ttcake

• We have found that expression of GPX1, GPX3, and GPX4 genes was decreased in ccRCC.
• eported earlier tha
• an allele that possess 5 alanine repeats is associated with the increased cancer risk.
• the frequency of alleles with repeats was similar among ccRCC patients and healthy individuals.
• localization and function.
• the number of alanine repeat codons in the coding sequence.
• 7 alanine repeats being more cytoplasmically located
• biologic consequence
• affect cancer risk
• Molecular consequences
• showed a significantly higher induction
• GPx-1 with 5 alanines
• The ALA6 allele was under transmitted
• ALA6 allele may be protective for AD.
• the allele of GPX1 containing four GCG repeats was significantly associated with breast cancer risk in premenopausal women (odds ratio
• There is a significant trend of increasing risk with increasing number of alleles with four GCG repeats
• There was a significant association between individuals with at least one ALA6 allele and an increased risk of CAD after adjustment for age
• The GPX1 gene has a GCG repeat polymorphism in exon 1,
• no significant association

17 more annotations...

maaihui

• , we show that IGFBP-3, if ectopically expressed in the nucleus, can induce apoptotic cell death. These results suggest that ubiquitin/proteasome-mediated proteolysis of IGFBP-3 may contribute to down-regulation of apoptosis.

lanny8p

• When initiated within 24 hours of symptom onset, oral zinc is associated with a shorter duration of the common cold in healthy people. However, there is no association between oral zinc and symptom severity, and the prevalence of adverse effects with zinc lozenges is high. Given the high heterogeneity of data, these results sh
• ermine the therapeutic and prophylactic effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) for the common cold. Zinc lozenges were administered once daily during the cold season for prophylaxis. For therapeutic purposes, lozenges were given 4 times per day. The primary objective of the study was the treatment effect on cold duration, and the secondary objective was the effect on the number of common colds. A putative control from our previous study was used for comparison. A total of 178 children, ages 12 to 18 years, was enrolled, of which 134 met criteria for efficacy analysis. The average cold duration with therapeutic lozenge use was
• benefits of prophylactic administration of zinc gluconate glycine lozenges in reducing the occurrence of colds. The medical charts of subjects enrolled at Utah's Heritage Center before and after the introduction of zinc gluconate glycine lozenges (between January 1998 and August 2001) were reviewed to identify those who experienced cold signs or symptoms. Two or more prespecified signs or symptoms on the same day identified a cold and, along with patient or medical staff reports and use of cold medications, were used to determine cold start and resolution dates. Results from subjects who did or did not take study treatment were compared statistically to determine the prophyl
• gestion, sneezing, cough, scratchy throat, hoarseness, muscle ache, fever, and headache were recorded daily for 12 days. Plasma zinc and proinflammatory cytokine levels were measured on day 1 and after participants were well.

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Hope Lappen

• 266737 794805 17840830 4465641 17811304 4709348 4761641 5079701 17742040 4914589 5823506 20329290 16017460 5610127 5883408

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silvia huerta

• Putative Breast Cancer Driver Mutations in TBX3 Cause Impaired Transcriptional Repression.
• TBX2 and TBX3 are frequently overexpressed in melanoma
• breast cancer
• cellular effects, among them suppression of senescence, promotion of epithelial-mesenchymal transition, and invasive cell motility
• loss of function of TBX3 and most other human T-box genes causes developmental haploinsufficiency syndromes
• breast tumor samples, identified five different mutations in TBX3, all affecting the DNA-binding T-domain

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sunxx1984

• employed
• measure structural and spontaneous functional changes in the brain, with a focus on the hippocampus and posterior cingulate regions
• suggest

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bouzina

• Right ventricular adaptation and failure in pulmonary arterial hypertension.
• Right ventricular adaptation and failure in pulmonary arterial hypertension.

• [Relevant issues in the pathology and pathobiology of pulmonary hypertension].

  Tuder RM, Archer SL, Dorfmüller P, Erzurum SC, Guignabert C, Michelakis E, Rabinovitch M, Schermuly R, Stenmark KR, Morrell NW.

  Turk Kardiyol Dern Ars. 2014 Oct;42 Suppl 1:5-16. Turkish.

  PMID:

  25697030

  Free Article

  Similar articles
• Right ventricular adaptation and failure in pulmonary arterial hypertension.
• Circulating biomarkers in pulmonary arterial hypertension: update and future direction.
• 11.

  Reducing TRPC1 Expression through Liposome-Mediated siRNA Delivery Markedly Attenuates Hypoxia-Induced Pulmonary Arterial Hypertension in a Murine Model.

  Sun CK, Zhen YY, Lu HI, Sung PH, Chang LT, Tsai TH, Sheu JJ, Chen YL, Chua S, Chang HW, Chen YL, Lee FY, Yip HK.

  Stem Cells Int. 2014;2014:316
• 14.

  Sirtuin 3 deficiency is associated with inhibited mitochondrial function and pulmonary arterial hypertension in rodents and humans.

  Paulin R, Dromparis P, Sutendra G, Gurtu V, Zervopoulos S, Bowers L, Haromy A, Webster L, Provencher S, Bonnet S, Michelakis ED.

  Cell Metab. 2014 Nov 4;20(5):827-39. doi: 10.1016/j.cmet.2014.08.011. Epub 2014 Oct 2.

  PMID:

  25284742
• 15.

  Cardiopulmonary and inflammatory biomarkers in the assessment of the severity of canine dirofilariosis.

  Carretón E, Morchón R, Simón F, Juste MC, Méndez JC, Montoya-Alonso JA.

  Vet Parasitol. 2014 Nov 15;206(1-2):43-7. doi: 10.1016/j.vetpar.2014.08.019. Epub 2014 Sep 6.

  PMID:

  25224789

  Similar articles

  Select item 2521888716.

  Evaluation of C-reactive protein as a clinical biomarker in naturally heartworm-infected dogs: a field study.

  Venco L, Bertazzolo W, Giordano G, Paltrinieri S.

  Vet Parasitol. 2014 Nov 15;206(1-2):48-54. doi: 10.1016/j.vetpar.2014.08.018. Epub 2014 Sep 1.

  PMID:

  25218887

  Similar articles
• 17.

  Erythropoietin upregulation in pulmonary arterial hypertension.

  Karamanian VA, Harhay M, Grant GR, Palevsky HI, Grizzle WE, Zamanian RT, Ihida-Stansbury K, Taichman DB, Kawut SM, Jones PL.

  Pulm Circ. 2014 Jun;4(2):269-79. doi: 10.1086/675990.

  PMID:

  25006446

  Free PMC Article

  Similar articles
• 18.

  Blood biomarkers and their potential role in pulmonary arterial hypertension associated with congenital heart disease. a systematic review.

  Giannakoulas G, Mouratoglou SA, Gatzoulis MA, Karvounis H.

  Int J Cardiol. 2014 Jul 1;174(3):618-23. doi: 10.1016/j.ijcard.2014.04.156. Epub 2014 Apr 22. Review.

  PMID:

  24814894

• Biomarkers and prognostic indicators in pulmonary arterial hypertension.

  Jardim C, Souza R.

  Curr Hypertens Rep. 2015 Jun;17(6):556. doi: 10.1007/s11906-015-0556-y.

  PMID:

  26054384
• 22.

  Relevant issues in the pathology and pathobiology of pulmonary hypertension.

  Tuder RM, Archer SL, Dorfmüller P, Erzurum SC, Guignabert C, Michelakis E, Rabinovitch M, Schermuly R, Stenmark KR, Morrell NW.

  J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D4-12. doi: 10.1016/j.jacc.2013.10.025. Review.

  PMID:

  24355640

  Free PMC Article

  Similar articles
• 23.

  Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 1--Cardiac diseases and pulmonary hypertension.

  Smith KF, Quinn RL, Rahilly LJ.

  J Vet Emerg Crit Care (San Antonio). 2015 May-Jun;25(3):311-29. doi: 10.1111/vec.12318.

• B-type natriuretic peptide, vascular endothelial growth factor, endothelin-1, and nitric oxide synthase in chronic mountain sickness.

  Ge RL, Mo VY, Januzzi JL, Jin G, Yang Y, Han S, Wood MJ, Levine BD.

  Am J Physiol Heart Circ Physiol. 2011 Apr;300(4):H1427-33. doi: 10.1152/ajpheart.00366.2010. Epub 2011 Jan 7.

  PMID:

  21217075

  Free Article

  Similar articles
• 23.

  Pulmonary arterial hypertension and microRNAs--an ever-growing partnership.

  Wang Y, Xue XY, Liu YX, Wang KF, Zang XF, Wang J, Wang PL, Zhang J, Pan L, Zhang SY, Wang JX.

  Arch Med Res. 2013 Oct;44(7):483-7. doi: 10.1016/j.arcmed.2013.08.003. Epub 2013 Sep 17. Review.

  PMID:

  24051036

  Similar articles

• Biomarkers for pediatric pulmonary arterial hypertension: challenges and recommendations.

  Lohani O, Colvin KL, Yeager ME.

  Paediatr Respir Rev. 2015 May 12. pii: S1526-0542(15)00036-6. doi: 10.1016/j.prrv.2015.05.003. [Epub ahead of print] Review.

  PMID:

  26036720

  Similar articles
• 24.

  Pim-1: A new biomarker in pulmonary arterial hypertension.

  Renard S, Paulin R, Breuils-Bonnet S, Simard S, Pibarot P, Bonnet S, Provencher S.

  Pulm Circ. 2013 Jan;3(1):74-81. doi: 10.4103/2045-8932.109917.

  PMID:

  23662177

  Free PMC Article

  Similar articles
• 31.

  Apelin and pulmonary hypertension.

  Andersen CU, Hilberg O, Mellemkjær S, Nielsen-Kudsk JE, Simonsen U.

  Pulm Circ. 2011 Jul-Sep;1(3):334-46. doi: 10.4103/2045-8932.87299.

  PMID:

  22140623

  Free PMC Article

  Similar articles
• 32.

  Toxicity as a biomarker of efficacy of molecular targeted therapies: focus on EGFR and VEGF inhibiting anticancer drugs.

  Dienstmann R, Braña I, Rodon J, Tabernero J.

  Oncologist. 2011;16(12):1729-40. doi: 10.1634/theoncologist.2011-0163. Epub 2011 Dec 1. Review.

  PMID:

  22135123

  Free PMC Article

• Angiotensin-converting enzyme inhibitor preserves p21 and endothelial nitric oxide synthase expression in monocrotaline-induced pulmonary arterial hypertension in rats.

  Kanno S¹, Wu YJ, Lee PC, Billiar TR, Ho C.

• The phosphodiesterase-5 inhibitor vardenafil reduces oxidative stress while reversing pulmonary arterial hypertension.

  Fan YF, Zhang R, Jiang X, Wen L, Wu DC, Liu D, Yuan P, Wang YL, Jing ZC.

  Cardiovasc Res. 2013 Aug 1;99(3):395-403. doi: 10.1093/cvr/cvt109. Epub 2013 May 6.

  PMID:

  23650288

  Free Article

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• 33.

  Design and validation of an endothelial progenitor cell capture chip and its application in patients with pulmonary arterial hypertension.

  Hansmann G, Plouffe BD, Hatch A, von Gise A, Sallmon H, Zamanian RT, Murthy SK.

  J Mol Med (Berl). 2011 Oct;89(10):971-83. doi: 10.1007/s00109-011-0779-6. Epub 2011 Jul 7.

  PMID:

  21735044

  Free PMC Article

  Similar articles

• PGC-1α induction in pulmonary arterial hypertension.

  Mata M, Sarrion I, Milian L, Juan G, Ramon M, Naufal D, Gil J, Ridocci F, Fabregat-Andrés O, Cortijo J.

  Oxid Med Cell Longev. 2012;2012:236572. doi: 10.1155/2012/236572. Epub 2012 Aug 29.

  PMID:

  22973467

  Free PMC Article

• erotonylated fibronectin is elevated in pulmonary hypertension.

  Wei L, Warburton RR, Preston IR, Roberts KE, Comhair SA, Erzurum SC, Hill NS, Fanburg BL.

  Am J Physiol Lung Cell Mol Physiol. 2012 Jun 15;302(12):L1273-9. doi: 10.1152/ajplung.00082.2012. Epub 2012 Apr 20.

  PMID:

  22523280

  Free PMC Article

  Similar articles
• 36.

  Proteomic identification of altered apolipoprotein patterns in pulmonary hypertension and vasculopathy of sickle cell disease.

  Yuditskaya S, Tumblin A, Hoehn GT, Wang G, Drake SK, Xu X, Ying S, Chi AH, Remaley AT, Shen RF, Munson PJ, Suffredini AF, Kato GJ.

  Blood. 2009 Jan 29;113(5):1122-8. doi: 10.1182/blood-2008-03-142604. Epub 2008 Nov 20.

  PMID:

  19023114

  Free PMC Article

  Similar articles

• The natriuretic peptide system: kidney and cardiovascular effects.

  Silver MA.

  Curr Opin Nephrol Hypertens. 2006 Jan;15(1):14-21. Review.

  PMID:

  16340661

  Similar articles

• Balloon atrial septostomy in pulmonary arterial hypertension: effect on survival and associated outcomes.

  Chiu JS, Zuckerman WA, Turner ME, Richmond ME, Kerstein D, Krishnan U, Torres A, Vincent JA, Rosenzweig EB.

  J Heart Lung Transplant. 2015 Mar;34(3):376-80. doi: 10.1016/j.healun.2015.01.004. Epub 2015 Jan 16.

  PMID:

  25813766
• Inactivation of p53 Is Sufficient to Induce Development of Pulmonary Hypertension in Rats.

26 more annotations...

Karen Fang

yan's chapter

• was identified as the most important predictor among 55 variables by random survival forest analysis.

Andrea Ketchum

• ("Substance-Related Disorders/rehabilitation"[Mesh]) AND "Occupational Therapy/therapeutic use"[Mesh]
• :
• AUID- ORCID: 0000000175476423
• OR
• Ducts, Pancreatic[tiab]
• types of causal effects
• methods of estimation of causal effect
• s including Western
• Overa

7 more annotations...

nikos papaxristou

"Common biological pathways underlying the psychoneurological symptom cluster in cancer patients."

phd-cancer-temp phd-papers-temp medicine-innovation-chronic-diseases

• Common biological pathways underlying the psychoneurological symptom cluster in cancer patients.

Allan McDougall

• difficulty in accessing assessment programs, activities, and tools
• Self-directed learning skills comprise an important strategy for specialists maintaining or expanding their expertise in patient care, but an important obstacle to answering patient care questions is the ability to formulate good ones.

young12

• New insights into pb5, the receptor binding protein of bacteriophage T5, and its interaction with its Escherichia coli receptor FhuA.

lillianzww

• Patients reported moderate levels of global QOL, symptom severity, and self-efficacy for coping with cancer. They also reported high physical and cognitive functions, but relatively low role and social functions. Factors were significantly related to the most functional dimensions, including self-efficacy, fatigue, pain, sleep difficulties, and demographic- and disease-related factors. Self-efficacy was the most robust factor for predicting QOL.
• Self-efficacy was the most robust factor for predicting QOL.
• Self-efficacy was the most robust factor for predicting QOL.
• Self-efficacy was the most robust factor for predicting QOL.
• self-efficacy can be used to identify individuals likely to have good perceived asthma control in the future.
• A significant decline in quality of life was observed at 6 months post diagnosis (p < 0.001). Perceived social support before radical treatment was the most important social support construct that predicted better global quality of life and less depression at six months, explaining approximately 30% of the variance. Despite men's self-management efforts and use of social support overtime, self-management self-efficacy significantly reduced at six months (p < 0.05).
• A significant decline in quality of life was observed at 6 months post diagnosis (p < 0.001). Perceived social support before radical treatment was the most important social support construct that predicted better global quality of life and less depression at six months, explaining approximately 30% of the variance. Despite men's self-management efforts and use of social support overtime, self-management self-efficacy significantly reduced at six months (p < 0.05).

• RESULTS:

  A significant decline in quality of life was observed at 6 months post diagnosis (p < 0.001). Perceived social support before radical treatment was the most important social support construct that predicted better global quality of life and less depression at six months, explaining approximately 30% of the variance. Despite men's self-management efforts and use of social support overtime, self-management self-efficacy significantly reduced at six months (p < 0.05).
• A significant decline in quality of life was observed at 6 months post diagnosis (p < 0.001). Perceived social support before radical treatment was the most important social support construct that predicted better global quality of life and less depression at six months, explaining approximately 30% of the variance. Despite men's self-management efforts and use of social support overtime, self-management self-efficacy significantly reduced at six months (p < 0.05).
• anticipat
• Growth curve analysis was used to test for changes in FCR over time and growth mixture modeling examined different trajectories in FCR and the ability of the CBM to predict these trajectories.
• plus an anchor question: "Overall how does bowel function affect your quality of life?"
• A phenomenon known as genetic anticipation has been documented in some hereditary cancer syndromes, where it was proved to relate to telomere shortening.
• In total, 126 lung cancer patients were evaluated, 38% had a diagnosis of depression.
• 31.

  Legitimising fatigue after breast-cancer treatment.
• This study used a longitudinal design to assess depressive symptomatology in patients receiving ADT compared with two groups of matched controls.
• The Fatigue Severity Scale scores were higher in the depressive group than in the non-depressive group (P<0.001). Multiple logistic regression analysis showed that the highest tertile level of fatigue (odds ratio, 7.31; 95% confidence interval, 3.81-14.02) was associated with the increased risk of depression.
• Despite men's self-management efforts and use of social support overtime, self-management self-efficacy significantly reduced at six months (p < 0.05).
• 2) fostering involvement before delivering treatments, by anticipating information on practical and emotional illness-related issues;
• Fatigue may be a surrogate sign for depression, and warrants further evaluation.
• After adjustment for sample differences, physical symptom distress was significantly associated with all illness perception dimensions (p < 0.01), excepting control beliefs. Optimism was positively correlated with perceived personal and treatment control (p < 0.01) and illness understanding (p < 0.01), but negatively correlated with other IPQ dimensions (all p < 0.01). IPQ domain differences by cancer type were eliminated by adjustment for sample characteristics.

• We used the anchor-based approach to identify the minimal clinically important difference (MCID) for improvement and deterioration for ESAS physical, emotional, and total symptom distress scores.

  METHODS:

  In this multicenter prospective study, we asked patients with advanced cancer to complete their ESAS at the first clinic visit and at a second visit three weeks later. The anchor for MCID determination was Patient's Global Impression regarding their physical, emotional, and overall symptom burden ("better," "about the same," or "worse"). We identified the optimal sensitivity/specificity cutoffs for both improvement and deterioration for the three ESAS scores and also determined the within-patient changes.
• Nausea was determined by a 7-item symptom scale measuring symptom number (SN) prior to (anticipatory), immediately after, and 15 and 30 min after rotation and by the Nausea Profile (NP) questionnaire immediately after rotation.
• Overshadowing is effective in reducing symptoms of anticipatory nausea and rotation-induced unconditioned nausea; its effect on endocrine and immunological parameters is gender specific. Its application in alleviation of anticipatory nausea in cancer patients is considered.
• These individuals were assessed on their social functioning, psychiatric symptoms, self-efficacy, and quality of life using standardised assessment scales at baseline, 6 months, and 12 months of follow-up.
• The reduced access to surgical resection and lower survival among lung cancer patients who present through an emergency admission, highlights the importance of ensuring symptoms are recognised early so that presentation as an emergency can be reduced.
• The correlations of these dimensions with the Brief Illness Perception Questionnaire and Karnofsky performance substantiated this interpretation.
• Rotterdam Symptom Checklist (RSCL)

• RESULTS:

  Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician's communication score < 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001).

  CONCLUSION:

  A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient's experience of disease.
• Anchor and distribution-based assessments were employed to determine the MID associated with this instrument. The anchor of overall QOL was used to determine meaningful change.
• Our results suggest that changes in illness perceptions are related to an improvement or worsening of patients' emotional well-being over time. These findings hold promise for the development of interventions that specifically target patients' representations of their illness.
• Fatigue-anorexia-cachexia
• Questionnaires were used to assess patients' QOL, symptoms, and self-efficacy before treatment and at one and three months following treatment. Factors related to the changes in global QOL and five functional dimensions were analyzed using six generalized estimating equation models.
• The aim of this article is to address the existing barriers in implementing PC into our cancer care delivery system and discuss how the oncology advanced practice nurse plays an essential role in providing high-quality cancer care.
• Patients seem to benefit from rapid reduction of tumor burden with surgery.
• and discuss a National Cancer Institute-funded program project currently conducted at a National Comprehensive Cancer Center, "Palliative Care for Quality of Life and Symptoms Concerns in Lung Cancer," which serves as a model to promote high-quality care for patients and their families.
• Key points Knowledge about the prevalence of early symptoms and other clinical signs in cancer patients in primary care remains insufficient. • 
• As such, ASCO recommends early integration of palliative care into comprehensive cancer care for all patients with advanced disease and/or significant symptom burden.
• These results suggest that patients who experience greater physical symptoms/side effects during treatment are at greater risk for later cancer-related distress and, in turn, general distress.
• the coping self-efficacy scale,
• (a) major impact of first chemotherapy sessions, and (b) some tendency to returning to baseline measures at 8 weeks.
• Our hypothesis was supported, and anxiety was strongly linked with personality trait and coping style.
• Results from path analyses showed that the relationships among CVD severity and health satisfaction were mediated by illness perception and self-efficacy beliefs.
• Low-Dose Computed Tomography for Lung Cancer Screening: A Review of the Clinical Effectiveness, Diagnostic Accuracy, Cost-Effectiveness, and Guidelines [Internet].
• Growth mixture modeling and a prospective longitudinal design were used to examine the course of fatigue after treatment for early stage breast cancer. Women (n = 261; mean age = 55.2 years) provided fatigue ratings for 6 months following treatment. A low-fatigue group (n = 85) and a high-fatigue group (n = 176) were extracted.
• Patients' own implicit common sense beliefs about their illness added small but significant amounts of variance to the prediction of QoL after 2 years.
• Negative perceptions about the duration of the illness (chronic timeline beliefs) and more negative perceived consequences also predicted worse QoL.
• A contributor to the lower survival rate is the fact that lung cancer is generally diagnosed at an advanced stage when patients present with symptoms and when cure by surgery is unlikely.
• difference between cycles in change of QOL from days 1 to 8.
• Illness Perception Questionnaire (IPQ), Mental Adjustment to Cancer Scale (MAC) and the Eysenck Personality Scales (EPS).
• Patients with chronically elevated distress were characterised by higher levels of neuroticism, greater symptom awareness, more pain and poorer self-rated general health.
• There was greater decrease in global QOL (p = 0.06) when patients received dexamethasone.
• Subgroups of patients with chronically high distress are characterised by factors including personality and negative perceptions and beliefs about their illness.
• The 1-year survival rate of treated patients (53.32%) was greater than that of non-treated patients (21.44%).
• After simultaneously considering these scales, we found significant independent predictors of survival were nausea/vomiting (HR = 0.11, 95% CI = 0.02-0.63 for score >0 compared with =0) in NSCLC patients with surgery and appetite loss (HR = 1.77, 95% CI = 1.26-2.49 for score >0 compared with =0) in NSCLC patients without surgery.
• Why do patients with cancer access out-of-hours primary care? A retrospective study.
• Despite Taiwan's NHI system, some lung cancer patients choose not to receive cancer treatment and the mortality rate for non-treated patients is significantly higher than that of patients who undergo treatment.
• and ability to detect change, comparing change from baseline PRO score at each cycle across PS and tumour response groups.
• Eight hundred and fifty-two patients made contact because of a symptom.
• pain (n = 262/852, 30.8%); nausea/vomiting (n = 102/852, 12.0%); agitation (n = 53/852, 6.2%); breathlessness (n = 51/852, 6.0%); and fatigue (n = 48/852, 5.6%).
• Pain management should specifically be addressed during routine anticipatory care planning.
• Anchor-based definition of response using mild, moderate, and severe categories of symptom severity were used. Responses and times to response for 15 symptoms were investigated in relation to trial arm, comorbid conditions, treatment protocols, and metastatic versus localized disease.
• Fifty-two percent of patients had chemotherapy, 49% received radiotherapy and 21% had surgery. 13% of treated patients were readmitted to hospital with complications of therapy. Median survival was 33 weeks (95% CI 30-40).
• We determined anchor-based differences using Karnofsky Performance Status (KPS), bone alkaline phosphatase (BAP), hemoglobin, time to disease progression (TTP), adverse events (AE), and survival.
• Within-subject, univariate, and multivariate analyses were used to derive classification trees for each user associating specific behavior variables with symptom levels over time.
• Such knowledge can promote realistic expectations and help patients come to terms with their outcome.
• then anchor-based categories can be developed to evaluate patients' responses to the intervention.
• Differences among adjusted mean interference scores for mild, moderate, and severe levels were tested at each contact. Differences among interference-based severity categories were consistent over time and clinically important, and thus can be used to anchor changes in symptom severity.
• (patients: mean difference of 1.01 for depression with a relative risk (RR) of 4.5 and 0.84 for anxiety with RR=6.1;
• Children and caregivers with higher asthma-management self-efficacy at the office visit reported better QOL 1 month later.
• Structural equation models, on the other hand, incorporated and tested specific clinically anticipated causal relationships among the symptoms and changes in those symptoms over time.
• In the multivariate analysis, age (> 55 years), chest pain, tumor volume (> 20 cm3), total number of removed lymph nodes (> or = 10), and number of involved N1 lymph nodes (> or = 3) were independent prognostic factors for 5 year survival.
• Differences in lung cancer incidence and mortality are associated with sociodemographic, clinical, and behavioral factors. These findings suggest modifiable exposures and behaviors may contribute to differences in incidence of and mortality by race/ethnicity for postmenopausal women. Interventions focused on these factors may reduce racial/ethnic differences in lung cancer incidence and mortality.
• Life-Orientation-Scale by Antonovsky (sense-of-coherence, SOC)
• 0-item self-efficacy-scale (SWE) by Jerusalem and Schwarzer.
• The data set included 155 participants and was analyzed using Structural Equation Modeling (SEM) designed to examine mutual influence in longitudinal data with Mplus software.
• classical conditioning processes
• instrumental
• Although objective polysomnography is needed to diagnose OSAS, the symptoms obtained during an office visit can offer adjunctive insight into important comorbidities and likely surgical responses.
• The effectiveness of home hospice care was helping patients to die at home, and reducing symptom burden.
• This multicenter, non-interventional, prospective, observational study aimed to determine whether patients' attitude to chemotherapy is an independent prognostic factor for survival in patients with advanced non-small cell lung cancer (NSCLC) who are treated with gemcitabine-platinum. Chemonaive patients (n=1895) with stage IIIB or IV NSCLC not amenable to curative surgery or radiotherapy were treated with a combination of gemcitabine plus cisplatin/carboplatin and followed for a maximum of 18 months. Patients' attitude to treatment was measured on a 5-point scale and responses were used to assign patients to one of the three need categories: A, maximum extension of survival with the acceptance of high toxicity (60.0% of patients); B, maximum extension of survival only if coupled with normal lifestyle (26.1%); C, relief of symptoms (13.8%). Median survival varied significantly among the need categories (A=13.00 months, B=15.70 months, C=15.33 months; log-rank test P=0.0415). Patient attitude to treatment (need categories) was not a significant prognostic factor for survival after adjusting for known prognostic factors (P=0.0503). After adjusting for baseline differences, patients in this study had a significantly lower risk of death than patients in three randomized trials (hazard ratio 0.879; 95% confidence interval: 0.775, 0.998; P=0.0458). In conclusion, in this observational study, patient attitude to chemotherapy was not an independent prognostic factor of survival.
• Toxicity rates reported by physicians were always lower than those reported by patients. For patients who reported toxicity (any severity), under-reporting by physicians ranged from 40.7% to 74.4%. Examining only patients who reported "very much" toxicity, under-reporting by physicians ranged from 13.0% to 50.0%.
• explore the relations between illness representations and to explain how two illness-specific representations--personal control and treatment control--were determined by a person-level factor, self-efficacy.
• Resilience is the capacity of individuals to maintain, or regain, their mental health in the face of significant adversity, including physical illness.
• Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE.
• Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group.
• There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group.
• Lung Cancer Symptom Scales
• The low GSE group was also significantly (p= < 0.001) less engaged with their healthcare providers.
• Neither cultural identity nor theories of intelligence moderated the relationship between self-efficacy and depression.
• Symptoms were assessed at presentation, prior to cancer treatment in 599 newly diagnosed lung cancer patients.
• Increased transgender identity associated with increased coping self-efficacy, which negatively associated with depression symptom odds.
• No association between fatigue and any measures of physical activity or fitness were found.
• One study did find, through structural equation modeling techniques that fatigue indirectly influences exercise through self-efficacy expectations.
• There is very limited evidence regarding associations between exercise, fitness, and fatigue after stroke. It still remains highly plausible that exercise can have a positive influence on fatigue. Future research should be longitudinal in design.
• Lung cancer symptom scale (LCSS)
• It is now widely accepted that QoL should be considered as a primary endpoint of treatment in patients with advanced lung cancer both in clinical practice and clinical trials to further define meaningful response. As the traditional outcome measures of survival and tumour response are poor in this population, QoL assessment may offer a more comprehensive approach to evaluating the relative risks and benefits associated with treatments.
• Dyspnea could not be treated as effectively as pain or nausea. Confusion and nursing problems worsened during the observation period. Dyspnea and confusion were associated with increased risk of death during the observational period.
• cognitive symptom management (CSM) and tangible help-seeking (TH) by constructing latent growth change models.
• This study revealed different underlying change mechanisms for two types of self-management behaviors.
• The aims of this pilot were to describe the trajectory of symptoms (pain, sleep, appetite, nausea, fatigue) and biological and behavioral variables (anxiety, stress, hematologic function) across 1 cycle and examine relationships between variables.
• This review will systematically determine if there are socio-economic inequalities in time from symptom onset to treatment for lung cancer.
• Less advanced stages of cancer, lower anxiety, less symptom distress and higher perceived self-efficacy in the preoperative interview could significantly predict which patients experienced more positive quality of life trends.
• In patients with moderate to severe impairment (MMSE  ≤  20), self-efficacy for symptom management behaved as a mediator between patient neuropsychiatric symptoms and symptoms of burden and depression in caregivers.
• we identified patients diagnosed with female breast (8,639), colorectal (5,912), lung (5,737) and prostate (1,763) cancers between 1998 and 2009
• For girls, self-efficacy had an independent effect on internalizing symptoms and also strengthened the relationship between participation in cultural activities and reduced externalizing symptoms.
• self-efficacy were identified as potential protective factors against mental health problems.
• Stronger positive relationships were found between psychosocial wellbeing and both global life control and self-efficacy for disease management and adjustment.
• This is the first study to explore the role of physical activity in alleviating symptoms in lung cancer survivors by using the GEE method.
• The symptom scales of the QLQ-C30 remained stable under chemotherapy even at the final chemotherapy cycle and decreased from 16.2 to 44.1 at the initial visit to 11.2-29.9 (p<0.001) at the final visit.
• changes in SE were influenced directly by both SN and AT.
• Recall amplification was associated with lack of PTSD symptom improvement (P<0.05), but not with degree of exposure, immediate stress response, mood or stress symptoms, personality, self-efficacy or social support.
• A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010.
• In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression.
• perceived self-efficacy and perceived social support are considered possible predictors.
• However, a wide range of practical interventions and complementary therapies are likely to be helpful such as: acupressure and acupuncture, stress management and relaxation, energy conservation measures, anticipatory guidance and preparatory information, and attention-restoring activities.
• In addition, low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1.
• Of the 194 patients, 148 (76.3%) showed symptoms of depression
• Patient-reported outcomes (PROs) for symptoms and health-related quality of life (QoL) are reported here.
• Demographic and illness characteristics were found to have a more significant relationship with illness representation components than with specific self-efficacy.
• The relationship between illness representation components and specific self-efficacy changes overtime, consequence and timeline were significantly related to self-efficacy measures initially; however, symptom and control/cure were the variables that were significantly related to self-efficacy measures 9 months later. After statistically controlling individuals' baseline self-efficacy measures, demographic and illness characteristic effects, symptom and control/cure were found to make significant contributions to exercise and diet self-efficacy, respectively, 9 months later.
• Perceptions of control were not completely determined by disease stage/disability.
• In contrast, greater use of negative religious coping was related to poorer overall QOL and lower scores on the existential and psychological QOL dimensions.
• The weight-based component of the recently proposed international consensus CACS definition is useful in identifying patients with advanced NSCLC who are likely to have significantly inferior survival and who will develop more precipitous declines in physical function and QOL.
• Depressive reactions are highly prevalent in lung cancer patients and related to patients' personality.
• Depression Coping Self-Efficacy Scale
• Despite maintenance of improvements in depressive symptom and depression coping self-efficacy scores, depressive symptom scores remained above cutoff levels at 2 years posttreatment.
• Co-morbidity and perceived self-efficacy (PSE) were positively associated with ADs.
• If a high prevalence of comorbid anxiety disorder is documented and if this comorbidity adversely affects the self-efficacy and self-care, symptom burden, and functioning in persons with asthma, then it will be important to develop treatment trials.
• At diagnosis, participants described poor sleep such as trouble falling asleep and frequent awakenings. Over time, as the treatment worsened their sleep symptoms, these participants still maintained hope for more time with treatment. This focus enabled them to tolerate the sleep-wake disturbances and treatment adverse effects. As the treatment effectiveness declined, their focus changed to spiritual meanings for the future and to keep living life with a purpose.
• This data indicates that only the leukocyte counts is an independent prognostic factors of survival in lung cancer.
• Factors associated with a likely psychological disorder included poorer physical function, younger age, non-white race, poverty, a likely drinking problem, neuroticism, a poor sense of self-efficacy, and limited social support.
• The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces the patient to face a new life situation, and demands one-on-one supportive care.
• (hopefulness, hopelessness, self-esteem, self-efficacy and symptom distress) and clinical outcomes (treatment toxicity) among adolescents newly diagnosed with cancer.
• self-efficacy (Arthritis Self-Efficacy Scales for pain and for other symptoms).
• Changes in self-efficacy and in corresponding health status measures were significantly correlated. For patients with above average educational level self-efficacy for pain at baseline was positively correlated to improvement in pain measures. Good mental health at baseline was correlated to improvement in self-efficacy for other symptoms, but only for patients with below average educational level.
• Baseline self-efficacy seems to influence future level of perceived pain and baseline mental health status seems to influence future self-efficacy.
• This study supports previous findings that there is a need for health professionals to provide emotional support and respond to the psychosocial needs of patients by eliciting their concerns and attempting to address them in the early stages of the disease process.
• For all health status measures, there was a significant correlation between the change over a 2-yr span and baseline self-efficacy, even after adjustment for demographic variables and for the baseline level of the health status measure. Favourable changes were associated with high self-efficacy scores.
• Of the 7 intervening variables examined, higher scores on self-esteem and self-efficacy predicted lower distress for both mothers and fathers 4, 12, and 24 months post-death.
• The patterns of symptom distress in adults receiving treatment for lung cancer varied between treatment groups and over time.
• Patients' symptoms and mood disturbances did not significantly change over time. The role of self-care self-efficacy with measures of adjustment was investigated using canonical correlations. For the predictor variables, subscores for coping and enjoying life on the SUPPH showed the strongest loadings, 0.83 and 0.94, respectively. On the dependent variables, the FACT was by far the most important variable, with a loading of 0.92.
• The direction of the relation between problem-focused scales and symptoms may depend in part on perceived efficacy, or how the respondent thought he or she handled the problem. Implications for the measurement of adaptive coping mechanisms and their contextual appropriateness are discussed.
• Intended coping responses to cancer symptoms in healthy adults: the roles of symptom knowledge, detection behavior, and perceived threat.
• Fatigue was significantly associated with subjective reports of poor sleep and objective measures of daytime sleepiness, but not with nocturnal sleep as measured with actigraphy. This relationship between fatigue and sleep warrants further studies to explore their possible common underlying etiology.
• The authors measured intended coping responses to the detection of cancer-related symptoms as either adaptive (e.g., visiting a general practitioner) or maladaptive (e.g., denial of the symptom).
• As expected, the findings revealed that well-known symptoms resulted in more anticipated adaptive coping and less anticipated maladaptive coping than less-known symptoms.
• Significant correlations (p < .05) occurred between self-care self-efficacy and mood states, health status, symptom distress, and perceived adherence to fluid restrictions. Correlations occurred more frequently between self-care self-efficacy and mood states than between self-care self-efficacy and other measures of adjustment.
• Patients who had increased confidence in self-care strategies (self-efficacy) were associated with having more positive mood states, health status, and perceived adherence to fluid restrictions and less symptom distress.
• Acupuncture and selected botanicals may reduce chemotherapy-induced nausea and emesis, and hypnosis and guided imagery may be beneficial in anticipatory nausea and vomiting.
• This in turn would allow women to anticipate symptoms, employ management strategies, and empower them to improve their cancer experience.
• older patient-physician relationships; the stress-coping social-support health model that dominates family caregiver research; the social learning-self-efficacy model; and literature on the quality of medical care.
• Furthermore, the focus of antiemetic therapy should be on prevention, as the presence and severity of acute symptoms have been linked to occurrence of symptoms in the delayed phase and the likelihood of anticipatory nausea and vomiting with further treatment cycles.
• Psychooncology. 2001 Jan-Feb;10(1):1-18.

  Adjustment to cancer - coping or personal transition?

  Brennan J¹.

  Author information

  • ¹Department of Clinical Health Psychology, Bristol Oncology Centre, Bristol, UK. james.brennan@bristol.ac.uk

  Abstract

  The term 'adjustment' is widely used within the psycho-oncology literature and, although it is a topic of central importance to the lived experience of people with cancer, the psychological mechanisms of adjustment have rarely been described. Rather than regarding it as the absence of psychopathology or the end-point of coping with the global threat of cancer, adjustment refers to the psychological processes that occur over time as the individual, and those in their social world, manage, learn from and adapt to the multitude of changes which have been precipitated by the illness and its treatment. However, these changes are not always for the worse: sometimes they precipitate 'healthy personal growth' in a number of areas. It is only from explicit theories of adjustment that progress can be made in understanding how and why psychological disorders so frequently develop in cancer and what steps may be taken to prevent them. This paper combines the complementary assets of coping theory and social-cognitive theory and proposes the Social-Cognitive Transition (SCT) model of adjustment, a clinical model which also accounts for the frequent reports of healthy personal growth associated with cancer.
• Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.
• Our results support the validity of nurse toxicity reporting and that the nurse staff could be successfully employed in collecting toxicity data because of a greater ability to elicit information from patients than the medical staff.
• Improved nutritional assessment skills are needed with an emphasis on anticipated problems and current status.
• Caregiving burden is problematic for both patients and spouses. Couples in which spouses report caregiving-related health problems may be at particular high risk of long-term elevated distress.
• A significant proportion of the patients in this pilot study had misconceptions regarding their illness and unrealistic expectations from palliative radiotherapy.
• In this study, we investigated patients' anticipatory fears about chemotherapy.
• Hair loss, vomiting, infection, nausea, and weight loss were ranked as the most feared side effects of cancer treatment for the group as they began treatment. Patients beginning chemotherapy endorsed frequent or intense levels of fatigue, worrying about the future, pain, and sleep problems. No differences were found in the reporting of symptoms based on gender, age, or educational level. While changes in symptom distress over the study period were unremarkable, changes in fears about chemotherapy were of interest. The most feared symptoms were re-ordered following the treatment experience. The endorsement of nausea and vomiting, alopecia, and loss of appetite decreased significantly. Thirty-five percent fewer chemotherapy patients reported vomiting as one of their most feared side effects; 45% fewer patients who received anti-emetics reported vomiting as one of their most feared side effects. Effective treatments, such as those that have been developed to treat acute chemotherapy-related emesis, can relieve the fears of patients on treatment.
• are fluid and malleable.
• Objective time spent coughing was also weak-moderately associated with subjective cough scores and visual analog scales, and most strongly correlated with cough-related quality of life (r = -0.54; P < .001).
• Subjective measures of cough and cough reflex sensitivity are poor surrogates for objective cough frequency in asthma. When designing studies to assess interventions for cough in asthma, we advocate a combination of both objective measures of cough and cough-related quality of life.
• more severe PTSD symptoms were prospectively and independently predicted by the following startle measures: greater subjective fear under low threat, greater skin conductance under high threat, and slower skin conductance habituation.
• These results imply that hypersensitivity to contextual threat (indexed by greater fear under low threat), elevated sympathetic nervous system reactivity to explicit threat (indexed by larger responses under high threat), and failure to adapt to repeated aversive stimuli (evidenced by slower habituation) are all unique preexisting vulnerability factors for greater PTSD symptom severity following traumatic stress exposure. These measures may eventually prove useful for preventing PTSD.
• Therefore, patient-centered outcome assessment tools applicable for both clinic and research should be developed. Report of symptoms via digital media provides a start for face-to-face communication, treatment decisions, and assessment of treatment effects. The increased use of electronic media for exchange of information may facilitate the development and use of electronic assessment tools and decision-making systems in oncology. In the future, patients may find that a combination of a face-to-face interview plus a transfer of information of subjective symptoms by electronic means will optimize treatment.
• he nutritional status of cancer patients can be supported by anticipating and managing disease- and treatment-related symptoms.
• Accuracy of symptom perception may be influenced by patient and parent affect characteristics.
• Lung cancer, malignant melanoma, multiple myeloma.
• This is the fourth of a six-part series on the metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6000 deaths per year in the United States.
• Interestingly, severity of distress did not differ in groups anticipating breast-conserving surgery (n = 35) instead of mastectomy (n = 39). The findings showed a discernible pattern of symptom distress before any treatment in women newly diagnosed with breast cancer, indicating a need for early intervention to promote the initial process of adjustment.
• Perceived stigma also accounted for significant unique variance in depressive symptomatology above and beyond that accounted for by relevant demographic, clinical, and psychosocial factors, β = 0.19, p<0.05.
• Although subjective fatigue is often related to objective changes in physical functioning or impaired performance status, the two phenomena are not synonymous and need to be distinguished. A number of robust and reliable assessment instruments to measure fatigue severity are now available and criteria for cancer-related fatigue syndrome have been proposed. The underlying mechanisms and pathophysiology of cancer-related fatigue are unclear
• Toxicity was greater than anticipated: 12% discontinued treatment due to toxicity, 29% developed at least one Grade 3 neuromuscular toxicity, and two patients died of sepsis while neutropenic.

• Management strategies include the use of psycho-educational interventions, exercise programmes and pharmacological treatments. The best evidence for the effectiveness of drug treatments is for the haematopoietic agents in anaemic patients undergoing chemotherapy and for methylphenidate in an on-treatment population.

  PMID:

  18381237

  [PubMed - indexed for MEDLINE]
• Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population.
• However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46).
• Although the majority of nurses in this study report providing anticipatory guidance, patient education, and supportive diarrhea management, they are not assessing diarrhea systematically. They report common use of nonprescription medications, with pharmacologic interventions varying with severity of diarrhea.
• Three hundred two (68%) underwent surgical resection only and 122 (27%) received surgical resection and radiation/chemotherapy. Recurrent or new lung malignancies were observed in 84 (19%) survivors. Significant decline or improvement in overall QOL over time were reported in 155 (35%) and 67 (15%) of 447 survivors, respectively. Among the 155 whose QOL declined, significantly worsened symptoms were fatigue (69%), pain (59%), dyspnea (58%), depressed appetite (49%), and coughing (42%). The symptom burden did not lessen among the 67 who reported improvement in overall QOL, suggesting that survivors had adapted to their compromised physical condition.
• psychologic symptoms; social, sexual, and vocational function; and beliefs about control over health.
• Predictors of greater psychologic distress included less education, younger age, anticipatory distress during chemotherapy treatment, and the combination of more medical problems after treatment with poorer family function. Anticipatory nausea and distress during chemotherapy predicted persistent visceral distress later, which occurred with reminders of treatment. Anticipatory vomiting predicted a greater tendency toward cancer-related intrusive thoughts and avoidance of reminders.
• Patients experiencing anticipatory distress during treatment who are younger and less educated should be monitored for depressive syndromes later.
• Although frequent assessments of pain using subjective reports remain the most valid indicators of adequate pain control, familiarity with radiologic interventions and responses of anatomic structures to various types of noxious stimuli allows the nurse to anticipate aspects of procedures known to be painful. Attention to symptom management both during and after the procedure is critical because patients with progressive cancer may present with significant physical and psychological alterations.
• Prior to the trial, clinical observation suggested that frequent short-lived episodes of pain might occur during this treatment regimen.
• Twenty-one patients provided longitudinal data for at least three cycles of chemotherapy. To assess transient pain, a routine QOL assessment at baseline and every third cycle was supplemented with pain measurements twice weekly.
• Management of anticipatory vomiting should concentrate on prevention, but once vomiting is established, behavioral therapy and the amnesic properties of lorazepam may be used.
• it was anticipated that changes may have occurred in patient perception of symptoms. The study was therefore repeated in 1993.
• The analysis presented here concentrates on two areas which was reported to influence distress in this population: (1) patients' perception of symptoms and symptom characteristics and their associated distress; and (2) the relationship between patients' causal reasoning and their distress.
• Better patient preparation about symptoms may alleviate some of the symptom distress in lung cancer patients.
• A significant relationship was found between the development of anticipatory nausea and the self-report of anxiety and depression score measured by HADS at baseline.
• Fifty-five ambulatory cancer patients were asked to record nine kinds of physical symptoms (e.g., nausea, vomiting, sweating) on time-scheduled symptom lists: after an infusion (indicating posttreatment symptoms) and prior to their next infusion (indicating anticipatory symptoms)
• At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care.
• In addition to occurring during, or up until days following, treatment with cytotoxic drugs, nausea and vomiting may begin to occur in anticipation of chemotherapy treatments.
• The placebo effect in LUTS has a strong behavioural component as patients become aware of their voiding habits and potential risk factors.
• Subjective symptom assessment should be a fundamental component of health-related quality of life (HRQL)
• However, poorly controlled emesis can lead to anticipatory nausea and vomiting in subsequent courses of chemotherapy, thus, consideration should also be given to the use of ondansetron in patients receiving moderately emetogenic chemotherapy
• Data analyses found that hope was inversely associated with major symptoms of cancer (i.e., pain, fatigue, and cough) and psychological distress (i.e., depression), even after accounting for important demographic and medical variables (i.e., age and cancer stage).
• symptom distress, mood disturbance, stage of disease, sensitivity to conditioning cues, emetic potential of antineoplastic drugs, age, psychosocial stress, and ability to cope.
• Delays in the diagnosis of lung cancer occurred because patients failed to recognise symptoms as serious and warranting medical attention.
• Predictors of depressive symptoms included younger age, antidepressant use at baseline, lower self-esteem and spiritual well-being, and greater attachment anxiety, hopelessness, physical burden of illness, and proximity to death. The combination of greater physical suffering and psychosocial vulnerability put individuals at greatest risk for depression.
• Most poorly understood is the anorexia-cachexia syndrome of advanced disease. Psychological causes often reflect anxiety about cancer, its possible progression, depression, anticipatory phenomena, and learned food adversions.
• aversions of specific foods seen among adult patients after chemotherapy or radiation.
• There is a growing awareness that symptoms frequently co-occur in 'symptom clusters' and that understanding these clusters may improve the management of unrelieved symptoms in patients. In-depth longitudinal exploration of lung cancer patients' symptom experiences is used to examine patient symptom experiences and distress across the disease trajectory of lung cancer.
• Participants were interviewed at five points during their first six cycles of therapy, and a subsample kept brief daily symptom diaries. Nausea, hair loss, and tiredness were each experienced by more than 80% of patients. By cycle 6, 46% of patients had thoughts about quitting therapy, but only a few had told medical staff.
• Communication between patient and practitioner was found to be inadequate in a number of respects (i.e., patients did not fully anticipate the toxicities of treatment and did not report their concerns to medical staff).
• Situational anxiety not corrected by psychosocial support, symptom control, or time may be successfully treated with benzodiazepines.
• Sleepiness and fatigue are two interrelated, but distinct phenomena; observed in a number of psychiatric, medical and primary sleep disorders. Despite their different implications in terms of diagnosis and treatment, these two terms are often used interchangeably, or merged under the more general lay term of 'tired'. Sleepiness is multidimensional and has many causes (multidetermined) and distinguished from fatigue by a presumed impairment of the normal arousal mechanism. Despite its ubiquity, no clear consensus exits as yet as to what constitutes sleepiness. Definitions of sleepiness, to date, are at best operational definitions, conceptualized so as to produce specific assessment instruments. As a result, while a number of subjective and objective measurement tools have been developed to measure sleepiness, each only captures a limited aspect of an otherwise heterogeneous entity. Fatigue is an equally complex phenomenon, its nature captured by a number of conceptualizations and definitions. Measures of fatigue have remained subjective, with a 'gold standard' for its measurement remaining elusive. Despite a high prevalence and high degree of morbidity, fatigue has remained a relatively under appreciated symptom, from both a clinical and research point of view.
• Lung cancer patients displaying more denial reported a better overall perception of health and better physical functioning.
• They complained less about fatigue, nausea and vomiting, appetite loss, dysphagia and pain in arm and shoulder than low deniers. Other symptoms did not differ among denial classes. Denial in lung cancer patients may well be an adaptive mechanism and have to be respected in clinical practice.
• High-dose radiotherapy or concurrent chemo-radiation in the treatment of lung cancer seems to be a well-tolerated treatment option with preservation of QoL.
• In this population, men aged 50-59 years with 40 and more pack-years could be an optimal target for lung cancer screening.
• Approximate likelihood ratios could be calculated for six symptoms or signs: haemoptysis 13; fatigue 5.7; cough 5.3; finger clubbing 3.9; weight loss 2.9; and dyspnoea 1.5-5.7, but none of these figures derived from single primary care studies.

• Anticipatory nausea in cyclical vomiting.

  McRonald FE¹, Fleisher DR.

  Author information

  • ¹Department of Clinical Dental Sciences, University of Liverpool, Daulby Street, Liverpool, L69 3GN, UK. f.e.mcronald@bham.ac.uk

  Abstract

  BACKGROUND:

  Cyclical Vomiting Syndrome (CVS) is characterised by discrete, unexplained episodes of intense nausea and vomiting, and mainly affects children and adolescents. Comprehending Cyclical Vomiting Syndrome requires awareness of the severity of nausea experienced by patients. As a subjective symptom, nausea is easily overlooked, yet is the most distressing symptom for patients and causes many behavioural changes during attacks.

  CASE PRESENTATION:

  This first-hand account of one patient's experience of Cyclical Vomiting Syndrome shows how severe nausea contributed to the development of anticipatory nausea and vomiting (ANV), a conditioned response frequently observed in chemotherapy patients. This conditioning apparently worsened the course of the patient's disease. Anticipatory nausea and vomiting has not previously been recognised in Cyclical Vomiting Syndrome, however predictors of its occurrence in oncology patients indicate that it could complicate many cases.

  CONCLUSION:

  We suggest a model whereby untreated severe and prolonged nausea provokes anxiety about further cyclical vomiting attacks. This anxiety facilitates conditioning, thus increasing the range of triggers in a self-perpetuating manner. Effective management of the nausea-anxiety feedback loop can reduce the likelihood of anticipatory nausea and vomiting developing in other patients.
• Factor analysis indicated that the LCS had the three dimensions of respiratory symptoms, appetite plus body weight, and clear thinking.
• A consistent pattern was found among the six subgroups, with breathing, pain, and fatigue rated as the symptoms most associated with distress.
• Descriptive cross-sectional analyses and longitudinal analyses using repeated measure ANOVA were conducted.
• Sensitivity to different symptom experiences and responses to those experiences between and within women and men is also necessary in the management of symptoms in patients with inoperable LC.
• In lung cancer, the social trajectory mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions: diagnosis, discharge after treatment, disease progression, and the terminal stage.
• Longitudinal evaluation of the Lung Cancer Symptoms Scale demonstrated lack of quality of life modification during the treatment period.
• JAMA. 2007 Mar 7;297(9):953-61.

  Computed tomography screening and lung cancer outcomes.
• Symptom clusters with four development patterns appeared over the time of CXRT. With some variation between patients, all symptoms had a significant impact on the level of interference (all P < .001). Fatigue, distress, and sadness were the single strongest predictors of total symptom interference (each R2 > or = 0.49). Physical symptoms had greater impact on interference with function when they were moderate to severe, whereas affective symptoms had the largest effect on interference when they were mild to moderate.
• Mortality increased with increasing number of organ system involvement and reaching up to 100% with involvement of 5 or more organ systems.
• This qualitative study aims to explore how people with inoperable lung cancer frame and conceptualize the onset of their sickness, to obtain knowledge which might facilitate earlier health care contact for people with potential lung cancer.
• Findings indicate a wide array of bodily experiences leading to diagnosis, including symptoms seen as related to other disorders, systemic complaints not conceptualized as symptoms or indications of a serious problem, and more rarely, symptoms triggering immediate action.
• Over the past 20 years there has been an upsurge in the number and types of HRQOL measures used in phase III cancer treatment trials.
• Results of trials reported after 2001 indicate a significant increase in specific treatment or disease-related symptom measures in lieu of or as companions to global HRQOL measures. Currently, open NCI-supported trials are incorporating a large number of targeted treatment- and/or disease-related measures.
• Global quality of life, functioning domains and symptom scores - such as appetite loss, fatigue and pain - were the most important indicators, individually or in combination, for predicting survival times in cancer patients after adjusting for one or more demographic and known clinical prognostic factors.
• Age significantly affects the presentation and treatment of non-small cell lung cancer patients. Although thoracic operation imparts the greatest survival advantage, this benefit is diminished due to advanced disease in the younger patients and lack of surgical intervention in the elderly.
• haemoptysis in lung cancer both had positive predictive values of 2.4%.
• The SF-36 summary score for mental health was significantly related to better survival, whereas the SF-36 summary score for physical health was not
• In the multivariate analysis, only the SF-36 mental health summary score remained an independent, significant predictor, mainly due to considerable intercorrelations between HRQoL scales.
• HRQoL contributes significantly to prediction of survival. Generic measures are at least as useful as disease-specific measures including symptoms. Intercorrelations between HRQoL variables and between HRQoL and clinical variables makes it difficult to identify prime predictors. We need to identify variables that are as independent of each other as possible to maximize predictive power and produce more consistent results.
• Lung Cancer Symptom Scale (LCSS) and/or QLQ-C30 (with LC13 module) assessment every 3 weeks.
• Study on the mode of presentation among 3815 lung cancer patients showed that 3608 (75%) presented with respiratory symptoms and 953 (25%) with extrapulmonary symptoms.
• Of the respiratory symptoms, cough was the complaint in 1940 (51%), features of superior vena cava obstruction (SVO) in 451 (12%), hemoptysis in 332 (9%), and dyspnea in 139 (4%).

234 more annotations...

alialzayeir

• Prospective randomized trial o
• 668 patients with diabetes
• t was concluded that the most common nosocomial infection after cardiac surgery congenital heart diseases in Georgian population was
• assigned to off-pump (OPCAB) (number [n]=222)
• OnP-BH) (n=223),
• con.ventional CABG (OnP) (n=223
• blood stream infection
• Myocardial injury was assessed by measuring the serial release of cardiac troponin I (cTnI) preoperatively,
• The early outcomes were compared
• The complete revascularization, postoperative drainage loss, intra-aortic balloon pump support, blood requirements, postoperative myocardial infarction, pulmonary complications, gastrointestinal complications, inotropic requirements > 24 hours, ventilation > 24 hours, intensive care unit stay > 24 hours, and in-hospital stay > 7 days were significantly lower in the OPCAB group
• In-hospital mortality was lower in the OPCAB group
• o differences in early and mid-term mortality were found between OPCAB and ONCAB in patients with triple-vessel disease and enlarged ventricles. However, OPCAB seems to have a beneficial effect on postoperative complications
• Off-pump CABG might be associated with decreased operative morbidity but did not affect operative death, compared with on-pump CABG.
• 4314 patients
• in terms of postoperative complications and myocardial protection in patients with diabetes
• is superior
• (OPCAB); n = 1958
• loodstream infection in
• assigned into five classes according to their BMI (underweight <20 kg/m(2), normal 20-24.99 kg/m(2), overweight 25-29.99 kg/m(2), obese 30-34.99 kg/m(2) and morbidly obese ≥35 kg/m(2))
• (ONCAB); n = 1756]
• Thirty-day mortality
• loodstream and surgical wound infection in 10 and 8%, respectively.
• MACEs
• length of in-hospital stay were analysed in relation to BMI only (whole cohort analysis), to BMI
• MNCAEs
• The main risk factors for developing HAI were
• 2.96-11.58] prolonged PCICU stay
• eonatal age
• 5.89, 95% confidence interval (CI):
• P < 0.05,
• ONCAB versus OPCAB
• as well as confounding factors
• open chest postoperatively
• gh complexity score
• no significant differences between BMI classes could be identified
• single internal mammary artery (SIMA) grafting
• 3102 patients
• n patients with higher BMI values, OPCAB appeared to reduce slightly the frequency of 30-day mortality, MACEs and MNCAEs, while slightly increasing the length of in-hospital stay.
• Compared with ONCAB
• study did not detect significant differences between BMI classes with regard to mortality and morbidit
• When comparing ONCAB versus OPCAB, patients with higher BMI values appeared to have a weak tendency towards a reduced short-term morbidity and mortality in favour of OPCAB.
• nonrandomized cohort of 742,909
• cluded 158,561 off-pump cases
• Blood loss and platelet transfusions were lower in the off-pump grou
• Sternal wound reconstruction wa

• CONCLUSIONS:

  The outcomes of contemporary CABG are excellent with low mortality, stroke, myocardial infarction and need for wound reconstruction and repeat revascularization whether performed on-pump or off-pump.
• , were examined as possible risk factors of nosocomial infections in
• bi-variable analysis.
• ariables that were found to be statistically associated with nosocomial infections in the bi-variable analysis were included in a multivariable logistic regression model to identify independent risk factors associated with nosocomial infections after open heart surgery.
• patients with CKD experience less death or incident RRT when treated with off-pump compared with on-pump CABG.
• drove this effect on the composite among patients with low eGFR.
• reduction in incident RRT
• prospective cardiac surgery database was performed for patients undergoing isolated CABG
• ody mass index (BMI) >30 kg/m(2). Uni- and multivariate analyses were performed for in-hospital mortality and long-term survival.
• all cases, N = 13 369.
• Univariate analysis identified
• in-hospital mortality was significantly lower in obese patients undergoing off-pump CABG; P = 0.01.
• On-pump and off-pump CABG achieved similar results of combined events at short-term and 5-year follow-up.
• off-pump CABG was associated with improved survival in obese patients; P = 0.01
• Multivariate analysis of obese patients identified off-pump CABG as being associated with significantly reduced in-hospital mortality (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34-0.93, P = 0.03), and significantly improved long-term survival (hazard ratio 0.81, 95% CI 0.67-0.98, P = 0.03).
• In-hospital mortality and long-term survival were significantly affected by the era of surgery, regardless of patients' BMI. Propensity matching of non-obese patients (N = 6088, 1:1 matching) did not identify on- or off-pump CABG as a significant factor determining in-hospital mort
• off-pump CABG yielded no advantage over on-pump CABG for actively treated diabetic patients
• Concordant with the ROOBY trial's overall findings
• uggest that obese patients undergoing CABG have reduced in-hospital mortality if they undergo revascularization with the off-pump technique
• Off-pump coronary artery bypass grafting does not preserve renal function to a greater extent than on-pump coronary artery bypass grafting.
• graft patency after off-pump surgery was inferior to that after on-pump surgery.
• 803 consecutive patients
• on-pump
• off-pump cases were excluded.
• patients were divided into 5 groups: underweight (BMI <20 kg/m(2)), normal weight (BMI 20.0-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2)), obese (BMI 30.0-34.9 kg/m(2)), and morbidly obese (BMI >34.9 kg/m(2))
• Early postoperative morbidity and mortality were evaluated using logistic regression analysis.
• 3 underweight (n = 15, 20%, odds ratio [OR] 6.54, p = 0.001)
• Prolonged intensive care unit stay (p < 0.001), prolonged hospital stay (p < 0.001), and mortality (p = 0.01) were significantly more common in patients in the underweight group than in the other groups.
• underweight, hypertension, and chronic renal failure were independent risk factors for mortality
• Underweight patients with a BMI <20 kg/m(2) are at increased risk of postoperative complications and mortality compared with normal-weight or overweight subjects
• body mass index (BMI) as a risk factor
• OPCAB
• s unknown.
• We postulated that BMI ≥ 30 kg/m(2) would adversely affect outcomes following OPCAB at our institution.
• 742 patients
• who underwent isolated OPCAB for analysis.
• Obesity does not influence operative characteristics or effect outcomes after OPCAB.
• prohibitive risk factor in isolated off-pump coronary revascularization.
• more intraoperative complications and no differences in 30-day or 1-year outcomes with OPCAB as compared with ONCAB
• between 115 perioperative variables.
• 2539 patients underwent randomizatio
• was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome
• 0 days after surgery
• Mortality rate was 34% for patients with prolonged MV
• 7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P=0.74)
• eath, stroke, myocardial infarction, or new renal-replacement therapy
• cardiac failure were significant risk factors for prolonged respiratory support.
• ulmonary hypertension
• patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery
• here were 146 episodes of NI during 381 admissions, yielding a nosocomial infection ratio of 38.3%, and a prevalence of PICU-acquired infection of 24.4% (93 admissions with NI out of a total of 381 admissions).
• most common NI sites were the bloodstream and the lower respiratory tract (65.8% and 16.4%, respectively).
• age < 2 months
• post operative complications, and open-chest procedure.
• Multivariate analysis revealed the following risk factors for NI
• ortality rate for patients with NI was 23.7%, compared with 2.2% for patients without NI (p < 0.001).
• Predictors for mortality in patients with NI were post operative complications, open-chest procedure, sepsis, and urinary tract infection.
• there were no significant differences between off-pump and on-pump with regard to 1-year general and disease-specific quality of life outcomes. Both treatment arms experienced some improvements by 3 months, with continued improvements through 1-year post-bypass.
• OPCAB grafting (compared with conventional CABG) before repairing MR is associated with favorable in-hospital outcomes for patients undergoing surgery for IMR.
• the ROOBY trial randomized 220
• Off-pump CABG resulted in significantly lower FitzGibbon A patency for arterial and saphenous vein graft conduits and less effective revascularization than on-pump CABG. At 1 year, patients with less effective revascularization had higher adverse event rates.
• No major differences in intermediate-term outcomes were found. However, the noninferiority of OPCAB with the prespecified margin could not be confirmed.
• However, intraoperative conversion to on-pump coronary artery bypass graft has been associated with adverse outcomes.
• 8,077 consecutive OPCAB cases
• in-hospital and long-term survival b
• risk of mortality (2.8% versus 2.1%; p<0.001).
• Converted patients had a higher
• Surgeon
• was the most significant multivariable predictor of conversion.
• Conversion to on-pump coronary artery bypass graft was associated with increased in-hospital (OR, 4.8; p<0.001)
• Conversion to cardiopulmonary bypass during OPCAB is associated with increased in-hospital and long-term mortality
• Major bleeding and reoperation did not differ significantly between patients undergoing on- or off-pump surgery.
• 4,700 patients
• utcomes are a composite of total mortality, myocardial infarction (MI), stroke, and renal failure at 30 days
• postoperative atrial fibrillation (POAF) in
• 2103 patient
• was studied
• Older age (P < .0001), white race (P < .001), and hypertension (P < .002) were predictors of POAF on
• Use of ONCAB versus OPCAB was not associated with increased rates of POAF
• he strategy of revascularization did not affect the rate of POAF.
• OPCAB patients requiring conversion had worse 30-day and 1-year outcomes. The OPCAB patients with right coronary artery disease or small targets were more often converted. The 30-day composite outcome trended worst for emergent OPCAB conversions.
• this randomized trial, off-pump and on-pump coronary artery bypass grafting were associated with similar early and late graft patency
• 13,819 patients
• 30 days, patients undergoing off-pump coronary artery bypass grafting had fewer events of bleeding
• and myocardial infarction
• the outcomes of patients with acute coronary syndromes, off-pump coronary artery bypass grafting was associated with lower rates of bleeding
• and non-Q-wave myocardial infarction
• o significant difference in the primary outcome of MACCE was found between off-pump and on-pump CABG. However, mortality seemed higher after off-pump CABG
• Early brain magnetic resonance imaging showed no significant differences in acute cerebral infarctions between the off-pump coronary artery bypass and cardiopulmonary bypass groups.
• There were no significant differences in both short-term
• In the ROOBY Trial, endoscopic vein harvest was associated with lower 1-year saphenous vein graft patency and higher 1-year revascularization rates, independent of the use of off-pump or on-pump cardiac surgical approach
• No difference was found between groups in the primary composite end point at 5-years follow-up. Althoug
• igher episodes of atrial fibrillation
• OPCAB surgery was related to a lower number of grafts
• it had no significant implications related to long-term outcomes
• Global right ventricular function was not better preserved 3 months after off-pump surgery than after conventional coronary bypass surgery.
• patients with 3-vessel disease and a high-risk profile we found no statistically significant difference in graft patency between off-pump and on-pump CABG at 1-year coronary angiographic follow-up.
• the absence of CPB during CABG preserves better the myocardium and attenuates inflammation-however, without improving survival.

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