Chronic Lymphocytic Leukemia: A Review of Front-line Treatment Options,With a Focus on Elderly CLL Patients

Chronic lymphocytic leukemia (CLL) remains the most prevalent form of leukemia in the Western world, with no cure to date. Ongoing and essential research into this heterogeneous disease has led to a number of new treatment options becoming available to CLL patients in the past decade. The present review presents the recent developments in the field of CLL treatment, with the main focus on elderly patients and CLL patients with coexisting comorbidities. The review discusses the current treatment regimens that provide the most promising outcomes for patients in this subgroup, with a number of important clinical trials summarized. These clinical trials, which have investigated promising single-agent therapies or combination therapies, are discussed, with an emphasis on the efficacy and tolerability for patients aged ≥ 65 years. Also, the misrepresentation of the true CLL population in many clinical trials and the need for better guidelines for participant inclusion criteria to provide a more realistic and accurate study population are noted.     

Changes in Health- Related Quality of Life and Psychosocial Well-being of Breast Cancer Survivors: Findings from a Group- Based Intervention Program in Malaysia

Background: There is a lack of evidence on the effectiveness of multifaceted group-based interventions toimprove psychological well-being and health-related quality of life (HRQOL) of breast cancer (BCa) survivors inMalaysia. This study is aimed at assessing the effectiveness of such intervention program among the BCa survivors.Materials and Methods: This was a group-based intervention program with pre- and post-test design, carried outamong BCa survivors (n=37) who were members of Breast Cancer Support Group Centre, Johor Bahru. A validatedself-administered questionnaire was used to assess the impact of the program on psychosocial well-being and HRQOL ofthe participants. Results: The mean age of BCa survivors was 58.1 years (SD=9.7), with mean age at diagnosis of49.9 years (SD=9.6). Majority of them were of Chinese ethnicity, married and had secondary level education, butwere unemployed. More than 86% of them were diagnosed to have early BCa diagnosis and have since completedthe treatment. There were significant decreases in median depression (p=0.001), anxiety (p<0.001) and stress (p<0.001)scores at post-intervention. More than 85% of the participants rated themselves to have a good or very good QOLat post-intervention, as opposed to 75.9% at pre-intervention. Significant improvements in several HR-QOL domainscores were seen, with psychological score improving the most (p<0.001), followed by social relationship (p=0.002)and physical health (p=0.004). Conclusions: Group-based multifaceted intervention can be a viable solution to improvepsychosocial well-being of BCa survivors.     

Inducing or Preventing Subsequent Malignancies for Breast Cancer Survivors? Double-edged Sword of Estrogen Receptor and Progesterone Receptor

Introduction

Hormone receptor and human epidermal growth factor receptor 2 (HER2) status is important for breast cancer (BC) treatment. Previous studies have shown that the long-term treatment outcomes of BC are significantly impaired by the development of subsequent malignancies. Therefore, in the present study, we evaluated the effect of hormone receptor/HER2 status on subsequent malignancies in breast cancer survivors.

Advocacy,support and survivorship in prostate cancer

Across Australia, prostate cancer support groups (PCSG) have emerged to fill a gap in psychosocial care for men and their families. However, an understanding of the triggers and influencers of the PCSG movement is absent. We interviewed 21 SG leaders (19 PC survivors, two partners), of whom six also attended a focus group, about motivations, experiences, past and future challenges in founding and leading PCSGs. Thematic analysis identified four global themes: illness experience; enacting a supportive response; forming a national collective and challenges. Leaders described men's feelings of isolation and neglect by the health system as the impetus for PCSGs to form and give/receive mutual help. Negotiating health care systems was an early challenge. National affiliation enabled leaders to build a united voice in the health system and establish a group identity and collective voice. Affiliation was supported by a symbiotic relationship with tensions between independence, affiliation and governance. Future challenges were group sustainability and inclusiveness. Study findings describe how a grassroots PCSG movement arose consistent with an embodied health movement perspective. Health care organisations who seek to leverage these community resources need to be cognisant of SG values and purpose if they are to negotiate effective partnerships that maximise mutual benefit.     

Social inequality in cancer survivors’ health behaviours—A Danish population‐based study

The aim of this study was to compare health behaviours (smoking, alcohol consumption, physical activity and diet), to explore social inequality in these behaviours among cancer survivors and individuals with no history of cancer, respectively, and to study the impact of time since diagnosis on cancer survivors’ health behaviours. Data from the Danish National Health Survey from 2013 were linked with data from the Danish Cancer Registry to identify all cancer diagnoses among the respondents during the period 1945–2012. In total, 11,166 cancer survivors and 151,117 individuals with no history of cancer were included. Cancer survivors smoked less and had a more sedentary lifestyle than individuals with no history of cancer. In relation to alcohol and dietary habits, no differences were found between the groups. Wide variations in health behaviours were seen across cancer sites, and in particular lung, bladder and oral cancer survivors had poor health behaviours. We found a clear social gradient in cancer survivors’ health behaviours which reveals the need for greater focus on socially differentiated initiatives within prevention and patient education for cancer survivors. Our study revealed rather blurred results in relation to identifying the optimal timing for health‐related behavioural interventions in cancer survivors.     

Informal support for older people in post-unification East Germany: Stability and change

German unification led to a substantial out-migration of younger eastGermans to the West. This paper discusses possible impacts of thisout-migration upon the social support networks of older people in the eastGerman city of Leipzig. Using Wenger's network typology, information wassought about the social support networks of 54 people aged 65+ for 1989and 1993. The intention was to identify the extent to which supportnetworks were resistant to change and, where changes occurred, whethersuch changes could directly be attributed to unification. The study'sfindings indicate only a modest impact of unification upon older people'ssocial support networks in Leipzig. The overwhelming majority of supportnetworks remained the same over the period of analysis, suggesting thatinformal support for older people is more robust and resistant to socialchange than might be anticipated.     

Long-term otologic status of older cleft palate patients

The purpose of this study was to evaluate the effectiveness of regular otologic care on the long-term outcome in patients with cleft palates. We report the otoscopic and audiologic findings of 50 patients who were followed regularly at our center for an average of 15.4 years. All these patients had their cleft palates repaired by the same surgical team and all ears were examined by one of the authors under the microscope and a chart review completed. Thirty eight patients had at least one tube placement. The physical abnormalities noted were tympanosclerosis (36%), retraction of tympanic membrane (TM) (20%), atrophy of TM (15%), perforation (11%), PE tube in situ (11%), thick TM (6%) and PE tube in middle ear (1%).The examination was normal in 36%. A conductive loss was noted in 18% and sensorineural loss in 3%. The results of this study support the concept of regular otologic care for cleft palate patients even when they are overtly asymptomatic.