Complaints In Cancer Patients Research Articles

Role of Trigger Point Injection in the Management of Proximal Tensor Fascia Lata Myofascial Trigger Point in a Stage 4 Breast Cancer Patient

Pain is a common and devastating complaint in cancer patients. The etiology of pain in these patients is numerous and proper assessment is needed for treatment. Myofascial pain syndrome (MPS) is a common but often neglected cause of pain. Cancer patients are at risk of developing MPS. An accurate and early clinical diagnosis along with appropriate intervention is required to address this cause of pain in order to decrease the sufferings of these patients. Here, we report a patient of metastatic breast carcinoma with severe lower back and lower limb pain, significantly relieved with Minimally invasive pain and spine interventions (MIPSI) of the trigger point in the tensor fascia lata, which is often a missed cause of pain in this subgroup of the patient.

The Role of Rehabilitation in the Treatment of Constipation in Oncological Patients.

Chemotherapy, as well as opioid and antiemetic drugs, can contribute to constipation in oncological patients. This systematic review aims to analyse the potential of specific rehabilitation strategies and alternative strategies for improving constipation symptoms, with the goal of incorporating these strategies into a dedicated protocol for managing cancer-related constipation. This could potentially reduce the dosages of or eliminate the need for constipation medications. A systematic search was conducted on PubMed, Scopus and Web of Science. The review included studies analysing constipation complaints in cancer patients treated with rehabilitation, acupuncture and osteopathy. The review included 16 studies in line with PRISMA and PICOS criteria. Most studies showed that physical exercise, abdominal massage, TENS, acupuncture and education on the correct defecation position positively impacted the management of constipation and quality of life in oncological patients. A physiotherapy program involving massages as well as aerobic and resistance training improved constipation in oncological women, regardless of age, sex and frailty. A combination of abdominal massage, abdominal muscle stretching and education on proper defecation position alleviated the severity of constipation and related depression. However, the outcomes regarding TENS were yet inconsistent. Another technique, becoming increasingly common for constipation, and demonstrating positive results, involved stimulating trigger points through acupressure and acupuncture. Conversely, osteopathic and superficial manipulations more frequently required constipation medications than did the other alternative approaches. However, no existing studies have proposed a specific protocol to manage cancer-related constipation. The results of the studies confirm the positive influences of rehabilitation, osteopathy and acupuncture on constipation and pain in oncological patients. Nevertheless, further studies are required to establish the best type, timing and duration of treatment, as well as how the stage and location of the cancer and the cause of constipation (drug-induced or functional) impact the results.

Efficacy and Safety of Jollab (a Saffron-Based Beverage) on Cancer-Related Fatigue in Breast Cancer Patients: A Double-Blind Randomized Clinical Trial

Introduction: Fatigue is a common complaint in cancer patients and profoundly affects the quality of life of the patients. Therefore, we designed a clinical trial to evaluate the safety and efficacy of Jollab (containing saffron, honey, and rose water) as a tonic beverage in the management of cancer-related fatigue in breast cancer patients. Methods: Seventy-five patients were randomly assigned into two groups, patients received either 4 weeks Jollab or the placebo (20 mL three times daily). Fatigue was assessed with scores of Visual Analogue Fatigue Scale (VAFS), Fatigue Severity Scale (FSS), and Cancer Fatigue Scale (CFS) at weeks 0 and 4 (before and after the intervention). Results: In the Jollab group, VAFS showed a significant decrease (p = 0.000), but in the placebo group, there was no significant difference (p = 0.258). In the Jollab group, FSS decreased significantly (p = 0.000), while in the placebo group, it slightly decreased (p = 0.096). CFS physical and cognitive subscales also showed improvement of fatigue in the Jollab group compared to the placebo group (p < 0.05), but affective subscale score did not show a significant change after the intervention in both groups (p > 0.05). Conclusions: Jollab beverage has significant positive effects on reducing fatigue in women with breast cancer. However, larger-scale trials with further sample size and longer period of the intervention are needed to confirm and develop our preliminary findings.

Frequência de queixas de deglutição e alimentação durante consulta compartilhada em cuidados paliativos oncológicos

ABSTRACT Purpose to identify the frequency of swallowing and feeding complaints in cancer patients in palliative care, and to associate them with clinical and functional data. Methods cross-sectional and descriptive study, carried out with cancer patients treated during shared consultation in a palliative care outpatient clinic, through speech-language pathology screening, protocols and scales, with statistical analysis of the obtained data. Results Sample consisted of 52 subjects, seen during 8 months, with a mean age of 66.7 years, PSS (Palliative Performance Scale) a mean of 57.5. The topography of the most frequent neoplasm was the gastrointestinal tract and the treatment was surgery and associated chemotherapy and radiotherapy . Complaints identified at screening were categorized into swallowing and feeding. Thus, swallowing was the most frequent and a large part of the sample required a functional assessment of swallowing. Only the association between swallowing complaints and the topography of the gastrointestinal tract showed a significant statistical relationship. Swallowing complaints were more frequent in those undergoing radiotherapy and with lower percentages on the PPS scale. Conclusion swallowing complaints were the most frequent and the associations made it possible to relate them to the location of the tumor, and to identify their frequency according to cancer treatment and terminal functional decline.

Electroacupuncture for Cancer-Related Cognitive Impairment: A Clinical Feasibility Study.

Background:Cancer-related cognitive impairment (CRCI) is a significant problem for cancer patients, as the number of cancer survivors experiencing cognitive impairments is increasing in the absence of standard treatment. There have been attempts to improve the cognitive function of patients with cancer using acupuncture; however, no studies have been conducted using electroacupuncture. Thus, we designed a preliminary study to investigate the feasibility of a clinical trial using electroacupuncture in CRCI patients.Methods:We conducted a single-arm, pilot, clinical trial to investigate the feasibility of a study protocol for further large-scale clinical trials of electroacupuncture in CRCI patients. All participants were treated with electroacupuncture twice a week for 30 minutes at a time, for 8 weeks on acupoints GV20, GV24, EX-HN1, and GB20, HT7, PC6, and KI3. Both subjective and objective outcomes of cognitive function, quality of life (QoL), and psychological factors were measured in all participants at baseline, week 4, 8, and 12. For safety assessment, vital signs, laboratory examinations, and adverse events (AEs) were observed throughout the trial.Results:A total of 12 participants were enrolled at Daejeon and Dunsan Korean Medicine Hospital of Daejeon University from 21 April 2017 to 31 January 2018. After 8 weeks of treatment, electroacupuncture significantly improved both subjective and objective cognitive outcomes, including the perceived cognitive impairments scale of the Functional Assessment of Cancer Therapy-Cognitive Function, QoL scale of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-C30, Korean version of Montreal Cognitive Assessment, Boston Naming Test, Seoul Verbal Learning Test, and Rey Complex Figure Test. During the entire trial period, 19 AEs were observed, with no serious AEs. Additionally, it was found that all feasibility outcomes, including recruitment, completion, and adherence rates, achieved successful results as the ratio exceeded 0.8.Conclusion:Our study results revealed that electroacupuncture improved cognitive complaints in cancer patients, and we expect electroacupuncture to be a safe and effective management therapy for CRCI patients. These feasibility trial results will be used as preliminary data for future randomized controlled clinical trials.Trial registration number:Korean Clinical Trial Registry (KCT0002168).

The Acute Effects of 5 Fluorouracil on Skeletal Muscle Resident and Infiltrating Immune Cells in Mice.

5 fluorouracil (5FU) has been a first-choice chemotherapy drug for several cancer types (e.g., colon, breast, head, and neck); however, its efficacy is diminished by patient acquired resistance and pervasive side effects. Leukopenia is a hallmark of 5FU; however, the impact of 5FU-induced leukopenia on healthy tissue is only becoming unearthed. Recently, skeletal muscle has been shown to be impacted by 5FU in clinical and preclinical settings and weakness and fatigue remain among the most consistent complaints in cancer patients undergoing chemotherapy. Monocytes, or more specifically macrophages, are the predominate immune cell in skeletal muscle which regulate turnover and homeostasis through removal of damaged or old materials as well as coordinate skeletal muscle repair and remodeling. Whether 5FU-induced leukopenia extends beyond circulation to impact resident and infiltrating skeletal muscle immune cells has not been examined. The purpose of the study was to examine the acute effects of 5FU on resident and infiltrating skeletal muscle monocytes and inflammatory mediators. Male C57BL/6 mice were given a physiologically translatable dose (35 mg/kg) of 5FU, or PBS, i.p. once daily for 5 days to recapitulate 1 dosing cycle. Our results demonstrate that 5FU reduced circulating leukocytes, erythrocytes, and thrombocytes while inducing significant body weight loss (>5%). Flow cytometry analysis of the skeletal muscle indicated a reduction in total CD45+ immune cells with a corresponding decrease in total CD45+CD11b+ monocytes. There was a strong relationship between circulating leukocytes and skeletal muscle CD45+ immune cells. Skeletal muscle Ly6cHigh activated monocytes and M1-like macrophages were reduced with 5FU treatment while total M2-like CD206+CD11c- macrophages were unchanged. Interestingly, 5FU reduced bone marrow CD45+ immune cells and CD45+CD11b+ monocytes. Our results demonstrate that 5FU induced body weight loss and decreased skeletal muscle CD45+ immune cells in association with a reduction in infiltrating Ly6cHigh monocytes. Interestingly, the loss of skeletal muscle immune cells occurred with bone marrow cell cycle arrest. Together our results highlight that skeletal muscle is sensitive to 5FU’s off-target effects which disrupts both circulating and skeletal muscle immune cells.

Increasing non-opioid pain management in the cancer patient presenting to the emergency department.

237 Background: The opioid epidemic is claiming more than 115 lives daily in the US (1). Pain is commonly the chief complaint of cancer patients presenting to the emergency department (ED) and aggressively managed with opioids. A recent study of cancer patients presenting to the ED showed they were also at high risk for opioid misuse (2). Non-opioid analgesia is often avoided from concerns of masking fevers, intolerance due to nausea/vomiting, or bleeding risk in thrombocytopenia. Our aim was to identify opportunities to reduce opioid use while safely alleviating pain in patients presenting to the Emergency Department of a comprehensive cancer center. Methods: Following the PDSA model, baseline data on current opioid use was obtained and perceived barriers to non-opioid analgesia were identified through questionnaires. Comfort level with non-opioid analgesia in cancer patients and current pain management practice was also queried. Patients eligible for non-opioid analgesia (solid tumors, no fever, pain score &lt; 7) were then identified through retrospective chart review and the prevalence of contraindications for non-opioid (renal/liver failure, thrombocytopenia, oral intolerance) and patient preference for opioids was calculated. This data and opportunities to use non-opioid analgesia was shared with providers in education sessions. Medication order panels were modified to provide easy access to oral and intravenous acetaminophen (APAP) and nonsteroidal anti-inflammatory drugs (NSAIDs). After two months the change in opioid prescribing was calculated. Results: Providers self-reported barriers to prescribing opioids as: low platelets, patient preference, and poor oral intake. Of 237 patients presenting to the MDA Emergency Department with complaints of pain between January 2018 and May 2018, 76 (32%) were eligible for non-opioid analgesia. Only 3 patients had absolute contraindications to both APAP or NSAIDs. After provider education, order entry simplification and prescribing guidance, the use of non-opioid analgesia rose from 3.9% to 9.4%. Patient satisfaction with pain control rose from 57.4 to 60.4 % following the intervention based on Press Ganey results. Conclusions: There is opportunity for non-opioid acute pain management in the solid tumor patients. Contraindications to non-opioid analgesia are uncommon. In the emergency department, safe pain relief can be provided by non-opioids such as NSAIDs and APAP.

Can aprepitant used for nausea and vomiting be good gastrointestinal complaints?

Aprepitant is a selective SP/NK-1 receptor antagonist and used in postoperative and chemotherapeutics induced emesis and vomiting. The aim of our study is to show aprepitant may have beneficial effects on gastrointestinal complaints in cancer patients undergoing chemotherapeutics by indomethacin-induced gastric ulcer model. A total of 48 rats were fasted 24h for ulcer experiment. Aprepitant doses of 5, 10, 20, and 40mg/kg were evaluated for their antiulcer activity. Omeprazole (20mg/kg) was used as a positive control group. Six hours after 25mg/kg indomethacin administration, all stomachs were dissected out. After macroscopic analyses, tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), COX-1, and COX-2 mRNA levels and SOD activity, and GSH and MDA levels of stomachs were determined. Histopathological examinations were evaluated. Aprepitant administration exerted 48.14%, 49.62%, 65.92%, and 76.77% ulcer inhibition effects at 5, 10, 20, and 40mg/kg, respectively. Aprepitant administration decreased oxidative stress and inflammatory parameters in stomach tissues dose dependently. Aprepitant administration increased stomach COX-2 mRNA levels at 20 and 40mg/kg doses. Although aprepitant appears to be disadvantageous in terms of treating gastric ulcer due to COX enzyme inhibition according to the previous studies, aprepitant has been shown to have ulcer healing effect in our study. When aprepitant is given as an anti-nausea and vomiting drug to cancer patients undergoing chemotherapy, we can argue that it will not be necessary to add a new gastric protective agent as it also shows beneficial effects in gastrointestinal complaints.

The role of metamemory on cognitive complaints in cancer patients

ObjectiveAlthough cancer patients frequently report cognitive disturbances, it is commonly asserted a lack of association between cognitive complaints and neuropsychological test performances. Our goal was to better understand the relationships between subjective and objective cognitive scores through a metamemory monitoring assessment.MethodsSixty cancer patients currently treated by chemotherapy and/or targeted therapy, and 30 healthy controls (HC) were included. Cognitive complaint was assessed by FACT‐cog, QAM and DEX questionnaires. One or more z‐scores ≤−1.65 among these three questionnaires defined the presence of cognitive complaints. Objective cognitive performances assessed episodic memory, processing speed and executive functions/working memory (ESR paradigm, TMT, Stroop, n‐back). Metamemory was assessed with a Judgment of Learning (JOL) task.ResultsPatients with cognitive complaints had significantly more depressive and anxiety symptoms (ps < .004), and lower performances on several cognitive tests (ps < .05) than both patients without complaints and HC. More specifically, analyses of the metamemory scores revealed that HC gave significantly more overestimations (“Yes” judgment and incorrect recall) than patients with cognitive complaints (p = .036). For these patients, JOL scores correlated positively with executive functioning (ps < .01).ConclusionMetamemory monitoring seems to be well‐preserved during cancer. What is more, patients make less overestimation than HC, and they do not underestimate their memory. An accurate self‐estimation of memory abilities in cancer patients, particularly those with mild cognitive deficits, may play an adaptive function. Our results suggest that the discrepancy frequently reported between cognitive complaints and objective cognitive scores may not be related to metamemory monitoring dysfunction.

Imaging of acute abdomen in cancer patients.

The pattern of disease causing acute abdominal pain has changed over last few decades, some of this has been attributed to intraabdominal cancers. The most common acute abdominal complaints in cancer patients are related to the gastrointestinal system. Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of. This article focuses on imaging illustrations with differential diagnosis for various emergency scenarios related to acute abdomen specifically in oncologic settings.

Evaluating treatment modalities in chronic pain treatment by the multi-criteria decision making procedure

BackgroundChronic pain is one of the most common complaints of cancer patients. There are many pharmacological and non-pharmacological treatment modalities used for the treatment of pain. Nonetheless, non-pharmacological interventions are preferred because of potential side effects in cases resistant to medical therapy that require a dose increase or potent drug use. In most real-life situations, the decision on which technique to choose is based on the clinical but subjective decisions of the practitioners. This study aimed to find out the best non-pharmacological treatment option for patients with chronic cancer pain by following a rational and reasonable approach.MethodsSince the evaluation of treatment options requires to make a comparison between a number of alternatives in the light of certain criteria, we utilize the order relation analysis (G1-method) which is a method for determining the weights based on the improved Analytic Hierarchy Process (AHP). The method uses the relative importances on prioritizing the four criteria and eight sub-criteria defined by the experts of three pain physicians, one oncologist, and one oncologic surgeon. Four alternatives are then compared according to the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) using the verbal subjective judgments of the practitioners.ResultsObtained results indicate that the general medical condition of the patient and the stage of the cancer are the essential factors in the selection of the treatment method. It is followed by the extent of the pain and the level of evidence, respectively. According to the evaluations performed, spinal port and splanchnic nerve radiofrequency thermocoagulation treatments are the first and second priority methods for pain treatment, respectively, compared to lumbar epidural catheter and celiac plexus block.ConclusionsThe results of this study emphasize the need to integrate critical criteria into the decision-making process objectively. This is the first study in which multi-criteria decision-making tools are used in the evaluation and selection of pain management methods in cancer patients.

The Complaints Feed By Breast Cancer Patients Based On Stadium And Duration Of Chemotherapy In Waled General Hospital Cirebon District

Breast cancer is a malignancy in cells found in breast tissue that can originate from the glandular components (epithelial tracts or lobules) as well as components other than such as fat tissue, blood vessels, and nerve tissue.In Indonesia, there are two types of cancer most commonly suffered by Indonesia people, namely breast cancer and cervical cancer. There is breast cancer rate of 42,1 by 100.000 population and cervical cancer of 23,4 by 100.000 population with an average death of 13,9 by 100.000 population. In Waled Regional Public Hospital Cirebon District, from 2018, 32 breast cancer patients were obtained. This study was conducted to determine complaints in cancer patients based on the stage and duration of chemotherapy at Waled Waled Regional Public Hospital Cirebon District. &#x0D; This type of research is a quantitative descriptive study using a retrospective. The sampling technique used is the total sample of 32 respondents. Statistical tests were performed by univriat analysis. This research was conducted at Waled Regional Public Hospital Cirebon District. The results of this study indicate all complaints of breast cancer sufferers in Cirebon District Hospital that are less tolerable at stage IIB (100%) which supports moderate chemotherapy (100%). &#x0D; During chemotherapy treatment, nurses monitor patients about changes in complaints experienced by patients.

The day after: correlates of patient-reported outcomes with actigraphy-assessed sleep in cancer patients at home (inCASA project).

Subjective sleep assessment in cancer patients poorly correlates with actigraphy parameters that usually encompass multiple nights. We aimed to determine the objective actigraphy measures that best correlated with subjective sleep ratings on a night-by-night basis in cancer patients. Thirty-one cancer patients daily self-rated sleep disturbances using the single dedicated item of the MD Anderson Symptom Inventory (0-10 scale) with 18 other items, and continuously wore a wrist actigraph for 30 days. Objective sleep parameters were computed from the actigraphy nighttime series, and correlated with subjective sleep disturbances reported on the following day, using repeated measures correlations. Multilevel Poisson regression analysis was performed to identify the objective and subjective parameters that affected subjective sleep rating. Poor subjective sleep score was correlated with poor sleep efficiency (rrm = -0.13, p = 0.002) and large number of wake episodes (rrm = 0.12, p = 0.005) on the rated night. Multilevel analysis demonstrated that the expected sleep disturbance score was affected by the joint contribution of the wake episodes (exp(β) = 1.01, 95% confidence interval = 1.00 to 1.02, p = 0.016), fatigue (exp(β) = 1.35, 95% confidence interval = 1.15 to 1.55, p < 0.001) and drowsiness (exp(β) = 1.70, 95% confidence interval = 1.19 to 2.62, p = 0.018), self-rated the following evening, and sleep disturbance experienced one night before (exp(β) = 1.77, 95% confidence interval = 1.41 to 2.22, p < 0.001). The night-by-night approach within a multidimensional home tele-monitoring framework mainly identified the objective number of wake episodes computed from actigraphy records as the main determinant of the severity of sleep complaint in cancer patients on chemotherapy. This quantitative information remotely obtained in real time from cancer patients provides a novel framework for streamlining and evaluating interventions toward sleep improvement in cancer patients.

Association between radiotherapy and obstructive sleep apnea in cancer patients: A systematic review and meta-analysis.

e17576 Background: With the increase in survival of cancer patients, consequently, increasing their quality of life is mandatory as well. Sleep disturbances, particularly Obstructive Sleep Apnea (OSA), is one of the main complaints of cancer patients in which patients face frequent episodes of upper airway closure during sleep. Possible causes for OSA include either the specific cancer or its treatment whether sedatives, narcotics, radiotherapy, or chemotherapy, but the primary cause is still hard to prove. Our aim was to investigate the association between the occurrence of OSA and radiotherapy in cancer patients. Methods: On the 9th of September, 2018, we have searched comprehensively 12 electronic databases to retrieve relevant studies. All eligible studies that assess the association between OSA and radiotherapy in cancer patients were included in our meta-analysis. Quality assessment of included studies was done using the NIH tool for cohort and cross-sectional studies. Results: Fourteen studies met our selection criteria, eight studies were eligible for our meta-analysis. There was a positive association between the occurrence of OSA and radiotherapy in cancer patients (OR 1.16, 95% CI [0.52–2.56]; P = 0.718). OSA was noted in 103 of 181 cancer patients who received radiotherapy, yielding a remarkable overall prevalence of 63% (95% CI [0.36–0.85]; P = 0.343). A positive risk ratio for the development of OSA in cancer patients treated with radiotherapy was detected (RRs 1.27, 95% CI [0.81–2.00]; P = 0.297). The overall mean of apnea hypopnea index (AHI) for patients with OSA in six studies was 22.45. Conclusions: These findings point to a striking association between OSA risk and radiotherapy in cancer patients. Since the early recognition and management of OSA in such patients may play an important role in improving their quality of life, we recommend screening all cancer patients treated with radiation for early signs of OSA to further improve their survival.

Efficacy of aromatherapy with Rosa damascena in the improvement of sleep quality of cancer patients: A randomized controlled clinical trial

• Sleep disorder is common medical complaint in cancer patients. • Aromatherapy is the practice of using aromatic essential oils extracted from plants to prevent or treat of diseases. • Aromatherapy with R. damascena essential oil has a beneficial effect on improving sleep quality in cancer patients.

Sleep Disturbance and Related Factors in Patients with Nasopharyngeal Carcinoma and Their Family Caregivers Prior to the Initiation of Treatment

Sleep disturbance is a common complaint in cancer patients. However, less is known about the parameters of sleep in patients with nasopharyngeal cancer (NPC) and their family caregivers (FCs) when they are about to begin treatment. We investigated the sleep quality in patients with NPC and their FCs before treatment and determined the related factors that predict sleep disturbance in these patients before therapy. A total of 101 patient-FC dyads were recruited. They completed the Pittsburgh Sleep Quality Index (PSQI) prior to treatment. No differences were found in sleep disturbance between patients (38.6%) and their FCs (31.7%). Patients reported significantly higher rates of short sleep duration than their FCs (P = 0.011). Logistic regression analyses showed that older patients were more prone to suffer from poor sleep quality before treatment (OR = 1.06, 95% CI = 1.01–1.10, P = 0.008), while patients with a higher BMI were less likely to experience sleep disturbance (OR = 0.83, 95% CI = 0.71–0.96, P = 0.012). Sleep disturbance is a significant problem in patients with NPC and their FCs before therapy. Older patients and those with a lower BMI appear to be more inclined to suffer from poor sleep before treatment.

1038 OBJECTIVE CORRELATES OF SLEEP COMPLAINT IN CANCER PATIENTS ON CHEMOTHERAPY TELE-MONITORED AT HOME: NIGHT-BY-NIGHT ANALYSIS.

Current wrist-actigraphy parameters poorly identify the cancer patients, who subjectively report poor sleep. However, most studies average multiple nights of data, not accounting for the changes that can occur while on treatment. Hence, our aim was to understand, on a night-by-night basis, the objective measures which best correlated with subjective sleep complaints. We investigated associations between sleep duration, timing, efficiency, latency and fragmentation, objectively measured by wrist-actigraphy, and the severity of self-rated sleep disturbance reported on the following day using a 0–10 scale questionnaire (M.D. Anderson Symptom Inventory) completed on a touch-screen computer at home. We used a dataset of 595 nights in 31 patients with advanced cancer participating in a pilot domomedicine study (inCASA project). First, we evaluated associations between actigraphy parameters and subjective sleep rating with Spearman’s correlations. Then, we categorised the objective sleep data into two groups depending on whether sleep disturbance was rated lower or higher than 2, which was previously found as corresponding to a level of intensity comfortable for the patient. Actigraphy parameters were compared in both groups using Mann-Whitney U-test. Multivariate regressions and classification and regression tree analysis were performed to identify independent predictors of subjective sleep. Sleep complaint severity was negatively correlated with timing of awakening (r=-0.22, p<0.001), total sleep time (r=-0.19, p<0.001) and sleep efficiency (r=-0.19, p<0.001). These associations were confirmed (p<0.001), with a median 40-min advance in timing of awakening, a median total sleep time shorter by 36 minutes, and a median sleep efficiency less by 2% for the nights rated as associated to sleep disruption as compared to comfortable sleep. The night-by-night approach within a multidimensional home tele-monitoring framework identified early awakening, short total sleep time and low sleep efficiency as significant objective correlates of poor sleep complaint in cancer patients on chemotherapy. These findings, if confirmed, will inform the development of both effective interventions and real time assessment in this frail patient population. European Commission through the ICT Policy Support Programme project inCASA (Contract CIP 250505, FP7), and the Coordinating Action Systems Medicine (CASyM) through research exchange grants in Systems Medicine.

Dentist Role in Oral Treatment Before Head Neck Cancer Therapy

&lt;p class="AbstractContent"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Various intra-oral conditions can be found in patient prior the cancer treatment that might include lesions associated with decreased immunity, such as viral infections and fungal infections. Dentist has a significant role to prepare the oral cavity to be in the best possible condition, in order to minimize oral disturbance and complaints of cancer patients.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Objective&lt;/strong&gt;: The purpose of this article is to review the importance of intra-oral treatment prior cancer therapy in patients with head and neck cancer.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Case Report&lt;/strong&gt;: A 35-years-old male patient was referred from the ENT Department, Cipto Mangunkusumo Hospital with suspected Nasopharyngeal Carcinoma for investigating the intra oral focal infection sources. Intra oral examination revealed various focal infection sources and pseudomembranous candidiasis. The candidiasis was completely healed after antifungal medication.&lt;/p&gt;&lt;p class="AbstractContent"&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Dentists’ role in preparing the oral condition prior cancer treatment is very important to reduce further oral complication. All oral lesions including fungal infection should be treated before the commencement of cancer treatment.&lt;/p&gt;

Abstract P3-08-01: Cognitive impairment and cortical network dysfunction following chemotherapy

Abstract A common complaint of cancer patients is the experience of cognitive difficulty during and after chemotherapy. However, the mechanisms through which this occurs are still unknown. We hypothesized that chemotherapy-induced cognitive impairment may result from dysfunction in large-scale brain networks, particularly those involved in attentional control. These networks are evident when measuring task-based brain activity during attention-demanding tasks, but can also be studied using resting state functional connectivity magnetic resonance imaging (rs-fcMRI). In rs-fcMRI, connectivity between brain regions is measured using data collected while participants lie awake in the magnet with their eyes open, but performing no task. It reliably distinguishes known sensory, motor, and executive networks based on connectivity patterns. These data complement information about structural (white matter) connectivity obtained using diffusion tensor imaging (DTI). Here we report a case-control study of women with a history of triple negative breast cancer (BrCa) who completed standard adjuvant chemotherapy within two years of study entry. The cases (n = 15) were defined as women who reported cognitive impairment by the Cognitive Failures Questionnaire and controls (n = 13) were women who did not report cognitive impairment. All participants eligible for MRI investigation underwent rs-fcMRI and DTI on a Siemens 3T TIM Trio scanner. DTI parameters measured included Fractional Anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD), and Axial Diffusivity. The study was conducted in its entirety at Washington University in St. Louis School of Medicine. Institutional review board approval was obtained prior to recruitment. The mean age of cases was 53.1 years and controls 51.6 years; all were diagnosed with invasive ductal or lobular BrCa. For each participant, we extracted the timecourse of brain activity for regions of interest in frontoparietal and cingularopercular control systems, measured indirectly via blood oxygenation level dependent (BOLD) contrast, from the MRI scans, and additional regions of interest distributed across the brain. We excluded scans that showed motion artifact. Pairwise connectivity was calculated using Pearson correlation between all regions of interest; we also used these regions in seed-based analyses. We compared the strength of rs-fcMRI-defined network connections between the two groups and used nonparametric permutation tests to calculate statistical significance. We found significant changes within several regions of the frontoparietal attention network, such that patients reporting greater cognitive difficulty showed weaker neural connectivity. In addition, DTI analyses revealed different patterns of anatomical connectivity between groups, including reduced FA (p&amp;lt;0.03) and increased MD and RD (p&amp;lt;0.02), both of which have been shown to be signatures of brain change in demyelinating disease. Together our results suggest that standard therapeutic levels of chemotherapy for BrCa patients may result in structural and functional connectivity alterations in the brain networks supporting executive attention, which in turn may be a contributing factor in cognitive difficulty. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-01.

Hypothyroidism after a cancer diagnosis: etiology, diagnosis, complications, and management.

Hypothyroidism is a common disease that is easily treated in the majority of cases, when readily diagnosed; however, presentation of an aggregate of its symptoms is often clinically overlooked or attributed to another disease and can potentially be lethal. Already prevalent in older women, its occurrence in younger patients is rising as a result of radiation therapy, radioactive iodine therapy, and newer antineoplastic agents used to manage various malignancies. The presence of nonspecific constitutional symptoms and neuropsychiatric complaints in cancer patients can be attributed to a myriad of other diagnoses and therapies. Thyroid dysfunction can be easily overlooked in cancer patients because of the complexity of cancer's clinical picture, particularly in the pediatric population. Underdiagnosis can have important consequences for the management of both hypothyroidism and the malignancy. At minimum, quality of life is adversely affected. Untreated hypothyroidism can lead to heart failure, psychosis, and coma and can reduce the effectiveness of potentially life-saving cancer therapies, whereas iatrogenic causes can provoke atrial fibrillation and osteoporosis. Consequently, the diagnosis and treatment of hypothyroidism in cancer patients are pertinent. We summarize the history, epidemiology, pathophysiology, clinical diagnosis, and management of hypothyroidism in cancer patients.