Cancer Treatment Care Research Articles

An international multicentre validation study of a pain classification system for cancer patients

Pain is a key symptom at all stages of cancer. It may be the first sign experienced by the patients, it may be a sign of relapse after curative treatment and many patients with metastatic disease may suffer for years due to suboptimal pain treatment. Cancer patients are reporting that pain is the symptom they mostly fear and that they hypothetically may consider to ask for euthanasia in a state of unbearable pain. During the last decade much attention has been given to improve pain treatment in cancer care; however, despite these efforts epidemiological studies are indicating that as many as 50% suffer from untreated pain. These data are in contrast to ‘older’ validation studies which have documented that as many as 90% may achieve acceptable pain control. Several explanations of the gap between best clinical practice and what happens in ‘real life’ have been put forward such as inferior diagnosis (pain classification), inferior follow up (evaluation of the pain treatment), lack of use of multi model treatment strategies and patient’s compliance to strong opioids. One fundament of medical science is to apply the existing knowledge about the use of diagnostic instruments such as biopsy, imaging, clinical examination and patient’s physical performance status in an appropriate and systematic manner. For cancer pain, international consensus does not exist

Determinants of outcome in elderly patients with positive sentinel lymph nodes

Background Older women are less likely to receive standard of care treatment for breast cancer. Methods We examined variables that affected the outcome of elderly patients ≥70 years old among 1,470 patients with invasive cancer with positive sentinel lymph nodes (SLNs). Results Elderly patients were less likely to undergo mastectomy, completion axillary node dissection (ALND), adjuvant chemotherapy, and radiotherapy (RT) following breast-conserving therapy (BCT) compared with patients <70 years old. The 5-year risk of disease progression and cumulative incidence of breast cancer–specific deaths were not significantly different for both groups. On multivariate analysis, hormone receptor–negative status, number of metastatic lymph nodes, high nuclear grade, and tumor size were the factors independently associated with increased risk of disease progression. Conclusions Tumor factors were the primary determinants of breast cancer outcomes in our cohort. Elderly patients are less likely to receive aggressive surgical interventions and adjuvant therapy because of perceived life expectancy.

ABC conceptual model of effective multidisciplinary cancer care

The treatment of cancer requires that health care providers and caregivers from many disciplines work together on the intertwined physical, psychological, social and spiritual needs of oncology patients. Providing a conceptual framework explaining how the members of multidisciplinary oncology treatment teams may best interact with each other and the patient helps drive patient-centered care and clarifies the roles of specific team members at various times over the course of treatment. The ABC model of multidisciplinary care in cancer treatment describes the roles of the active caregivers (for example, physicians or nurses), basic supportive caregivers (for example, psychologists or chaplains) and community support (for example, advocacy groups or hospital staff) providing the full continuum of the cancer treatment experience. Teams trained in the ABC model should better understand the function and importance of each member's role, increase patient involvement and satisfaction with treatment, and ultimately improve patient outcomes.

Caring for cancer patients on non-specialist wards

As cancer is the leading cause of death worldwide, every nurse will be required to care for patients with the condition at some point in his/her career. However, non-specialized oncology nurses are often ill-prepared to nurse patients suffering from cancer. This literature review aims to provide an overview of current trends and developments in cancer care nursing in an attempt to identify the range of previous research pertaining to caring for patients with cancer on non-specialist wards. The review finds that non-specialized cancer nurses report a lack of education and training with regard to cancer care and cancer treatments, which acts as a barrier to providing quality nursing care. Emotional and communication issues with patients and their families can also cause non-specialist nurses significant distress. International research has shown that specialist oncology nurses make a considerable difference to physical and psychosocial patient care. It is therefore paramount that non-speciality nurses' educational needs are met to develop clinical competence and to provide supportive holistic care for both patients and their families.

Accuracy of cancer information on the Internet: A comparison of a Wiki with a professionally maintained database.

6058 Background: A Wiki is a website which can be directly, openly edited; Wikipedia, a collaborative encyclopedia, is a well-known example. Due to a Wiki's lack of editorial control and formal structure, we hypothesized that the content would be less complete and less accurate than that presented on a formal, peer-reviewed web site. Our goal was to compare the coverage, accuracy, and readability of cancer information from a Wiki (Wikipedia) with a peer-reviewed web site, the patient-oriented National Cancer Institute's Physician Data Query (PDQ) comprehensive cancer database. Methods: For each of ten cancer types, an appraisal form was created to include content of epidemiology, etiology, symptoms, diagnosis, treatment, and controversial topics in cancer care. Statements were obtained and validated from standard oncology texts. Medically-trained personnel scored PDQ and Wikipedia web pages for accuracy and presentation of controversies. Reliability was assessed using inter-observer variability (correlation coefficient) and test-retest reproducibility (Ebel's algorithm). Readability was calculated from word and sentence length. Results: Examiners were able to assess web sites rapidly, with a mean of 18 minutes per article. Test-retest reliability was 0.71. Inter-observer variability was 0.53. For both web sites, inaccuracies (as agreed upon by ≥ 2 raters) were rare and comprised < 2% of information examined. PDQ was significantly more readable than Wikipedia: Flesch-Kincaid grade level 9.6 ± 1.5 vs. 14.1 ± 0.5 (p < 0.0001). There was no difference in depth of coverage between PDQ and Wikipedia (29.9 ± 8.3, 34.2 ± 14.0 respectively; max. possible score 72). Controversial aspects of cancer care were relatively poorly discussed in both resources (2.9 ± 2.8 and 6.1 ± 6.3 for PDQ and Wikipedia respectively [NS]; max. possible score 18). A planned sub-analysis comparing common to uncommon cancers demonstrated no difference between the two for either resource. Conclusions: Although the Wiki resource had similar accuracy and depth to the professionally edited database, it was significantly less readable. Further research is required to assess how this influences patients' understanding and retention. No significant financial relationships to disclose.

Abstract 5390: QBI-139, a human RNase variant in a phase I trial, works in combination

Abstract The EVade™ Ribonucleases (RNases) are a new class of anti-cancer drugs that target the RNA in cancer cells. These EVade™ RNases are variants of native mammalian RNases that have been converted to anti-cancer agents by diminishing their binding to their natural inhibitor protein. One of these EVade™ RNases, called QBI-139, has advanced to human clinical trials. QBI-139 shares 95% sequence identity with the wild type human RNase 1. QBI-139 has shown tumor growth inhibition against a variety of cancers, including: colon, non-small cell lung, ovarian, pancreatic and prostate cancers. QBI-139 is currently in a Phase I clinical trial in patients with solid tumors. A frog RNase called Ranpirnase (Alfacell) that shares only 20% sequence identity with human RNase 1 has been in clinical trials and responses have been seen in esophageal, non-small cell lung and breast cancers as well as unresectable mesothelioma. The next stage of clinical development of QBI-139 will require selection of a specific indication as well as an existing treatment regimen to be used in combination with QBI-139. The Phase I trial may provide insights about sensitive tumor types. However, mouse models of cancer will be used to select the combinations for development. QBI-139 has shown efficacy against non-small cell lung cancer (A549 cell line) in xenograft models. Cisplatin is a standard of care treatment for non-small cell lung cancer in patients. The ability of QBI-139 and cisplatin to work together to cause tumor growth inhibition was determined in a non-small cell lung cancer xenograft model (A549 cell line). Cisplatin (3 mg/kg) and QBI-139 (15 mg/kg) were used as controls. The combination of cisplatin and QBI-139 (3 and 15 mg/kg, respectively) was also tested. Cisplatin treatment resulted in tumor growth inhibition (TGI) of 60% while QBI-139 caused 76% TGI. The combination of the two drugs resulted in a TGI of 96%, strongly supporting the use of QBI-139 in combination with cisplatin for the treatment of lung cancer. Even the combination of the two drugs exhibited minimal impact on the health of the animals. EVade™ Ribonucleases are novel agents that provide a new way to target the RNA in cancer cells and are an innovative new tool for oncologists. QBI-139 has a variety of benefits, including: a novel mechanism of action with clinical support, broad in vivo anti-tumor activity alone and in combination with standard of care therapies and a strong tolerability profile. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5390.

Patient satisfaction instruments for cancer clinical research or practice

Cancer patient satisfaction assessment is increasingly considered, owing to the need to assess evolving patterns of care organization and delivery or to test new cancer treatments and interventions. This article reviews cancer patient satisfaction questionnaires using key methodological criteria. In total, 17 patient satisfaction instruments validated for the field of oncology during the period of 1999–2009 were identified from previous literature reviews and a literature search. Most of these instruments were developed with the input of the target population, relating to various cancer care contexts or treatments, and demonstrating reasonable psychometric performance. Future endeavor should address the appropriate comparison and interpretation of satisfaction data across cultures/languages, cancer treatment or care programs.

Acupuncture Versus Venlafaxine for the Management of Vasomotor Symptoms in Patients With Hormone Receptor–Positive Breast Cancer: A Randomized Controlled Trial

Vasomotor symptoms are common adverse effects of antiestrogen hormone treatment in conventional breast cancer care. Hormone replacement therapy is contraindicated in patients with breast cancer. Venlafaxine (Effexor), the therapy of choice for these symptoms, has numerous adverse effects. Recent studies suggest acupuncture may be effective in reducing vasomotor symptoms in menopausal women. This randomized controlled trial tested whether acupuncture reduces vasomotor symptoms and produces fewer adverse effects than venlafaxine. Fifty patients were randomly assigned to receive 12 weeks of acupuncture (n = 25) or venlafaxine (n = 25) treatment. Health outcomes were measured for up to 1 year post-treatment. Both groups exhibited significant decreases in hot flashes, depressive symptoms, and other quality-of-life symptoms, including significant improvements in mental health from pre- to post-treatment. These changes were similar in both groups, indicating that acupuncture was as effective as venlafaxine. By 2 weeks post-treatment, the venlafaxine group experienced significant increases in hot flashes, whereas hot flashes in the acupuncture group remained at low levels. The venlafaxine group experienced 18 incidences of adverse effects (eg, nausea, dry mouth, dizziness, anxiety), whereas the acupuncture group experienced no negative adverse effects. Acupuncture had the additional benefit of increased sex drive in some women, and most reported an improvement in their energy, clarity of thought, and sense of well-being. Acupuncture appears to be equivalent to drug therapy in these patients. It is a safe, effective and durable treatment for vasomotor symptoms secondary to long-term antiestrogen hormone use in patients with breast cancer.

Smoking cessation interventions in cancer care: opportunities for oncology nurses and nurse scientists.

Smoking cessation is essential after the diagnosis of cancer to improve clinical outcomes. The purpose of this chapter is to provide a systematic review of research on smoking cessation in the context of cancer care with an emphasis on nursing contributions to the field. Data sources included research reports of smoking cessation interventions conducted in people with cancer. Nineteen primary studies were reviewed. High intensity interventions, targeting multiple behaviors, and/or using a multicomponent intervention that included pharmacotherapy, behavioral counseling, and social support were characteristics of the most successful treatments for tobacco dependence. The majority of interventions were conducted in adults with smoking-related malignancies during acute phases of illness. The most striking finding was that more than one half of the studies tested the efficacy of nurse-delivered interventions. Conceptual and methodological issues that can be improved in future studies include: using theoretical frameworks to specify how the intervention will affect outcomes, ensuring adequate sample sizes, using biochemical verification to monitor smoking outcomes, and using standardized outcome measures of abstinence. Although effective interventions are available for healthy populations, further research is needed to determine if tailored cessation interventions are needed for patients with cancer. To provide optimal quality care it is imperative that delivery of evidence-based smoking cessation interventions be integrated into the cancer treatment trajectory. Multiple barriers, including patient and nurse attitudes toward smoking and lack of knowledge related to tobacco treatment, prevent translating evidence-based tobacco dependence treatment into clinical practice. Further nursing research is needed to address these barriers.

Promise and challenges in drug discovery and development of hybrid anticancer drugs

Background: Because cancer is a complex disease, it is unlikely that a single mono functional ‘targeted’ drug will be effective for treating this most advanced disease. Combined drugs that impact multiple targets simultaneously are better at controlling complex disease systems, are less prone to drug resistance and are the standard of care in cancer treatment. In order to improve the efficiency of using a two-drug cocktail, one approach involves the use of the so-called hybrid drugs, which comprises the incorporation of two drugs in a single molecule with the intention of exerting dual drug action.Objective: In the present article, we discuss the design, synthesis and various applications of anticancer hybrid agents and the developments in this field during the last few decades. Additionally, we describe different types of linkers and their role in contributing towards biological effects and the in vivo mechanism of drug release. We also depict some challenges from scientific and regulatory perspectives in the hybrid drug development process.Conclusion: In the era of increasing drug resistance in cancer patients, the discovery of hybrid drugs could provide an effective strategy to create chemical entities likely to be more efficacious and less prone to resistance. However, some technical and regulatory challenges will have to be surmounted before hybrid drugs succeed in the clinical settings and justify the considerable promise of this novel concept.

A personal touch - the value of guided treatment in cancer care

A personal touch - the value of guided treatment in cancer care

Determinants of outcome in elderly patients with positive sentinel lymph nodes

614 Background: Older women are less likely to receive standard of care treatment for breast cancer. This undertreatment may be linked to the perception that elderly patients (pts) may not tolerate or derive benefit from treatment that is often viewed as “too toxic.” Methods: From July 1997 to July 2003, 1,470 pts with invasive cancer with positive sentinel lymph nodes (PSLN) by intraoperative frozen section or final pathologic exam by hematoxylin-eosin and/or immunohistochemistry (IHC). We examined sociodemographic, pathologic, and therapeutic variables that affected the outcome of elderly pts ≥70 years old. A comorbidity score was assigned using Adult Comorbidity Evaluation-27 system. Chi-square, Fisher's exact Wilcoxon tests, and multivariate logistic regression analysis were used. Results: The median age was 53 years (range 21–89) and median tumor size 1.6 cm (range 0.1–11). 1,265 (86.1%) pts were &lt;70 years old and 205 (13.9%) pts were ≥70 years old. 183 (12.5%) pts had IHC only PSLN, 1,021 (69.5%) had 1–3 PSLN, and 266 (18%) ≥4 PSLN. Breast conservation therapy (BCT) was performed in 59.7% of pts. Elderly pts were more likely to have moderate to severe comorbidities (46% vs. 11%, p &lt; 0.0001) and BCT (67% vs. 59%, p = 0.026), compared to pts &lt;70 years old. Elderly pts were less likely to undergo completion ALND (73% vs. 89%, p &lt; 0.0001), adjuvant chemotherapy (43% vs. 90%, p &lt; 0.0001) and radiotherapy following BCT (82% vs. 90%) compared to pts &lt;70 years old. The 5-year disease-free survival (DFS) was not significantly different for elderly pts compared to non-elderly pts (87.7% vs. 91.9%, p = 0.21), on the other hand the 5-year overall survival was significantly worse for elderly pts (80.4% vs. 93.2%, p &lt; 0.0001), a difference that was mainly due to a significantly higher 5-year cumulative incidence of death due to other causes (13.2% vs. 1.9%, p &lt; 0.0001). On multivariate analysis, ER or PR positive status, IHC only PSLN and T1 tumors were the only factors independently associated with improved odds of 5-year DFS. Conclusions: Tumor rather than patient factors were the primary determinants of breast cancer outcomes in our cohort of node positive breast cancer pts. Elderly breast cancer pts with an estimated life expectancy beyond 5 years should receive the same standard of care therapy as their younger counterparts. No significant financial relationships to disclose.

Sensitivity to change of the Spanish validated Memorial Pain Assessment Card in cancer patients

Pain intensity is a good parameter to assess effective treatment of cancer and palliative care. The Memorial Pain Assessment Card (MPAC) is a quick, easy and reliable measure of quality of life in cancer patients. The MPAC was validated in Spanish in 2004. This study evaluated the sensitivity to change Spanish version of the MPAC. An epidemiological, prospective, 1- month, multicentre study, conducted at 4 oncology services. Patients evaluated suffered chronic cancer pain and were in a susceptible situation of change. The MPAC was administrated at baseline, at one week and at one month, including the 4 subscales (pain relief [VASPR], pain intensity measured by VAS [VASPI] and by an 8-item descriptor [Tursky], and psychological distress [VASMOOD]). Satisfaction of patients and health-care professionals with the MPAC was also evaluated. A total of 54 patients were studied. All of the MPAC subscales showed sensitivity to change during the follow-up. The subscale values at visit 1 vs. visit 3 were: VASPR 4.5+/-1.9 vs. 6.3+/-2.3, VASPI 6.6+/-1.6 vs. 3.5+/-1.9 and VASMOOD 5.5+/-2.1 vs. 4.0+/-2.1). Patients and healthcare professionals agreed in the facility use MPAC card (63% and 71% of cases, respectively). The present study showed sensitivity to change among the different MPAC subscales of the Spanish version. Moreover, the MPAC Spanish version has proven to be a good tool accepted by health-care-professionals and patients. Due to its facility of administration, it may allow a useful and quick evaluation of cancer-related pain in the clinical practice.

Patient Education About Treatment in Cancer Care

An increasing number of older people are treated for cancer. Several factors, such as comorbidity and sensory deficits, occur more frequently in older patients than in younger patients. In addition, their life circumstances, values, and preferences may differ. These factors ask for tailored nurse-older patient communication. This article reviews recent literature on the specific needs of older patients with cancer in the treatment phase of the disease. No studies addressed treatment-related needs of older patients specifically. Seventeen studies controlled for age showed that many older patients want as much information on disease and treatment as possible, but they are less interested in details than younger patients. Furthermore, older patients reported less need for information on sexual consequences and psychosocial support. The results remain difficult to interpret because of variation in study designs and questionnaires. Moreover, none of the studies controlled for age-related variables. Studies that illuminate the unique needs of older patients with cancer in the treatment phase of the disease are strikingly limited given the demographics of cancer in our society. Research is needed that explicitly investigates these needs and the influence of age-related changes in cognitive, physical, and psychosocial functioning.

Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study.

BackgroundQuality of life (QOL) issues are of interest in cancer because effective methods of treatment and detection have led to an increase in the number of long-term survivors. The objectives of the study were: to assess the subjective QOL of stable Sudanese women cancer outpatients and their family caregivers, using the WHO 26-item QOL Instrument; compare with matched general population groups, as well as diabetic and psychiatric patient groups; examine patient-caregiver concordance in ratings; and assess the variables associated with their QOL, with a view to identifying factors that can enhance quality of care.MethodsResponses of oncology outpatients with breast cancer (117), cervical cancer (46) and ovarian cancer (18) (aged 44.6, SD 11.5) were compared with those of their family caregivers and matched general population groups. Data were analyzed by univariate and multivariate statistics.ResultsThe cancer groups had similar QOL domain scores, which were significantly lower than those of their caregivers, but higher than the control group as well as those of psychiatric and diabetic patients studied previously. Patients who were married, with higher education, better employment, and with longer duration of illness had higher QOL. Patients on radiotherapy and their caregivers had higher QOL scores. Correlations between patient's ratings and caregiver impression of patient's QOL were high. Caregiver impression was a significant predictor of patient's and caregiver's QOL. Other predictors for the patient were: currently feeling sick and duration of illness; for the caregiver: feeling sick, relationship to patient, and age.ConclusionCancer patients in stable condition and with psychosocial support can hope to enjoy good QOL with treatment. The findings constitute an evidence base for the country's cancer care program, to boost national health education about prognosis in cancer. Families living with women cancer patients are vulnerable and need support if the patient is recently diagnosed, less educated, single, not formally employed; and the caregiver is female, parent, younger, less educated, unemployed and feels sick. Clinicians need to invest in the education and support of family caregivers. The patient-caregiver dyad should be regarded as a unit for treatment in cancer care.

Efficacy of psychosocial interventions in cancer care: Evidence is weaker than it first looks

With increasing sophistication, successive reviews find weaker evidence for the efficacy of psychosocial interventions to reduce distress among cancer patients. However, these appraisals may still be overly positive because of reviewers' uncritical acceptance of flaws in the design, analysis, and reporting of the results of such trials. Using randomized trials from high-impact journals, we show confirmatory bias, selective reporting of the most favorable of multiple outcome measures, suppressing of null results in subsequent citations of trials, and dropping of data for patients least likely to benefit from intervention. The conclusion that typical cancer patients do not benefit from interventions to reduce distress is strengthened when these endemic problems with the literature are taken into account. Required registering of the details of clinical trials and adherence to CONSORT reduces but does not eliminate bias in the literature.

Randomized Phase III Trial of Topotecan Following Carboplatin and Paclitaxel in First-line Treatment of Advanced Ovarian Cancer: A Gynecologic Cancer Intergroup Trial of the AGO-OVAR and GINECO

The combination of carboplatin and paclitaxel is the standard of care for the treatment of ovarian cancer, yet rates of recurrence and death remain high. We performed a prospective randomized phase III study to examine whether sequential administration of topotecan can improve the efficacy of carboplatin and paclitaxel in first-line treatment of advanced epithelial ovarian cancer. A total of 1308 patients with previously untreated ovarian cancer (International Federation of Gynecology and Obstetrics stages IIB-IV) were randomly assigned to receive six cycles of paclitaxel and carboplatin followed by either four cycles of topotecan (TC-Top; 658 patients) or surveillance (TC; 650 patients) on a 3-week per cycle schedule. The primary endpoint was overall survival, and secondary endpoints were progression-free survival, response rate, toxicity, and quality of life. Time-to-event data were analyzed using the Kaplan-Meier method, and a stratified log-rank test was used to compare distributions between treatment groups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a Cox proportional hazards model. Categorical data were compared using a stratified Cochran-Mantel-Haenszel test. All statistical tests were two-sided. Median progression-free survival was 18.2 months in the TC-Top arm versus 18.5 months in the TC arm (stratum-adjusted HR = 0.97 [95% CI = 0.85 to 1.10]; P = .688). Median overall survival was 43.1 months for the TC-Top arm versus 44.5 months for the TC arm (stratum-adjusted HR = 1.01 [95% CI = 0.86 to 1.18]; P = .885). At 3 years, overall survival in both arms was 57% (58.5% in the TC arm and 55.7% in the TC-Top arm). Compared with patients in the TC arm, patients in the TC-Top arm had more grade 3-4 hematologic toxic effects (requiring more supportive care) and more grade 3-4 infections (5.1% versus 2.7%; P = .034) but did not have a statistically significant increase in febrile neutropenia (3.3% versus 3.1%; P = .80). Among patients who had measurable disease (TC, n = 147; TC-Top, n = 145), overall (i.e., complete or partial) response was 69.0% (95% CI = 61.4% to 76.5%) in the TC-Top arm and 76.2% (95% CI = 69.3% to 83.1%) in the TC arm (P = .166). The sequential addition of topotecan to carboplatin-paclitaxel did not result in superior overall response or progression-free or overall survival. Therefore, this regimen is not recommended as standard of care treatment for ovarian cancer.

Improving the quality of life of patients with prostate carcinoma

Treatments for clinically localized prostate carcinoma are accompanied by sexual, urinary, and bowel dysfunction and other sequelae that can result in significant distress and reduced well being. Methods capable of improving quality of life are needed that can be integrated into clinical practice. To address this need, a nurse-driven, cancer care intervention was developed and tested. Within 6 weeks after completing treatment, 99 patients, along with their partners, were enrolled into a prospective, controlled trial and were randomized to receive the cancer care intervention or to receive standard care. Participants in the intervention arm met once each month for 6 months with an oncology nurse intervenor, who helped patients identify their quality-of-life needs using an interactive computer program. The intervener then provided education and support tailored to participants' needs. Primary outcome variables included 1) disease-specific quality of life, including sexual, urinary, and bowel outcomes and cancer worry; 2) depression; 3) dyadic adjustment; and 4) general quality of life. Outcomes data were collected prior to randomization and again at 4 months, 7 months, and 12 months posttreatment. Patients in the intervention arm experienced long-term improvements in quality-of-life outcomes related to sexual functioning and cancer worry compared with patients who received standard care. Baseline depression moderated the impact of the intervention on several other quality-of-life outcomes. The findings of the current study indicated that a computer-assisted, nurse-driven intervention was capable of providing durable improvements in the quality of life of men who underwent treatment for clinically localized prostate carcinoma.

A 6 years experience in Home-Care: Efficient and cost-effective strategy of treatment in terminal cancer care

8183 Background: The G.R.A.D.O. Association (Gruppo Ricerca Assistenza Domiciliare Oncologica) providing home-care for cancer patients was begun in June 1998. The drawing thought of our work is that, in the advanced phases of cancer, the best place of treatment should be the patients’ home, considering that house is the natural container of persons’ life which, with a convenient help, would prefer to spend the terminal phases of their life at home rather than hospital. Patients and Methods: Patients are visited at home by an oncologist and a professional nurse; they together draw up the assistance program. The professional teem is also composed of an internist, a physician for pain therapy, a psychologist, a physiotherapist. Assistance is completely free for the patients and their families. The professional team is also supported by a group of trained volunteers who are responsible for the social aspects of the patients’ life. During these six years of activity 455 patients, the mean age was 64.7 yrs (16–90), have been followed: they requested 3352 oncological visits, 991 medical visits, 25 chemotherapies, 288 thoracentesis, 292 paracentesis, 2538 nurse interventions, 2839 supportive treatments, 35 physiotherapeutic interventions and 661 psychological supports. The median follow up were 37 days (3–359). The 88% of the patients died at home. Conclusion: The data regarding our activity showed us that this specifically oriented medical assistance permits education and adaptation of patients and their families with the disease and diminishes the hospitalization of these patients, resulting in an improvement of their quality of life (better preserved in their family environment). During our years of activity we have distributed 31.439 days of medical services and it has certainly helped in saving the expenses of the welfare state. So considering the mean cost of a day in a general hospital approximately equivalent to 700,00$ and considering a day of medical services= a day of non-hospitalization, our work allowed an economical benefit of 22.007.300,00$ for the public health resources (3.667.883,33$/year). Home-Care models could be the successful instruments and strategies of treatment in advanced cancer care. No significant financial relationships to disclose.

Circadian function of patients with advanced non-small cell lung cancer

7291 Background: Preclinical data shows that abolishing circadian function accelerates tumor progression and shortens survival, while restoring normal circadian function enhances the survival benefits of chemotherapy. A significant fraction of patients with advanced cancer express the symptoms of disrupted circadian function, such as poor sleep quality and fatigue. There is little data in the literature on circadian function of cancer patients. Consequently, we measured the prevalence of symptoms associated with a disrupted circadian rhythm in advanced non-small cell lung cancer. Methods: Prior to initiation of therapy, actigraphy bracelets were worn on the non-dominant wrist for at least three days. The Pittsburgh Sleep Quality Index (PSQI), assessed sleep quality; European Organization for Research and Treatment for Cancer Care (EORTC) and the Ferrans and Powers Quality of Life Index (QLI) assessed quality of life and fatigue levels. Results: At the time of analysis there were 21 male and 12 female patients enrolled in the study. 20 had metastatic disease while 13 were stage III. 18 had prior treatment while 15 were newly diagnosed. The mean PSQI score was 10.6, a score routinely recorded in insomniacs. QLI domain scores were one to two standard deviations lower and EORTC domain scores were one standard deviation lower than the general population norms with low scores indicating worse QoL. The mean EORTC fatigue item score of 53 was much higher than that in normal population (28.8), higher the score, worse the fatigue. The wrist actigraphs recorded that patients slept 148.5 minutes more during the putative wake span and 113.1 minutes less during the putative sleep span than population controls. Conclusions: Patients with advanced non-small cell lung cancer have significantly disturbed circadian rhythms - experience poor sleep quality, high levels of fatigue, and an overall poor quality of life. The interesting question is whether restoring the patients’ circadian function also improves sleep quality, reduces fatigue levels, and improves QoL. This issue is currently being investigated at our center in a randomized clinical trial evaluating the chronotherapeutic role of melatonin in the treatment of stage III and IV non-small cell lung cancer. No significant financial relationships to disclose.