Do Patient-Reported Androgen-Deprivation Therapy Side Effects Predict Anxiety and Depression Among Prostate Cancer Patients Undergoing Radiotherapy? Implications for Psychosocial Therapy Interventions

Antiandrogen therapy (AAT) is a common adjunct treatment for prostate cancer (PCa) patients and has shown significant benefits to long-term outcomes from radiation or surgery. Although AAT has some adverse side effects and data from breast cancer patients indicate that such side effects from hormonal therapies may contribute to anxiety and depression and may also hinder AAT treatment compliance, this issue has not been investigated within a sample of PCa patients. This study explores the incidence of AAT side effects in a sample of PCa patients, the links between those side effects and anxiety and depression, the possible ways in which these factors may contribute to AAT treatment noncompliance in PCa patients, and how psychosocial treatments might be developed to attend to this issue. 147 PCa patients completed questionnaires on demographic factors, treatment compliance, AAT side effects, anxiety and depression. About 18% of the sample reported AAT side effects, and there was a significant association between the presence of side effects and elevated anxiety and depression scores. Increased frequency of side effects was significantly associated with elevated anxiety, but not depression. The most powerful relationship between AAT side effects and anxiety-depression was for the subfactors of (1) Fatigue, Pain and Discomfort, and (2) Psychological Agitation and Pessimism. Although fatigue, pain, and discomfort may be outcomes of the hormonal treatment itself, psychological agitation and pessimism represent a discrete psychological pathway between AAT side effects and anxiety and depression and (potentially) treatment noncompliance. Methods of addressing patients’ loss of optimism in their treatment outcomes are discussed.     

Prehospital Research in Sub‐Saharan Africa: Establishing Research Tenets

Prehospital care constitutes an important link in the continuum of emergency care and confers a survival benefit to injured and ill persons. As development of acute and emergency care in sub‐Saharan Africa expands, there is a strong need to improve the delivery of prehospital care to help relieve the overwhelming regional morbidity and mortality attributable to time‐sensitive, life‐threatening conditions. Effective research is integral to prehospital care development, as it helps quantify the need for prehospital care and tests effective solutions. Unfortunately, there is limited consensus guiding such research in the low‐resource nations of sub‐Saharan Africa that face unique challenges. This article aims to assimilate the current pertinent literature to demonstrate research success stories and challenges, and ultimately to build on previous efforts to establish prehospital research priorities for sub‐Saharan Africa. Region‐specific obstacles hindering prehospital research include the lack of epidemiologic data on emergency conditions, the underdevelopment of in‐hospital emergency care, confusing prehospital terminology, poorly defined prehospital research priorities, the lack of qualified local prehospital researchers, and a poor understanding of local prehospital care systems. Solutions are offered to overcome each challenge by building on previous recommendations, by proposing new guiding principles, and by identifying areas where further consensus‐building is needed. These guiding principles and suggestions are designed to steer discussions and output from future global health meetings targeted at improving prehospital research and development in sub‐Saharan Africa.     

Successful mobilization,harvest and transplant of peripheral blood stem cells using AMD3100 and G‐CSF following high dose craniospinal irradiation for medulloblastoma in a young child

Contemporary protocols for the treatment of malignant brain tumors such as medulloblastoma (MB) in children, often involve craniospinal irradiation (CSI) at diagnosis followed by serial courses of high dose chemotherapy and autologous hematopoietic stem cell support. Patients often require several pheresis procedures in order to collect sufficient stem cells for this type of treatment, particularly if they have already had CSI. We describe the successful mobilization, collection and subsequent transplant of a 7‐year‐old female with medulloblastoma after recent CSI using granulocyte colony stimulating factor (G‐CSF) and the CXCR4 antagonist AMD3100 after a failed previous mobilization attempt using G‐CSF alone. Pediatr Blood Cancer 2010;54:613–615. © 2009 Wiley‐Liss, Inc.