Prevalence and correlates of the supportive care needs of Italian early-stage melanoma patients in follow-up

Abstract

Purpose: To describe the supportive care needs of early-stage Italian melanoma patients and identify the predictors of unmet needs.

Design: Bicenter cross-sectional.

Sample: Two hundred eight (TIS-T3) melanoma patients in follow-up.

Methods: In person self-assessment procedures; the Supportive Care Needs Survey short-form 34, the Distress Thermometer and the Hospital Anxiety and Depression Scale were used.

Results: Of the patients surveyed, 56% experienced at least one or more moderate-to-high unmet needs. Lack of melanoma-specific information and psychological support aids were the most intense sources of need. Being aged 60–69?years, retired and distressed predicted unmet needs.

Conclusions: This study’s results demonstrate the need to implement supportive care needs screening among Italian early-stage melanoma patients during follow-up and to improve patient information and psychological support.

Implications for psychosocial providers or policy: Providing patients with a point person within the hospital staff who centralizes the demand and refers to appropriate interventions may help the management of unmet needs.     

Comparison of the prognostic accuracy of the sixth and seventh editions of the TNM classification for intrahepatic cholangiocarcinoma

Background

The seventh TNM edition introduced a new, specific staging structure for intrahepatic cholangiocarcinoma (IHC).

Objective

To compare the accuracy of the sixth and the new seventh edition to predict survival after hepatectomy for IHC.

Methods

In all, 434 consecutive patients who underwent hepatectomy at 16 tertiary-care centres (1990–2008) were identified. End points were overall (OS) and recurrence-free survival (RFS) for both T cohorts and stage strata.

Results

After a median follow-up of 32.4 months, 3- and 5-year OS and RFS estimates were 47.1% and 32.9%, and 26.5% and 19.1%, respectively. Overall, both the editions were statistically significant discriminators of OS and RFS (P < 0.05). However, the survival curves of the new T2a and T2b cohorts appear superimposed. Conversely, the old T2 and T3 cohorts accurately stratify patients into distinct prognostic groups (P < 0.01). The seventh edition does not show monotonicity of gradients (the T4 category demonstrates significantly better OS and RFS compared with T2 patients). The seventh edition stage I and II are significantly different whereas the old stage I and II were not.

Conclusions

The new seventh edition of the AJCC/UICC Staging System proved to be adequate although further studies are need to confirm its superiority compared with the previous edition.     

Staging of colorectal liver metastases after preoperative chemotherapy. Diffusion-weighted imaging in combination with Gd-EOB-DTPA MRI sequences increases sensitivity and diagnostic accuracy

Objectives

To compare the diagnostic accuracy and sensitivity of Gd-EOB-DTPA MRI and diffusion-weighted (DWI) imaging alone and in combination for detecting colorectal liver metastases in patients who had undergone preoperative chemotherapy.

Methods

Thirty-two consecutive patients with a total of 166 liver lesions were retrospectively enrolled. Of the lesions, 144 (86.8 %) were metastatic at pathology. Three image sets (1, Gd-EOB-DTPA; 2, DWI; 3, combined Gd-EOB-DTPA and DWI) were independently reviewed by two observers. Statistical analysis was performed on a per-lesion basis.

Results

Evaluation of image set 1 correctly identified 127/166 lesions (accuracy 76.5 %; 95 % CI 69.3–82.7) and 106/144 metastases (sensitivity 73.6 %, 95 % CI 65.6–80.6). Evaluation of image set 2 correctly identified 108/166 (accuracy 65.1 %, 95 % CI 57.3–72.3) and 87/144 metastases (sensitivity of 60.4 %, 95 % CI 51.9–68.5). Evaluation of image set 3 correctly identified 148/166 (accuracy 89.2 %, 95 % CI 83.4–93.4) and 131/144 metastases (sensitivity 91 %, 95 % CI 85.1–95.1). Differences were statistically significant (P?<?0.001). Notably, similar results were obtained analysing only small lesions (<1 cm).

Conclusions

The combination of DWI with Gd-EOB-DTPA-enhanced MRI imaging significantly increases the diagnostic accuracy and sensitivity in patients with colorectal liver metastases treated with preoperative chemotherapy, and it is particularly effective in the detection of small lesions.

Key Points

? Accurate detection of colorectal liver metastases is essential to determine resectability. ? Almost 80 % of patients are candidates for neoadjuvant chemotherapic treatment at diagnosis. After chemotherapy, metastases usually decrease, and drug-induced liver steatosis may be present. ? The sensitivity of imaging is significantly inferior to that in chemotherapy-naïve patients. ? DWI combined with Gd-EOB-DTPA increases sensitivity in detecting small metastases after chemotherapy.     

Major Liver Resections Synchronous with Colorectal Surgery

Background Surgical strategy in liver metastases synchronous to colorectal cancer remains controversial. The aim of this study was to evaluate feasibility and short-term outcomes of major hepatectomies synchronous to colorectal surgery. Methods Between January 1985 and December 2004, 79 patients underwent major hepatectomy for metastases synchronous to colorectal cancer; 31 underwent synchronous hepatectomy and colorectal surgery, and 48 underwent delayed liver resection. Results The synchronous group had a higher rate of right colectomy (38.7% vs. 18.8%, P = .0499) and larger metastases (8 vs. 5.3 cm, P = .0032). Mortality (one patient in synchronous group), morbidity, and anastomotic leak rates were similar in the two groups. Colon-related morbidity did not cause adjunctive liver complications. Hospitalization in delayed hepatectomies was shorter (10.4 days vs. 13.9 days, P = .0021). Blood and plasma transfusions were higher in synchronous resections (41.9% vs. 16.7%, P = .0131 and 54.8% vs. 31.3%, P = .0370); no differences were found in the last 10 years. Considering both surgical procedures (colorectal + liver resection), in delayed hepatectomies, morbidity was higher (56.3% vs. 32.6%, P = .0369) and hospitalization was longer (20.5 vs. 13.9 days, P = .00001). Nine patients underwent major hepatectomy at the same time as anterior rectal resection with no mortality (morbidity 22.2%, mean hospitalization 12.4 days). Conclusions Major hepatectomies can be safely performed at the same time as colorectal surgery in selected patients with synchronous metastases with similar short-term results, even in the presence of rectal cancer.     

Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy

BACKGROUND: To establish a reliable definition of postoperative hepatic insufficiency (PHI) in noncirrhotic patients undergoing major hepatectomy. No standard definition of PHI has been established, but one is essential for meaningful comparison of outcomes data across studies. METHODS: Data from 1,059 noncirrhotic patients who underwent major hepatectomy (3 or more liver segments) at 3 centers from 1995 to 2005 were analyzed. Receiver operating characteristics (ROC) analysis of peak postoperative bilirubin ((Peak)Bil) and international normalized ratio ((Peak)INR) were used to define PHI. RESULTS: A total of 669 patients (63%) underwent resection of 3 to 4 liver segments; 390 (37%) underwent resection of 5 or more segments. Complications occurred in 453 (43%). The 90-day all-cause mortality rate was 4.7%, which is 47% higher than the 30-day rate (3.2%). Twenty (1.9%) patients died of causes unrelated to the liver. Of the remaining 1,039 patients, 30 (2.8%) died a median 36 days from liver-related causes (liver failure with or without multiorgan failure). ROC analysis revealed cut-offs that predict liver-related death are (Peak)Bil 7.0 mg/dL (area under the curve 0.982; sensitivity 93.3%; specificity 94.3%) and (Peak)INR 2.0 (area under the curve 0.846; sensitivity 76.7%; specificity 82.0%). (Peak)Bil > 7.0 mg/dL was the most powerful predictor of any (odds ratio [OR] = 83.3) or major complication (OR = 10.0), 90-day mortality (OR = 10.8), and 90-day liver-related mortality (OR = 250) (all p < 0.0001). CONCLUSIONS: PHI defined as (Peak)Bil > 7.0 mg/dL accurately predicts liver-related death and worse outcomes after major hepatectomy. Standardized reporting of complications, PHI, and 90-day mortality is essential to accurately determine the risk of major hepatectomy and to compare outcomes data.     

Evaluation of an Active Humidification System for Inspired Gas

ObjectivesThe effectiveness of the active humidification systems (AHS) in patients already weaned from mechanical ventilation and with an artificial airway has not been very well described. The objective of this study was to evaluate the performance of an AHS in chronically tracheostomized and spontaneously breathing patients.MethodsMeasurements were quantified at three levels of temperature (T°) of the AHS: level I, low; level II, middle; and level III, high and at different flow levels (20 to 60 L/minute). Statistical analysis of repeated measurements was performed using analysis of variance and significance was set at a P<0.05.ResultsWhile the lowest temperature setting (level I) did not condition gas to the minimum recommended values for any of the flows that were used, the medium temperature setting (level II) only conditioned gas with flows of 20 and 30 L/minute. Finally, at the highest temperature setting (level III), every flow reached the minimum absolute humidity (AH) recommended of 30 mg/L.ConclusionAccording to our results, to obtain appropiate relative humidity, AH and T° of gas one should have a device that maintains water T° at least at 53℃ for flows between 20 and 30 L/m, or at T° of 61℃ at any flow rate.