The validity of average 8-h pain intensity assessment in cancer patients

Aim of this study was to validate the use of subjective average pain assessment over an 8-h time period to evaluate cancer pain intensity.A sample of 95 consecutive cancer inpatients were asked to score on 0–10 numerical scales the intensity of their pain at hourly intervals, and then, at the 8th hour, to rate their average pain intensity over the last 8 h. Agreement between the average of the 8 hourly measures (8hA) and the single patient-rated average (PA8h) was examined with the intraclass correlation coefficient (ICC) and the absolute difference (AD) between the two measurements. Associations between AD, gender, age older than 70, somatic pain, visceral pain, neuropathic pain, pain on movement and the presence of pain exacerbations during the 8-h period, were also examined.Average pain intensity scores were very similar with the two measurement schedules: 3.4 for 8hA and 3.7 for PA8h, with a median AD of 0.44 points. Only six patients (6.3%) showed ADs higher than 2 points. Also the ICC (0.85) showed a substantial agreement between the two schedules. Among the examined variables, gender, age over 70 years and presence of pain exacerbations showed a significant association with the agreement level.Overall, our results support the validity of a subjective average pain measurement over 8-h period in cancer patients.     

The diagnostic accuracy of neck ultrasound, 4D-Computed tomographyand sestamibi imaging in parathyroid carcinoma

IntroductionOur aim was to investigate the accuracy of available imaging modalities for parathyroid carcinoma (PC) in our institution and to identify which imaging modality, or combination thereof, is optimal in preoperative determination of precise tumor location.MethodsAll operated PC patients in our institution between 2000 and 2015 that had at least one of the following in-house preoperative scans: neck ultrasonography (US), neck 4D-Computed Tomography (4DCT) and 99mTc Sestamibi SPECT/CT (MIBI). Sensitivity, specificity and accuracy of PC tumor localization were assessed individually and in combination.Results20 patients fulfilled the inclusion criteria and were analysed. There were 18 US, 18 CT and 9 MIBI scans. The sensitivity and accuracy for tumor localisation of US was 80% (CI 56–94%) and 73% respectively, of 4DCT was 79% (CI 58–93%) and 82%, and of MIBI was 81% (CI 54–96%) and 78%. The sensitivity and accuracy of the combination of CT and MIBI was 94% (CI 73–100%) and 95% and for the combination of US, CT and MIBI was 100% (CI 72–100%) and 100% respectively. The wash-out of the PC lesions, expressed as a percentage change in Hounsfield Units from the arterial phase to early delayed phase was −9.29% and to the late delayed phase was −16.88% (n = 11).ConclusionsThe sensitivity of solitary preoperative imaging of PC patients, whether by US, CT or MIBI, is approximately 80%. Combinations of CT with MIBI and US increase the sensitivity to 95% or better. Combined preoperative imaging of patients with clinical possibility of PC is therefore recommended.     

Thermal Ablation versus Surgical Resection for the Treatment of Stage T1 Hepatocellular Carcinoma in the Surveillance,Epidemiology, and End Results Database Population

Purpose

To compare survival outcomes of small solitary hepatocellular carcinomas (HCCs) treated with thermal ablation vs resection in the Surveillance, Epidemiology, and End Results (SEER) cohort.

Laser and photochemotherapy for the treatment of oral mucositis in young patients: Randomized clinical trial

BackgroundThe aim of the present study was to evaluate the effect of low-level laser therapy (LLLT) combined with photochemotherapy (PCT) for the treatment of chemotherapy-induced oral mucositis in young patients.MethodsA randomized, blind, clinical trial with a split-mouth design was conducted involving a sample of 15 cancer patients aged three to 16 years at the Aldenora Bello Hospital in the city of São Luís, Brazil. The treatments (PCT + LLLT and LLLT alone) were randomly determined for each side of the oral cavity. The patients were blinded to the type of therapy performed on each side. The outcome was the area of the lesion measured in cm² over an eight-day evaluation period. Treatment and follow up of the lesions under evaluation as well as other lesions occurred until complete remission. Friedman and Wilcoxon tests were employed. Significance was set at a 95% confidence level (α = 0.05) and the effect size was calculated.ResultsA statistically significant difference was found between therapies for lesion area on Days 6–8 (p = 0.020, 0.011 and 0.005, respectively), which was confirmed by the moderate effect size. Lesions submitted to PCT + LLLT had a smaller area at the end of the evaluation period.ConclusionBased on the present findings, PCT + LLLT had a greater therapeutic effect in comparison to LLLT alone regarding the reduction in the degree of severity of chemotherapy-induced oral mucositis.     

Perioperative therapies – Enhancing the impact of cancer surgery with repurposed drugs

Surgical resection remains the major modality for modern curative treatment for solid tumours. However, post-surgical recurrence, even following clear-margin resection and adjuvant treatment, remains common in many types of cancer. Reducing recurrence rates, therefore, offers the potential to increase cure rates and increase overall survival. Perioperative therapies, simple interventions during the perioperative period, are designed to address some of the factors which influence post-surgical recurrence. A range of perioperative therapies are introduced and the rationale for further clinical investigation outlined.