Greek Cancer Patients Research Articles

The Experience of Hopelessness in a Population of Greek Cancer Patients Receiving Palliative Care

Beck Hopelessness Scale (BHS) has been translated and validated in many languages. The validation of the English version of BHS in advanced cancer patients receiving palliative treatment in Greece. The final sample was 112 advanced cancer patients. Internal consistency, item-total correlations, and test-retest using four different approaches were calculated for the assessment of the reliability. Construct validity was used by examining correlations between BHS, Hospital Anxiety and Depression Scale (HAD-Depression) and the Schedule of Attitudes toward Hastened Death (SAHD). Known-groups validity was also assessed by detecting group differences according to disease severity as measured by the Eastern Cooperative Oncology Group (ECOG) performance status. Univariate and multivariate analyses were constructed to explore the relationship between hopelessness, depression, hastened death and the patients' demographic and clinical characteristics. One factor solution was yielded accounted for 46.64% of the variance. The test-retest reliability was satisfactory (p < 0.0005). Validity as performed using known-group analysis showed good results. Most significant correlations were found between BHS, ECOG (p = 0.018) and gender (p = 0.08). The strongest predictors were gender (p = 0.050) and ECOG (p = 0.045). BHS seemed to be a useful instrument to assess pessimistic attitude and hopelessness in a Greek cancer population, with valid psychometric properties.

Psychometric Properties of the Brief Fatigue Inventory in Greek Patients with Advanced Cancer

To validate the Greek version of the Brief Fatigue Inventory (BFI-Gr) in a sample of cancer patients, the scale was translated with the “forward–backward” procedure to Greek. It was administered twice, at a three-day interval, to 102 eligible patients with cancer. Together with the BFI-Gr scale, the patients also completed the European Organization for Research and Treatment of Cancer QLQ-C30 (version 3.0) subscales of fatigue and emotional functioning, and the M. D. Anderson Symptom Inventory. The BFI-Gr had an overall Cronbach alpha for the nine items of 0.954. The assessment of the relationships between the BFI-Gr and the other measurements showed statistically significant correlations between all the assessed measurements ( r values between 0.47 and 0.76, P < 0.0005), except with the emotional subscale of the European Organization for Research and Treatment of Cancer scale. Factor analysis yielded a one-factor solution, explaining 73.6% of the variance. Interitem correlations were high and ranged from 0.567 to 0.882 ( P < 0.0005). The test–retest reliability of scale showed that the coefficient agreement was 0.901 ( P < 0.0005). Univariate analysis revealed significant correlations between hemoglobin and fatigue ( r = −0.21, P = 0.037), and between performance status ( P < 0.0005) and opioids ( P = 0.009). These results support that the BFI-Gr is an instrument with satisfactory psychometric properties, and is a valid research tool for cancer-related fatigue in Greek cancer patients

General perceived self-efficacy: validation analysis in Greek cancer patients

The present study aims to validate the General Perceived Self-efficacy Scale (GSE) in Greek cancer patients. The scale was administered twice, with a 3-day interval, to 99 advanced cancer patients. The patients also completed the Anxiety Subscale from the Greek Hospital Depression and Anxiety Scale. Factor analyses identified a one-factor solution, explaining 74.6% of the variance. The Greek version of the GSE had a Cronbach's alpha of 0.927. Validity as performed using known-group analysis showed good results. Satisfactory construct validity was supported by the correlation analysis between the GSE and anxiety (r = -0.507, p < 0.0005). Interitem correlations was also satisfactory at p < 0.0005. These psychometric properties of the Greek version of the GSE showed that it is a valid and reliable measured when administered to cancer patients.

Somatic mutations of EGFR and KRAS in pure bronchioloalveolar carcinomas and adenocarcinomas of the lung with bronchioloalveolar features

21111 Background: EGFR mutations are more common in lung cancers from female, non-smoking patients of Asian ethnicity with adenocarcinoma histology. We investigated the relationship between clinicopathologic parameters and mutations of EGFR and KRAS in patients with pure bronchioloalveolar carcinomas (BACs) and adenocarcinomas (ADCs) with BAC features, not previously treated with EGFR inhibitors. Methods: We retrospectively reviewed the files of patients who were diagnosed with pure BACs or ADCs with BAC features between February 2001 and May 2005. Demographics, stage and smoking histories were recorded. Paraffin embedded tissue blocks were retrieved and re-examined using the WHO 1999/2004 histological criteria for lung cancers. EGFR expression, detected by immunohistochemistry, was scored from 0 to +3. Expression was considered positive when the score was +1, or higher. DNA was isolated from paraffin blocks (containing at least 75% tumor cell content) and exons 18–21 of the EGFR gene and exon 2 of the KRAS gene were amplified by PCR and bi-directionally sequenced. The chi-squared test and regression analysis were used to identify parameters correlating with EGFR or KRAS mutations. Results: A total of 46 patients were eligible for this study. Tissue was available from 43 patients, 19 with pure BAC and 24 with ADC with BAC features. There were 27 (62.8%) males and 16 (37.2%) females, all of Greek descent. Mean age was 62.7 years (range, 41–79). There were 34 smokers and former smokers (79%) and 9 never-smokers (21%). Tumors were classified as mucinous (20), non- mucinous (19) or mixed (4). We detected somatic EGFR mutations in 7 patients (including common mutations, delEx19, L858R, G719C), and KRAS codon 12 mutations in 13 patients. EGFR and KRAS mutations were mutually exclusive. No clinicopathologic parameters correlated with the presence of EGFR or KRAS mutations. Conclusions: Among Greek lung cancer patients with pure BACs or ADCs with BAC features, unselected for response to EGFR inhibitors, the incidence of KRAS or EGFR mutations was 30.2% and 16.3% respectively. EGFR and KRAS mutations were mutually exclusive but no clinicopathologic factor predicted the presence of mutations in either gene. Further molecular analysis is ongoing. No significant financial relationships to disclose.

Psychometric Properties of the Impact of Event Scale in Greek Cancer Patients

To develop the Greek version of the Impact of Event Scale-Revised (IES-R-Gr), assess its psychometric properties, and finally to examine the impact of cancer diagnosis to a palliative care patient sample, the IES-R was translated into Greek using the “forward-backward” procedure. It was administered twice, at one-week intervals, to 82 eligible patients with advanced cancer. Together with the IES-R-Gr scale, the patients also completed the Hospital Anxiety and Depression (HAD) Scale. Reliability was assessed in terms of internal consistency (Cronbach's alpha coefficients) and test/retest (Spearman's r value and Kendall's tau-b). Construct validity was demonstrated through association with the HAD Scale, and convergence and discriminative validity and interscale correlations were also assessed. The Greek version of the IES-R had Cronbach's alphas for the intrusion, avoidance, and hyperarousal scales of 0.72, 0.77, and 0.85, respectively. Overall test-retest reliability was satisfactory at P < 0.0005. Satisfactory construct validity was supported by the correlation analysis between the IES-R-Gr subscales and anxiety and depression. Factor analysis yielded three factors, explaining 57.26% of the variance. Interscale and interitem correlations were found satisfactory at P < 0.0005. These results demonstrate that the IES-R-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the impact of cancer diagnosis in advanced cancer patients.

1591 POSTER Newly diagnosed Greek lung cancer patients' quality of life and symptom distress: comparison of patients and their partners perceptions

1591 POSTER Newly diagnosed Greek lung cancer patients' quality of life and symptom distress: comparison of patients and their partners perceptions

Greek M.D. Anderson Symptom Inventory: Validation and Utility in Cancer Patients

Objective: The M.D. Anderson Symptom Inventory (MDASI) is a brief assessment of the severity and impact of cancer-related symptoms. The purpose of this study was the translation and validation of the questionnaire in Greek (G-MDASI). Methods: The translation and validation of the assessment took place at a Pain Relief and Palliative Care Unit. The final validation sample included 150 cancer patients (61 males, 89 females, age range 31–88 years, mean age 63.32). The patients completed the questionnaires at the outpatient clinic. Assessing the validity and reliability constituted the actual validation of the G-MDASI. Results: The item ‘diarrhea’ had a score of 0 in 139 patients and, thus was omitted from the ‘core’ list. Consequently, the core questionnaire consisted of 14 items. Factor analysis resulted in a 3-factor model, in both validation and cross-validation samples. The examination of the sensitivity of the MDASI revealed that there were differences between patients with poor-to-good performance status but no differences were found between patients in different treatment groups. Conclusions: The results showed that the G-MDASI is a reliable and valid measure in Greek cancer patients. It has proved to be a comprehensive symptom assessment tool.

The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability.

The aim of the present study was to validate the Greek version of the Hospital Anxiety and Depression Scale (HAD) in a palliative care unit. The scale was translated with the "forward-backward" procedure to Greek. It was administered twice, with a 1-week interval, to 120 patients with advanced cancer. Together with the HAD scale, the patients also completed the Spielberger State-Anxiety Scale (STAI-S). Factor analyses identified a two-factor solution corresponding to the original two subscales of the HAD, which were found to be correlated. The Greek version of the HAD had Cronbach's alphas for the anxiety and depression scales of 0.887 and 0.703, respectively. Validity as performed using known-group analysis showed good results. Both anxiety and depression subscales discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Correlations between the HAD scale and the STAI-S was 0.681 for the anxiety subscale and 0.485 for the depression subscale. These psychometric properties of the Greek version of the HAD scale confirm it as a valid and reliable measure when administered to patients with advanced cancer.

Greek McGill Pain Questionnaire: Validation and Utility in Cancer Patients

In 1968, Melzack and Casey suggested that there are three major psychological dimensions of pain: sensory, affect, evaluative. These categories interact with one another to provide quantitative and qualitative information on the components of pain. In 1975, Melzack developed the McGill Pain Questionnaire, which is composed of four major parts and evaluates the qualities of pain. The aim of this study was to assess the applicability, reliability, and validity of the McGill Pain Questionnaire on a sample of Greek cancer patients receiving palliative treatment. It was administered to 114 cancer patients before the initiation of the palliative treatment, and then to 80 cancer patients during the treatment 7 days later. The results indicated that scale reliability was very good (0.95–0.97). During the pretreatment period, correlations between Present Rating Index (PRI), Present Pain Intensity (PPI), and Number of Words Chosen (NWC) ranged between 0.42 and 0.92. During the post-treatment time, the correlations ranged between 0.28 and 0.91. Only 21.8% of the words met a criterion of 30% for representativeness on the first administration of the questionnaire, and 9% met this criterion on the second. Validity was satisfactory ( P < 0.005) according to ‘responsiveness to changes in time’, as there was a statistical difference between the pretreatment and post-treatment time. Patients presented a desirable level of convergent construct validity ( P < 0.05) concerning their performance status. Exploratory factor analysis was examined and two factors with eigenvalue over 1 were extracted, and they accounted for 95.2% of the variance. These results support the Greek-MPQ as a reliable and valid measure for evaluating the qualities of cancer pain in patients receiving palliative care.

Information needs and awareness of diagnosis in patients with cancer receiving chemotherapy: a report from Greece.

This study assessed the information needs of Greek cancer patients and examined whether awareness of diagnosis had any impact on patients. One hundred patients were interviewed about overall and specific information needs, satisfaction, emotional distress, and quality of life. Patients exhibited a great desire for information overall. The need to have more information was high especially regarding the aftermath of chemotherapy, prognosis, how chemotherapy worked, and diagnosis. Patients were more satisfied with care but less satisfied with the information received. Only 37% knew they had cancer, especially the younger, the better educated, and those with breast cancer. Awareness was not related to satisfaction, emotional distress, or quality of life. Our findings suggest that Greek cancer patients need more factual information about their condition and management. Greek oncologists may feel freer to inform their patients about the diagnosis and other issues following their judgement, rather than employing the policy of concealing the truth.

The families evaluation on management, care and disclosure for terminal stage cancer patients.

BackgroundQuality of life is an important concept which is subjective and personal; what is an acceptable quality of life to one may be 'worse than death' to another. The objective of this study was to develop and validate a questionnaire to assess relatives' perceptions and attitudes towards their terminal stage cancer patients' management (information disclosure, treatment choice, hospitalization and support-communication and care) including aspects regarding end-of-life and quality-of-life decisions.MethodsThe final study consisted of 146 relatives of advanced terminal stage cancer patients receiving palliation, attending a Pain Relief and Palliative Care Unit. The questionnaire incorporated 6 multi-item and 7 single-item scales, and was developed following a systematic review of measures appropriate for use in palliative care settings.ResultsFollowing analysis of the 25-item scale, the questionnaire has been validated as a shortened 21-item scale consisting of 5 multi-item and 5 single-item scales. Factor analysis was based upon information disclosure, hospitalization, and support-communication demonstrating Cronbach's alpha coefficients of 0.66, 0.5 and 0.70 respectively. Average item totals and inter-item scale correlations were between 0.62–0.70, with convergent validity correlations between 0.60–0.86. The questionnaire was well accepted by all subjects with an 8–10 minute completion time.ConclusionThe shortened 21-item self-assessment questionnaire may provide acceptable and valid assessment of caregiver(s)/Greek cancer patients' relatives perceptions on palliative care.

The informational needs of greek cancer patients receiving chemotherapy

The informational needs of greek cancer patients receiving chemotherapy

The EORTC core quality of life questionnaire (QLQ-C30, version 3.0) in terminally ill cancer patients under palliative care: validity and reliability in a Hellenic sample.

In 1986, the European Organization for Research and Treatment (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. The questionnaire was designed to measure cancer patients' physical, psychological and social functions. The questionnaire is composed of 5 multiitem scales (physical, role, social, emotional and cognitive functioning) and 9 single items (pain, fatigue, financial impact, appetite loss, nausea/vomiting, diarrhea, constipation, sleep disturbance and quality of life). It was administered to the patients before the initiation of palliative treatment and then once again during the treatment. The validation of the questionnaire took place at Areteion Hospital, while the translation was conducted by the EORTC bureau. The final validation sample consisted of 120 cancer patients. The clinical variable assessed was the performance status. The aim of our study was to assess the applicability of this quality of life measurement on a Hellenic sample of cancer patients receiving palliative care. The results showed that the questionnaire was well accepted in the present patient population. In addition, the questionnaire was found to be useful in detecting the effectiveness of palliative treatment over time. The scale reliability was very good (pretreatment from 0.57-0.79, ontreatment from 0.56-0.75), especially for the functioning scale. In addition, very good validity was found in all the approaches used. Moreover, the factor analysis results in a 6-factor solution that satisfies the criteria of reproducibility, interpretability and confirmatory setting. Performance status showed an improvement (p < 0.0025) during the studied period. These results support that the QLQ-C30 (version 3.0) has proven to be a reliable and valid measure of the quality of life in Greek cancer patients receiving palliative care treatment.

Impact of Cancer on Primary Caregivers of Patients Receiving Radiation Therapy

The main objective of this study was to assess the consequences of caregiving on primary caregivers of Greek cancer patients receiving radiotherapy. Sixty-five caregivers participated in the study and data were collected through structured interviews. Our results pointed to a lack of association concerning extent of patients' disease, treatment schedule, performance status or awareness of diagnosis. However, female caregivers with low qualifications, partners, and those living with the patient were more likely to report heightened symptoms of anxiety and depression, severe impact of caregiving on their lives, poor health and low quality of life. In addition, it was shown through multivariate analyses that psychological distress was the sole predictor of overall health and global quality of life. In conclusion, Greek caregivers are to a great extent affected by the disease. Caring for significant others is essential to promoting quality of life for the family and the patient.

Selenium status of cancer patients in Greece

The Se status of 177 Greek cancer patients has been assessed by fluorimetric analysis of the Se concentration in whole blood, urine (morning) and hair. Patients either with newly diagnosed cancers or with metastases or who are undergoing therapy have statistically significant less blood, urine and hair Se than age- and sex-matched healthy controls. There is a strong and significant correlation between blood and urine or hair Se in the newly diagnosed cancers. In cancers of systems involving absorption, metabolism and excretion of Se, and in female breast cancer, the Se levels in blood, urine and hair are significantly lower than in the controls. In cancers of the respiratory and haematologic systems, blood and urine Se are normal, while hair Se is significantly lower than in controls. The results are compared with literature data; conflicting data may be due to different dietary habits of the various populations. Some cancerous tissues, such as those of the peptic system, accumulate Se compared with their adjacent, apparently healthy tissues, but others, of the urinary system for example, do not. The reason(s) for this behaviour, however, is not known.