaccine, vaccine knowledge, testing and research, provider recommendation, mistrust, alternative medicine, misperceptions and vaccine accessibility/availability. A strong theme emerged about the need for information from HIV/AIDS vaccine clinical trials, including the demographics of the studies' volunteer base, to inform decision-making about taking an HIV/AIDS vaccine in the future. CONCLUSIONS: Although fewer than half of the women indicated they would receive or recommend the vaccine, most agreed that development of a vaccine was an important endeavor. The findings of this study may assist in future efforts to determine how best to promote acceptance of an HIV/AIDS vaccine to minority women should one become available.     

Adequacy of cervical cancer screening among innercity women: results from a defined population

Despite declines in mortality of cervical cancer, a sizableminority of women fail to obtain routine screening with thePapanicolaou smear and are at risk from this disease. Beforeimplementing a long-term community-based intervention studyto improve screening rates and reduce the stage of disease atdiagnosis, a cervical cancer screening canvass of a definedpopulation of poor, inner-city Baltimore residents was conductedbetween 1987 and 1989. A total of 4089 at-risk women were interviewed(81.3% response), of whom 95.5% reported ever having a Pap test,and 28% gave histories of inadequate recent screening. Reportingnever having received a Pap test was associated with age, infrequentcontact with the medical care system, and no recall of beingadvised how often to obtain Pap tests. Race was not a significantpredictor. Logistic regression analysis yielded two importantfactors—no recent physician visit or recall of periodicityrecommendation. For current screening adequacy, age, medicalcare encounters and recall of physician advice were significantin bivariate analysis as well as in multivariate analysis: noracial differences were seen. The results demonstrate the keyrole played by primary health care providers and the power ofphysician advice in reinforcing the need to maintain routinescreening examinations. Since most of the women interviewedhad an encounter with the medical care system, ‘missedopportunities’ for early cancer detection continue tooccur.     

Cylcosporinepancuronium interaction in a patient with a renal allograft

A case is described of a 54-year-old 55 kg patient who presented for clipping of a middle cerebral aneurysm two years after a successful renal allograft. Immunosuppression was maintained with azathioprine 100 mg daily, cyclosporin 300 mg daily and prednisone 10 mg daily. The patient had chronic hypertension controlled with nifedipine 40 mg daily and furosemide 20 mg daily. The cyclosporine level taken on the morning of surgery was 166 ?,g·L^-1. Induction of anaesthesia consisted of fentanyl 350 ?g, thiopentone 125 mg and pancuronium 5.5 mg. Anaesthesia was maintained with nitrous oxide 70 per cent in oxygen and isoflurane 0.5-1 .5 per cent. No additional doses of pancuronium were given during the four hour surgical procedure. At the end of surgery, four twitches were present with train-of-four stimulation, but evidence of residual muscle paralysis was present. Residual neuromuscular blockade was reversed with atropine 1.2 mg and neostigmine2.5 mg. Residual paralysis was present in the Recovery Room and edrophonium 10 mg was given prior to extubation. Clinical testing demonstrated adequate reversal of neuromuscular blockade. Twenty minutes following extubation, increasing respiratory distress was noted. There was clinical evidence of muscle paralysis. The patient was re-intubated. It is proposed that cyclosporine potentiated the pancuronium blockade producing prolonged neuromuscular relaxation resulting in residual paralysis following surgery. The potential interactions of cyclosporine and muscle relaxants deserve further study.     

Epidural catheter migration during labour: an hypothesis for inadequate analgesia

The purpose of this study was to determine the incidence and factors associated with poor analgesia during epidural block for labour pain. Emphasis was placed on determining the incidence, magnitude and factors associated with epidural catheter migration as well as any relationship between catheter migration and the quality of analgesia. Catheter movement was assessed, prospectively, in 211 consecutive parturients who had an epidural catheter placed for labour analgesia. The magnitude and direction of catheter movement was assessed by measurement of the length of the catheter at the skin at the time of epidural placement, and immediately before removal of the catheter, after delivery. Fifty-four per cent of the catheters migrated during labour and 70 per cent of these migrated out of the epidural space. The quality of analgesia provided by the epidural block was assessed by the caseroom nurse caring for the patient. Seventeen per cent of the patients had unsatisfactory analgesia. There was an increase in poor analgesia in those patients whose catheters migrated compared with those in whom the catheters were stable (P less than 0.05). We conclude that catheter migration during labour results in a greater incidence of inadequate block and unsatisfactory analgesia.