Gender-specific quality of life after cancer in young adulthood: a comparison with the general population

Purpose

Over the last years, adolescents and young adults with cancer (AYA) have moved strongly into scientific focus. However, there have only been a few studies about the quality of life of the AYA group, and gender differences have very rarely been examined.

Methods

A cross-sectional study was conducted with young adult cancer patients who were aged 18–39 years at the time of survey and had completed their acute treatment. We used the quality of life questionnaire European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). The EORTC QLQ-C30 contains five function scales (physical, role, emotional, cognitive and social), nine symptom scales and a global quality of life scale. The patient sample was compared to a gender- and age-matched representative sample (REP).

Results

Compared to the general population (N = 585), significantly poorer quality of life (p = .001) was observed for the 117 young cancer patients (40 male, 77 female) on all scales and items of the EORTC QLQ-C30. Analyses of variance with the factors group (AYA vs. REP) and gender showed interaction effects for the physical (p < .012), emotional (p < .029) and cognitive function scales (p < .008) and fatigue (p < .026) as well as for the items insomnia (p < .011), constipation (p < .037) and financial difficulties (p < .026). The pattern of the interaction was that female cancer patients reported the lowest quality of life outcomes. The same effects were found for the three calculated sum scales function, symptom and total.

Conclusions

Results clearly indicate that young adult cancer patients have a reduced quality of life in comparison with the general population even long after the treatment of their disease is complete. Women had a lower quality of life than men. Age-specific interventions should be offered that lead to improvements in quality of life for this age group. And future studies should clarify what factors lead to women’s quality of life being worse than men’s.     

Cardiovascular safety of PDE5 inhibitors

Erectile dysfunction (ED) and cardiovascular disease share many of the same risk factors and have some common elements of pathophysiology. Clinically, they often coexist. Another link between the two conditions is that sildenafil, the first oral therapeutic agent effective in treating ED, has been shown to potentiate the hypotensive effects of nitrates, a potentially serious side effect. Nitrates are commonly used in the treatment of coronary artery disease. As such, sildenafil (and, likely, other new phosphodiesterase type 5 [PDE5] inhibitors) is contraindicated in men who use nitrate medications. This article will examine the risk of an acute coronary event during sexual activity, and review an algorithm for evaluating the cardiac risk of a patient with ED. The interaction between PDE5 inhibitors and cardiac medications will be discussed, along with guidelines for using sildenafil in men with cardiac disease.     

Echinococcal disease of the kidney presenting as a renal filling defect

We report a unique case of renal echinococcal disease. The patient presented with only a left renal pelvic filling defect without hepatic, pulmonary or other renal involvement. Management consisted of successful exploration and removal of the hydatid mass without sacrifice of renal tissue. The pathogenesis, diagnosis and treatment of echinococcal disease are reviewed.     

Urinary conduit formation using a retubularized bowel from continent urinary diversion or intestinal augmentations: ii. Does it have a role in patients with interstitial cystitis?

PURPOSE: Interstitial cystitis (IC) may require surgical treatment in a minority of patients in whom conservative treatment failed. This treatment includes enterocystoplasty (ECP), or continent or incontinent urinary diversion with or without cystourethrectomy. Patients with IC who underwent ECP or continent urinary diversion (CUD) occasionally have recurrent pain in the augmented bladder or continent pouch. In these patients a new ileal conduit is frequently constructed. Using part of the continent urinary diversion or bladder augmentation patch to make the ileal conduit has been reported. However, there may be some concern with performing the procedure in patients with IC because of the theoretical risk of continued pain in the converted ileal segment. We evaluated the role of conduit formation using retubularized bowel from ECP or CUD in patients with IC. MATERIALS AND METHODS: A total of 11 patients with a mean age of 45 years underwent conduit formation using the augmentation patch of ECP or part of the continent urinary reservoir. Patients were followed by history, physical examination, laboratory tests and urography. RESULTS: Followup was 20 to 80 months. One patient continued to have pelvic pain. None of the patients had residual pain in the conduit. One patient had intermittent pain in the conduit 32 months after conversion. Two patients had ureteral obstruction requiring ureteral reimplantation revision. No patient complained of new gastrointestinal problems. CONCLUSIONS: Retubularization of a previously used bowel segment from ECP or CUD to form a urinary conduit seems to be an acceptable alternative in patients with IC.