Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioning

The objective of this study is to assess the mental health and psychosocial adjustment of children in remission from acute lymphoblastic leukaemia (ALL), and parental functioning compared to healthy controls. A cross-sectional study of 40 children treated for ALL (mean age 11.8 years, range 8.5–15.4) and healthy controls ( n  = 42) (mean age 11.8 years, range 8.11–15.0) were assessed by the Child Behaviour Checklist (CBCL), the Youth Self-Report (YSR) and the Strength and Difficulties Questionnaire (SDQ). The parent's own mental health was assessed by the General Health Questionnaire (GHQ-30). Children treated for ALL showed on average significantly more symptoms as measured by the CBCL Total Behaviour Score for mother's report ( P  = 0.005), and for father's report ( P  = 0.004) compared with healthy children. Fathers reported more anxiety ( P  = 0.03) and depression ( P  = 0.02) as measured by the GHQ-30 compared with healthy controls. Children in remission from ALL showed on average significantly more problems regarding mental health and psychosocial adjustment, as reported by their parents, compared with healthy controls. Adequate rehabilitation and follow-up programmes should be implemented for children in remission from ALL. The results indicate the need to pay attention to the mental health of fathers during the rehabilitation phase.     

Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: a double-blind placebo-controlled randomized clinical trial

We evaluated the efficacy of benzydamine oral rinse for prevention of radiation-induced mucositis. Patients with head and neck cancers, who were referred in 2004–2005, received an oral rinse of either benzydamine or placebo. One hundred patients were randomized in this trial. At the end of the study, 19 patients were excluded from the analysis because they did not use the medication for the assigned period. In the benzydamine group, the frequency of mucositis grade ≥3 was 43.6% in contrast to 78.6% in other group ( P  = 0.001). Grade ≥3 mucositis was 2.6 times more frequent in the placebo group. Intensity of mucositis increased up to fourth week of treatment in both groups to grade 2. In the treated group the grade of mucositis was approximately constant to the end of therapy; but in the control group it raised to grade 3 ( P  < 0.001). The highest grade of mucositis during the treatment time was significantly different between two groups ( P  = 0.049). The median interval to observation of grade ≥2 mucositis was 24 days in the placebo group and 28 days in the benzydamine group ( P  = 0.12). Benzydamine oral rinse seems to be effective, safe, and well tolerated for prophylactic treatment of radiation-induced oral mucositis in head and neck tumours.     

Assessing the unmet supportive care needs of newly diagnosed patients with cancer

Adequate monitoring in cancer control needs to include measures of psychosocial outcomes so as to take account of the totality of the felt cancer experience. There is a need to know whether the experience of cancer is changing, as well as a need for tools to identify where supportive care interventions or services could be targeted to good effect. The aim of this study was to investigate the utility of using a telephone-administered survey to identify the unmet needs of cancer patients. Participants were identified from a statewide population-based cancer registry following an episode of hospitalized care in Victoria (Australia). Of the 506 eligible patients, 236 completed a telephone adaptation of the Supportive Care Needs Survey-Short Form (SCNS-SF31). Sampling from the cancer registry was shown to provide timely contact with patients. Results from the survey indicated that perceived needs for this newly diagnosed group of cancer patients were mostly in the area of information provision. Results also showed that some socio-demographic and disease-specific variables affected the level of perceived unmet needs. Overall, this study indicated that registry-based sampling was practical and the telephone adaptation of the SCNS-SF31 provided a reliable method to explore the unmet needs of newly diagnosed patients with cancer.     

Factors influencing return to work: a narrative study of women treated for breast cancer

JOHNSSON A., FORNANDER T., RUTQVIST L.E. & OLSSON M. (2010) European Journal of Cancer Care 19 , 317–323
Factors influencing return to work: a narrative study of women treated for breast cancer The purpose of this qualitative study was to identify factors contributing to a successful return to the labour market after treatment for breast cancer from the women's own perspective. The study is based on 16 narratives – open‐ended, in‐depth interviews – about women's experiences and thoughts from the period after breast cancer surgery when they focused on their return to work. The women were recruited from participants of a multicentre trial, which allowed comparisons across a range of adjuvant therapies. The narratives of women who worked full time at a cut‐off point of 1 year after surgery are analysed separately from the narratives of women still sick‐listed at that point of time. The findings show that while all the women strove to belong to the labour market, the study also reveals changes in women's perceptions of the value of employment. The quality of social support received from employers and coworkers differed between women who returned to work and those still sick‐listed 1 year after breast cancer treatment. A need to design interventions focusing on the work arena of women treated for breast cancer is pointed out.     

Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord‐Trøndelag Health Study): prevalence,socio‐demographics and health perceptions

STEINSBEKK A., ADAMS J., SIBBRITT D. & JOHNSEN R. (2010) European Journal of Cancer Care 19 , 346–351
Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord‐Trøndelag Health Study): prevalence, socio‐demographics and health perceptions The aim of the study was to identify the use of complementary and alternative medicine (CAM) practitioners among current and previous cancer patients in a total population. A secondary analysis of data from the Nord‐Trøndelag Health Study (otherwise known as the HUNT 2 Study) – a total population survey conducted in central Norway – was undertaken. Analysis focused upon the response of 1406 individuals who reported to have or have had cancer and who answered a question on visits to CAM practitioners. The study identified 16.1% of respondents had visited a CAM practitioner in the prior 12 months compared with 12.8% in the total population, and the likelihood of consulting a CAM practitioner was significantly increased among those who had a university degree, who reported a lower perceived global health and who had experienced a health complaint during the last 12 months. Complementary and alternative medicine practitioner consultations among individuals with a previous or current malignant disease were highest for those with poor self‐reported health status and with a recent health complaint. From the socio‐demographic variables studied only the reporting of a university degree was significantly associated with higher CAM practitioner use.     

Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety,efficacy and their correlation with pain neuromediator expression

CHIARETTI A., RUGGIERO A., BARONE G., ANTONELLI A., LAZZARESCHI I., GENOVESE O., PAIANO S., SAMMARTINO M., MAURIZI P. & RICCARDI R. (2010) European Journal of Cancer Care 19 , 212–220
Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator expression Invasive procedures, such as the lumbar puncture, can cause anxiety and pain in children undergoing treatment for acute lymphoblastic leukaemia (ALL). We investigated the safety and efficacy of two different protocols for analgo‐sedation in 20 children with ALL undergoing lumbar puncture. We have conducted a prospective, cross‐over study. Protocol A was composed of an association between propofol and alfentanil. Protocol B consisted in the combination of propofol and ketamine. We also evaluated the levels of nerve growth factor, substance P and enkephalins in the cerebrospinal fluid of these patients. All patients showed a satisfactory sedation and analgesia. We found a statistically significant difference of vital parameters between protocol A and protocol B, while there were no significant differences between sedation scores and the other parameters evaluated. Patients in protocol A showed a higher incidence of major side effects, such as respiratory depression. Pain neuromediator levels did not show any statistical difference between the two groups. This study shows that both protocols are effective to obtain a good sedation and analgesia in children with ALL undergoing lumbar puncture, but the association between propofol and ketamine appears to be safer due to the lower incidence of side effects.     

Self‐efficacy beliefs and levels of anxiety in advanced cancer patients

MYSTAKIDOU K., TSILIKA E., PARPA E., GOGOU P., THEODORAKIS P. & VLAHOS L. (2010) European Journal of Cancer Care 19 , 205–211
Self‐efficacy beliefs and levels of anxiety in advanced cancer patients The aims of this study were to investigate the self‐efficacy and anxiety in advanced cancer patients in a palliative care unit. The subject is some 99 advanced cancer patients, treated for pain relief and cancer‐related symptoms. Patients completed the General Perceived Self‐Efficacy Scale (GSE) and the Spielberger's State‐Trait Anxiety Inventory (STAI). The Eastern Cooperative Oncology Group was used to measure patients' performance status. Statistically significant associations were found between GSE, patients' gender, performance status, opioids and all the STAI scales. The multiple regression analysis revealed that self‐efficacy was predicted by patients' age, performance status, gender, as well as by their high levels on two STAI scales, in a model explaining 39.7% of the total variance. In advanced cancer patients, self‐efficacy is significantly correlated with levels of anxiety, patients' physical condition and demographic characteristics. Also, it seems to be influenced by components of the STAI, patients' age, physical performance and gender.     

Oral treatment of metastatic breast cancer with capecitabine: what influences the decision‐making process?

GÓRNA? M. & SZCZYLIK C. (2009) European Journal of Cancer Care 19 , 131–136
Oral treatment of metastatic breast cancer with capecitabine: what influences the decision‐making process? The importance of selecting treatment for metastatic breast cancer (MBC) that best suits the needs of the patient while offering a good clinical outcome is becoming more prominent in the decision‐making process. We designed a questionnaire‐based study to identify factors influencing treatment choice. We prospectively surveyed 218 female MBC patients scheduled to receive chemotherapy who were eligible for capecitabine monotherapy. All 215 patients who answered the questionnaire preferred oral capecitabine to intravenous chemotherapy. The most frequently cited reason for this preference was convenience (72%). The possibility of staying at home during treatment was considered important by 67% of patients overall, 42% of the 71 patients giving only one reason for their preference, 65% of those receiving first‐line therapy and 74% treated in the second‐line setting. Our study suggests that most patients prefer oral chemotherapy because of the convenience and possibility of staying at home during treatment. The study did not explore patient perceptions of efficacy or tolerability, which play a pivotal role in treatment selection from both the patient and physician perspectives. Capecitabine provides a very effective treatment for MBC and additionally addresses patients’ desire to receive treatment at home.