Secondary prevention of colon cancer]

Each year more than 6000 patients in Poland die from cancer of the colon. Morbidity due to colonic cancer increases rapidly in our country. From 1973 to 1982 there was a three-fold increase in the morbidity due to colonic cancer as compared to the years 1952-1955. Five-year relative survival in the same periods did not improve, either being 28% in men and 27% in women. To compare, in the USA with high morbidity rates due to colonic cancer where each year there are 145,000 new cases of cancer, 5-year relative survival is 42% for men and 54% for women. This raises a question whether our strategy of treatment of colonic cancer is correct. This question is even more justified now when secondary prevention of colonic cancer is of practical value. Total mortality due to colonic cancer is 60%. However, diagnosis and treatment of early forms of colonic cancer reduces mortality to 20% and below. Therefore, effective management colonic cancer should include not only the so-called primary prevention (interfering with etiological factors for instance through high fibers diet) but also secondary prevention through monitoring of precancerous changes in the colon, removal of potentially malignant lesions and early forms of colonic cancer [19]. Secondary prevention interfering with the pathogenesis of colonic cancer is the subject of the present paper. We would like to emphasize the need for a better management program for colonic cancer, especially that the data concerning colonic cancer in Poland may be underestimated due to diagnostic neglect and faulty cancer register.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cancer curriculum in the Asia–Pacific: Opportunities and challenges in the age of globalization

With the rising incidence and prevalence of cancer in Asia–Pacific, the need for adequate cancer education of medical graduates in the region has become particularly urgent. There are 769 medical schools across the Asia–Pacific region in 33 countries serving over 60% of the world population in very diverse socioeconomic environments. This paper discusses some of the challenges for medical education in the Asia–Pacific in light of increasing globalization of health care, including the need to develop global standards in the area of diverse resources and health care priorities. It also points out emerging opportunities including online learning, telemedicine and collaborative educational initiatives across the region.     

Access to assisted reproductive technology for cancer patients in Australia

Aim: To evaluate patterns of care and equity of access to assisted reproductive technology (ART) for cancer patients in Australia Methods: A review of state and national legislation and Medicare numbers relevant to ART and phone interviews with representative fertility facilities in each State and Territory. Results: There appears to be little legal restriction to ART for cancer patients although in some states, clinical practice is in fact contrary to legislation. The cost of ART is influenced by Medicare rebates and the overall cost of fertility treatments as set out by the specific fertility unit. There is no rebate for embryo and sperm storage. Costs of receiving an ART intervention vary greatly. Out‐of‐pocket costs ranged from nil to approximately $3000 per year for an in vitro fertilization or intracytoplasmic sperm injection cycle, from nil to $700 for embryo storage and from nil to $1500 for embryo transfer. All but two of the fertility clinics felt that the numbers of oncology patients accessing ART were low. The most common barrier to access identified by the fertility clinics interviewed was time restriction in a setting where there is a time pressure for a patient to commence anti‐cancer treatment. Conclusion: Legislation is unlikely to be a barrier to the use of ART by cancer patients. The main reasons for limited access to ART may be cost or other factors including time pressure, the lack of a partner and age. Further research in this area is warranted.     

A randomised pilot of a self-help workbook intervention for breast cancer survivors

Purpose  

The aim of this study is to evaluate the efficacy of a self-help workbook for improving adjustment for breast cancer survivors.     

Circadian rhythm and variability of blood pressure and target organ damage in essential hypertension

The aim of this study was to evaluate the influence of blood pressure variability and circadian rhythm on left ventricular mass and urinary albumin excretion rate (UAE) in patients with essential hypertension. 82 untreated patients (35 women and 47 men; mean age 41.1 +/- 13.7) were recruited to this study. Mean office blood pressure at entry was 152/97 mmHg. Ambulatory blood pressure monitoring (ABPM) was performed using an Medilog ABP recorder (Oxford). Blood pressure variability was estimated as the standard deviation (SD) of systolic and diastolic ambulatory blood pressure. Urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. Echocardiography was used to measure left ventricular mass and left ventricular mass index (LVMI). The median urinary albumin excretion for the whole group was 8.2 mg/day; in 18 patients (21.9%) microalbuminuria was present. Left ventricular mass index in a whole group was 109.1 g/m2; in 23 subjects (28.0%) left ventricular hypertrophy (LVH) was found. Patients with microalbuminuria as well as with left ventricular hypertrophy had higher office and 24 hour ambulatory systolic and diastolic blood pressure and higher systolic blood pressure variability. During ABPM 18 patients with absent nocturnal fall in blood pressure (non-dippers) were found; they did not display more frequent prevalence of target organ damage. Increased 24-hour blood pressure variability present in hypertensive subjects with both microalbuminuria and left ventricular hypertrophy may suggest that this phenomenon plays role in development of target organ damage.     

Returning to work following curative chemotherapy: a qualitative study of return to work barriers and preferences for intervention

Purpose

This study aimed to explore barriers to return to work (RTW) and preferences for intervention and support for cancer patients treated with curative intent from the perspectives of cancer survivors and oncology health professionals.

Methods

Participants attended a focus group (N?=?24) or an individual interview (N?=?14). A topic guide and a semi-structured recorded interview format were used to gather data, which were later transcribed and analysed for global themes and subthemes.

Results

With regard to barriers, the global theme ‘work capacity’ captured an array of barriers encompassing financial pressure, preparedness for work, lack of confidence as well as other key physical, practical and psychosocial barriers. Participants expressed a preference for RTW models that focus on objective and structured assessment whilst allowing for flexibility to address individual needs.

Conclusions

Cancer survivors perceive multiple barriers when attempting to RTW. These barriers were perceived to impact upon work capacity, where ‘capacity’ was defined broadly to include practical, physical and psychosocial concerns. RTW is an important concern for cancer survivors and structured RTW interventions should be incorporated into the care of cancer survivors.     

What should doctors know about cancer? Undergraduate medical education from a societal perspective

Cancer is a major health problem, but medical undergraduate education about cancer leaves many practitioners ill-prepared. All practitioners need some knowledge of cancer. Those practising in rural areas might need more knowledge because of their isolation from tertiary services. We review the need for cancer education from the perspective of patients and clinicians, and examine the cancer-knowledge skills and attitudes of medical undergraduates. Patients with cancer expect their family practitioner to be knowledgeable enough to act as their advocate and to be able to interpret for them the complex array of tests and treatments that they could face. Many oncologists think that they do not have adequate access to students because of entrenched attitudes within universities that aim to protect established teaching programmes and leave little room to adapt teaching to the changing needs of society. Surveys of medical undergraduates have shown that, over the past decade, students have less contact with patients and retain some misconceptions about cancer. To deliver appropriate standards of cancer teaching, an undergraduate programme should incorporate a national or international standard curriculum and a minimum number of essential experiences. Because assessment drives education, students' knowledge, skills, and attitudes relating to cancer should be assessed, and the outcomes of such assessment should inform the curriculum.