Problem In Cancer Patients Research Articles

Treatment options in extravasation injury: an experimental study in rats.

Local skin necrosis after extravasation of doxorubicin hydrochloride (Adriamycin), a widely used chemotherapeutic agent, is a common problem in cancer patients. Even though several treatment options have been proposed for extravasation injury, there is still controversy regarding the management of such lesions. The aim of this study was to compare the efficacy of saline infiltration, vitamin C infiltration, suction technique, and early surgical excision as a treatment in a rat extravasation model. The authors planned their study in two stages. In stage 1, the lowest effective dose of doxorubicin at which a homogeneous skin necrosis was formed and the method of administration were investigated. Intradermal and subpannicular injections were made for six rats, using six different concentrations of doxorubicin (0.33, 0.5, 0.66, 1.0, 1.33, and 1.5 mg/ml). In stage 1, the intradermal injection produced homogeneous and uniform tissue necrosis. In stage 2, the efficacy of saline infiltration (group 1), vitamin C infiltration (group 2), suction (group 3), suction and saline washout (group 4), suction and vitamin C washout (group 5), and early surgical excision (group 6) was compared. The treatment options were applied 2 hours after doxorubicin injection. At the end of the seventh day, the presence and size of ulcers at the injection site were calculated. Fourteen days after injection, a histopathologic examination was performed for each treatment and control group. In groups 1 and 3, there was no statistically significant difference in the size of necrosis compared with the control groups. In groups 2, 4, and 5, the size of necrosis was smaller compared with the control groups, and this was statistically significant. Furthermore, in group 4 (suction and saline washout) and group 5 (suction and vitamin C washout), the calculated area of necrosis was smaller compared with other treatment groups, and this was statistically significant. The findings supported the assertion that suction and saline or vitamin C washout reduce necrotic tissue size in extravasation injury.

Rehabilitation after surgery for gastrointestinal malignant tumors

In Germany every year about 100,000 people develop a malignant tumor of the gastrointestinal tract. Only few of them are included in a structured rehabilitation program after surgery. The aim of such a rehabilitation program is to minimize the sequels of gastrointestinal tumor disease and its treatment and influence on the daily life of patients. Malnutrition is a common symptom of tumor manifestation, especially in the gastrointestinal tract. It is important to establish the diagnosis of malnutrition and to treat such patients with nutritional support.Fatigue and impairment of physical performance are serious problems of cancer patients. Particularly in the recovery phase immediately after treatment, low physical performance imposes limitations on basic daily activities. An active aerobic training program can improve the physical performance and fitness in a short time. Deficits and symptoms depend on tumor stage and localisation. A specialised team is necessary to treat all the possible symptoms and complications after cancer surgery. Patients have to be informed precisely about structural and functional deficits due to tumor operation. Only the well informed patient will comply to the suggested treatment.

Comparative genomic hybridization study of genetic changes associated with vindesine resistance in esophageal carcinoma

The acquisition of drug-resistance is a major problem for cancer patients undergoing chemotherapy. To clarify genetic alterations in cancer cells that develop drug-resistance, comparative genomic hybridization (CGH) was applied to esophageal squamous cell carcinoma cell lines (SH-1V1, SH-1V2, SH-1V4 and SH-1V8) and chemoresistance-related genes in altered chromosomal regions were evaluated. These cell lines were derived from the parental SH-1 cell line, after multiple steps of selection by an increasing exposure to vindesine. SH-1V8 cells were strongly resistant to vindesine. DNA copy number at 16p which includes the MRP (multidrug resistance related protein) gene was markedly increased in all cell lines examined. Increased DNA copy numbers were found at the regions of 5q31-32, 10q11.1-23, and 14q32-qter in SH-1V8 cells that acquired resistance to other drugs as well. Both SH-1V4 and SH-1V8 showed increased DNA copy numbers at 7q11.1-22, 16q12.1-qter, 19p13.2-13.3, 19q11-13.2 and 20q13.1-qter. The chromosomal region of 7q11.1-22 including MDR-1 (multidrug resistance-1) gene was highly amplified in SH-1V4 and SH-1V8. Amplification of the MRP region suggests the prerequisite of developing resistance to vindesine, and further amplification of MDR-1 may play a critical role in acquiring drug-resistance. Several unknown genes related to the induction of chemoresistance might be concealed in other altered chromosomal regions.

Sexual Functioning in Cancer Patients

Controversy exists regarding the extent and nature of sexual problems in cancer patients. The incidence of sexual problems varies in published studies irrespective of the cancer site. Most of the studies are retrospective and descriptive in design and many do not take into account the preexisting physical, psychosocial, sexual, and marital problems. However, it is clear that sexual problems are common in cancer patients and may be caused by all the available treatment options. Management of sexual problems in this patient population has not been systematically studied. This article reviews prevalence of sexual problems that result from various treatment modalities (such as surgery, radiotherapy, and chemotherapy) and describes guidelines for management of sexuality related issues in cancer survivors.

Assessment and treatment of psychosocial problems in cancer patients: an exploratory study of a course for nurses

A course in psychosocial oncology for nurses was developed and evaluated within the framework of a prospective randomised study. Six nurses participated. Areas covered were basic techniques for assessment of psychosocial problems, for relieving anxiety and depression, solving problems in conjunction with treatment and disease, and improving communication. Participants met for four 3 h weekly lessons. Between meetings, they met to train assessment and techniques. Follow-up discussions were held at termination and 5 months later. Participants reported that the new knowledge and skills had made them feel more confident when handling patients’ psychosocial situation. However, treatment of psychological problems did not prove to be a predominant aspect of their patient work. The evaluation of the course suggests that participants improved their skills for assessment of patient problems and, therefore, felt more confident when handling psychosocial issues.

Detecting social problems in cancer patients.

Diagnosis of and treatment for cancer may not only create physical and emotional difficulties for patients but may also have an impact on social aspects of patients' lives. Screening for social problems has not become part of routine oncology practice. This may be due to lack of a suitable questionnaire. This paper presents a psychometric analysis of the Problems Checklist with a view to assessing its usefulness as a screening tool for social problems in oncology. Evaluation was undertaken using data from an earlier study of 505 patients who completed the checklist. Frequency of endorsement, missing values, factor analysis and reliability and validity analysis of the summated scales were carried out. Missing data rates ranged from 4 to 18% over the 16 items. Fourteen items were well endorsed. Factor analysis produced a four-factor structure with components labelled daily living, relationships, economics and emotions. Reliability and validity tests endorsed the factor structure with the components on economics and emotions being particularly credible. Difficulties with relationships are harder to measure and results from the analysis suggest that this is an area that warrants further investigation. The checklist is a useful tool for highlighting problems. As a tool for screening for social problems it has some limitations.

Detecting social problems in cancer patients

Diagnosis of and treatment for cancer may not only create physical and emotional difficulties for patients but may also have an impact on social aspects of patients' lives. Screening for social problems has not become part of routine oncology practice. This may be due to lack of a suitable questionnaire. This paper presents a psychometric analysis of the Problems Checklist with a view to assessing its usefulness as a screening tool for social problems in oncology. Evaluation was undertaken using data from an earlier study of 505 patients who completed the checklist. Frequency of endorsement, missing values, factor analysis and reliability and validity analysis of the summated scales were carried out. Missing data rates ranged from 4 to 18% over the 16 items. Fourteen items were well endorsed. Factor analysis produced a four-factor structure with components labelled daily living, relationships, economics and emotions. Reliability and validity tests endorsed the factor structure with the components on economics and emotions being particularly credible. Difficulties with relationships are harder to measure and results from the analysis suggest that this is an area that warrants further investigation. The checklist is a useful tool for highlighting problems. As a tool for screening for social problems it has some limitations. Copyright © 2001 John Wiley & Sons, Ltd.

Body image and sexual problems in cancer patients

Body image and sexual problems in cancer patients

Influence of the Ward Colon Tumor on the Innate and Endotoxin-Induced Inflammatory Response of the Rat

Cachexia, a depressed immune function, and an increased infection rate are recurring problems for cancer patients; the response of the host to an infection may also be increased. We have reported that the transplantable Ward colon tumor (WCT) enhanced the lethality of endotoxin (lipopolysaccharide [LPS]) to the host. The mechanism of this increased LPS lethality and the effect of the presence of the WCT on the host inflammatory response, however, have not been reported. The effect of a transplantable WCT on the innate and endotoxin-induced inflammatory response of rats was, therefore, investigated. The innate inflammatory response was investigated in two ways. First, the formation of a granuloma around a sterile string implanted subcutaneously for 6 days was determined. Second, the effect of tumor presence on the trafficking of leukocytes to a sponge implanted subcutaneously for 2 or 6 days was determined. The tumor decreased the foreign body granuloma formation around a sterile string. The presence of the WCT also significantly blunted the increase of lymphocytes that migrated to the sponge area at 6 days. There was no significant effect of the WCT, however, on the migration of neutrophils, monocytes, or eosinophils to the implanted sponge. The leukocyte distribution of the peripheral blood was not affected by the presence of the WCT or implantation of a sterile string or sponge. To determine the effect of the presence of the WCT on the response of the host to an infection, rats were given LPS (5 mg/kg, i.p.) and the alanine amino transferase (ALT) of plasma and inducible isoforms of nitric oxide synthase (NOS2) protein content of liver, spleen, and terminal ileum was determined. The LPS challenge resulted in an increase in plasma ALT concentrations and NOS2 protein content of liver and spleen, but not the terminal ileum of WCT rats. This elevation in WCT rats confirms that the enhanced LPS-related toxicity in WCT rats was related to an increased liver toxicity. The increased toxicity may be related to an increase in the nitric oxide synthesis of the liver. These results suggest that the WCT, and possibly other tumors, will reduce the ability of the host to respond to a foreign body. If this were an infection, the host would be more likely to succumb to the resulting inflammatory mediators. Further evaluations of the lymphocyte subsets and cytokines in the sponge exudate will be required to completely understand this response.

The Relationship of Anorexia, Nausea, Vomiting, Oral Intake and Nutritional Status in Patients Receiving Chemotherapy

Malnutrition is a common problem in cancer patients. In addition anticancer drugs used in chemotherapy as a major therapeutic mode are famous as the side effect like nausea, vomiting, which lead the patients to malnourished state. This study was to determine the relationship of anorexia, nausea, vom...

Management of cancer pain

PREVIEWPain is one of the most common problems for cancer patients, and its management is often hindered by barriers created by patients and physicians alike. By avoiding potential barriers and understanding the principles of pain management and drug selection and titration provided here by Dr Hartmann and colleagues, physicians can safely administer adequate pain relief to their patients in need.

Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy

BACKGROUND Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy. The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients. METHODS A group of cancer patients receiving high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group; n = 27) followed an exercise program during hospitalization. The program was comprised of biking on an ergometer in the supine position following an interval training pattern for 30 minutes daily. Patients in the control group (n = 32) did not train. Psychologic distress was assessed at hospital admission and discharge with the Profile of Mood States and Symptom Check List 90. RESULTS By the time of hospital discharge, fatigue and somatic complaints had increased significantly in the control group (P for both < 0.01) but not in the training group. Furthermore, by the time of hospital discharge, the training group had a significant improvement in several scores of psychologic distress (obsessive-compulsive traits, fear, interpersonal sensitivity, and phobic anxiety) (P value for all scores < 0.05); this outcome was not observed in the control group. CONCLUSIONS The current study found that aerobic exercise can reduce fatigue and improve psychologic distress in cancer patients undergoing chemotherapy. Cancer 1999;85:2273–7. © 1999 American Cancer Society.

Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy

Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy. The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients. A group of cancer patients receiving high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group; n = 27) followed an exercise program during hospitalization. The program was comprised of biking on an ergometer in the supine position following an interval training pattern for 30 minutes daily. Patients in the control group (n = 32) did not train. Psychologic distress was assessed at hospital admission and discharge with the Profile of Mood States and Symptom Check List 90. By the time of hospital discharge, fatigue and somatic complaints had increased significantly in the control group (P for both < 0.01) but not in the training group. Furthermore, by the time of hospital discharge, the training group had a significant improvement in several scores of psychologic distress (obsessive-compulsive traits, fear, interpersonal sensitivity, and phobic anxiety) (P value for all scores < 0.05); this outcome was not observed in the control group. The current study found that aerobic exercise can reduce fatigue and improve psychologic distress in cancer patients undergoing chemotherapy.

Subjective Global Assessment Compared to Prognostic Nutritional Index in Cancer Patients

Malnutrition is a common problem in cancer patients and, if untreated, can lead to cancer cachexia and poor response to therapies. Subjective Global Assessment (SGA) has been shown to be valid and comparable with objective measures such as the Prognostic Nutritional Index (PNI) in general surgery patients. The purpose of this study was to determine the reproducibility of SGA ratings of gynecologic oncology patients between two raters, and to determine whether SGA was comparable to PNI as a tool for nutritional assessment of cancer patients. Sixty-seven consecutive patients admitted to the hospital gynecologic oncology service were assessed by a dietitian using PNI. Fifty-six of these patients were assessed using SGA by a second dietitian and a pharmacist who were blinded to medical records and the PNI results. Both PNI and SGA scores were categorized into severely and moderately malnourished or well-nourished. Reproducibility of SGA raters and the consistency between SGA versus PNI were assessed with a weighted Kappa statistic. There was a high level of agreement (83.9%) between the two SGA raters (weighted Kappa=0.797; 95% confidence intervals 0.67-0.92). In comparing SGA and PNI, there was less agreement (57%) (weighted Kappa=0.0435; 95% confidence intervals 0.28-0.59). There was moderate agreement between SGA and the individual variables of PNI: SGA vs. albumin (r=0.493), SGA vs. transferrin (r=0.353) and SGA vs. triceps skinfold (r=0.427). In summary, there was a high level of agreement between independent SGA raters, moderate agreement between SGA and PNI methods, and moderate agreement of SGA with individual PNI variables. For this heterogenous population, a combination of nutritional assessment methods may be preferred.

Nutritional support of the cancer patient.

Malnutrition, a common problem in cancer patients, adversely affects survival and quality of life. It results from several factors that alter nutritional intake and cause massive metabolic disturbances. Anticancer therapies may compound the malnutrition. Optimal nutrition improves therapeutic modalities and the clinical course and outcome. Oral nutrition should be used whenever possible; in patients unable to ingest adequate amounts orally, enteral and parenteral feedings are safe and effective.

Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation.

BACKGROUND Fatigue and loss of physical performance are frequent problems of cancer patients. In a pilot study, the authors evaluated the feasibility and effects of aerobic training in the rehabilitation of cancer patients after completing high dose chemotherapy. METHODS Sixteen patients participated in a specially designed rehabilitation program for 6 weeks. The patients entered the program, which consisted of walking on a treadmill, shortly after completing treatment. Sixteen patients who did not train served as controls. Physical performance (maximum speed on the treadmill test), cardiac function, and hemoglobin concentration were compared at the time of discharge from the hospital and 7 weeks later. At the second examination, fatigue and limitations in daily activities due to impaired endurance were assessed during personal interviews. RESULTS At the time of discharge from the hospital, maximum physical performance (training group: 6.2 ± 1.1 km/hour; controls: 6.2 ± 1.3 km/hour) and hemoglobin concentration (training group: 10.1 ± 1.4 g/dL; controls: 10.1 ± 1.2 g/dL) were similar for both groups. After 7 weeks, improvement in maximum physical performance (training group: 8.3 ± 1.6 km/hour; controls 7.5 ± 1.3 km/hour) and hemoglobin concentration (training group: 13 ± 1 g/dL controls: 12 ± 1.4 g/dL) were significantly higher for the training group (P < 0.05). By the second examination, no patient in the training group but 4 controls (25%) reported fatigue and limitations in daily activities due to low physical performance. CONCLUSIONS Aerobic exercise improves the physical performance of cancer patients recovering from high dose chemotherapy. To reduce fatigue, this group of patients should be counseled to increase physical activity rather than rest after treatment. Cancer 1997; 79:1717-22. © 1997 American Cancer Society.

Malignant Pleural Effusions: Recent Advances and Ambulatory Sclerotherapy

Malignant pleural effusions are a common problem in cancer patients with advanced disease. Patients typically present with progressive dyspnea, cough, and/or chest pain that significantly compromises their quality of life. Treatment is often palliative, usually consisting of sequential thoracenteses or tube thoracostomy with or without sclerotherapy. The traditional method of treatment--tube thoracostomy with large-bore chest tubes connected to continuous wall suction--requires hospitalization, is expensive, limits patient mobility, and can cause significant patient discomfort. More recent trials have explored new techniques, including thoracoscopic insufflation of talc and small-bore catheters. Most of these studies have been performed on inpatients, although a recent multi-institutional trial was initiated to evaluate the feasibility and efficacy of ambulatory (outpatient) pleural drainage and sclerotherapy using small-bore catheters. All patients fulfilling eligibility criteria had a small-bore catheter placed in the pleural space that was then connected to a closed gravity drainage bag system. When daily tube drainage was <100 mL, sclerotherapy was performed. Response rates at our institution demonstrated 10 patients (53%) had a complete response, 5 (26%) had a partial response, and 4 (21%) had progressive disease at 30-day follow-up. These preliminary results suggest ambulatory sclerotherapy is a safe, viable alternative to conventional inpatient treatment of malignant pleural effusions in a select group of patients.

Effect of megestrol acetate and prepulsid on nutritional improvement in patients with head and neck cancers undergoing radiotherapy

Background and purpose: Anorexia is a common problem in cancer patients who receive radiotherapy. In this current study, we attempt to determine the effect of megestrol acetate and prepulsid on appetite and nutritional improvement in patients with head and neck cancers undergoing radiotherapy. Materials and Methods: One hundred twenty-nine consecutive patients with head and neck cancers treated between July 1993 and June 1994 were prospectively randomized to receive either megestrol acetate, 40 mg qid (megace group), prepulsid, 5 mg tid (cisapride group), or a placebo treatment (control group) during radiotherapy. Before radiotherapy, body weight (kg), appetite score, performance status, biochemical parameters and hematological parameters were evaluated, and the above-noted clinical and biochemical parameters were assessed and recorded every other week. All patients received 6–10 MV X-rays or Co-60 γ-ray to head and neck region for a full course of radiotherapy, 61.2–75.6 Gy/7–9 weeks. Results: Forty-eight patients were enrolled in the megace group, 41 patients in the cisapride group, and 40 patients in the control group. At the 2nd, 4th, 6th and 8th week, as the radiation dose escalated, the megace group had significantly less body weight loss than did the cisapride and control groups ( P = 0.045, 0.024, 0.006, 0.003, respectively). The appetite scores of the megace group were significantly higher than those of the cisapride and control groups ( P = 0.0001). However, there were no statistically significant differences in the change of albumin level among these three groups at the 2nd, 4th, 6th and 8th week ( P > 0.05, respectively). Conclusions: Megestrol acetate can significantly decrease the degree of body weight loss, and can prevent the deterioration of appetite in patients with head and neck cancers receiving radiotherapy. However, prepulsid lacks the above-mentioned clinical benefits.

Thrombocytopenia after high-dose chemotherapy and autologous stem cell transplantation: an unresolved problem and possible approaches to resolve it.

Prolonged thrombocytopenia is a frequent clinical problem in cancer patients undergoing high-dose chemotherapy and autologous transplantation. The use of GM-CSF as an adjuvant to autologous bone marrow transplantation (ABMT) has significantly reduced the duration of neutropenia after high-dose chemotherapy but failed to accelerate platelet recovery in transplanted patients. The more rapid hematopoietic reconstitution obtained by autologous mobilized peripheral blood progenitor cell transplantation (PBPCT) after high-dose chemotherapy has resulted in its increasing use instead of ABMT. However, PBPCT does not always produce faster platelet engraftment after high-dose chemotherapy, and persistent thrombocytopenia remains a significant clinical problem in PBPC-transplanted patients. The duration of severe thrombocytopenia (requiring frequent platelet transfusions) until platelet recovery varies widely depending on the quality of the autograft and previous radiotherapy or chemotherapy. The median days to reach 20,000/microliters platelets ranged from 10 to 32 days. Pilot clinical studies in which cancer patients were transplanted with enriched CD34+ cell autografts, obtained from G-CSF-mobilized PB, showed a similar platelet recovery after high-dose chemotherapy but also wide variation among the patients. The median days to reach 20,000/microliters platelets ranged from 9 to 38 days. The dose of CFU-GM in the autograft has been identified as the best predictive factor for hematopoietic recovery (p < 0.0001) after high-dose chemotherapy and autologous PBPCT in 118 patients with hematologic malignancies. A similar assessment of the megakaryocyte progenitor cells (BFU-MK and CFU-MK) in the autograft not only could predict time to platelet recovery but also could help to optimize the number and method of mobilization of the PBPC required to shorten the problematic obligatory 2-week duration of thrombocytopenia after high-dose chemotherapy. A routine assessment of the number of BFU-MK and CFU-MK present in each autograft and correlation with platelet recovery after transplantation would enable us to define the clinical threshold cell dose required for rapid platelet recovery. Recently, several non-specific cytokines with thrombopoietic activity have been evaluated in phase I clinical trials, including interleukin-1, interleukin-3 followed by GM-CSF, interleukin-6, and interleukin-11 in cancer patients, showing an encouraging trend toward a decrease in thrombocytopenia after chemotherapy. The recently cloned specific platelet cytokine, thrombopoietin, is currently undergoing phase I clinical studies, and the results are awaited with interest.

Thrombin treatment of endothelial cells stimulates adhesion of oncogene transformed but not parent rat liver epithelial cells

Increased blood coagulation is a well known clinical problem in cancer patients with metastasis (1). Therefore, a number of studies have been undertaken to define the role of thrombin in tumor-endothelial cell adhesion, a crucial step in the development of organ-specific metastasis (2). Tumor cells, either preincubated or coinjected with thrombin, have increased metastatic capability, and in vitro studies have demonstrated that thrombin treatment of tumor cells and platelets leads to more avid adhesion to endothelial cells and subendothelial matrix molecules (3–6). The thrombin-mediated effect has been associated with stimulation of integrin receptors, known to mediate platelet-tumor cell and tumor-endothelial cell adhesion (5). Thrombin-mediated tumor cell adhesion was also shown to involve the protein kinase C signal transduction pathway (5). In the present study, the following questions were asked: 1) Does treatment of endothelial cells with thrombin lead to a transient increase in tumor cell adhesion, similar to that described for thrombin treated tumor cells; 2) Do oncogenically transformed cells differ from the noneoplastic parent cells in their adhesive capacity to thrombin activated endothelium; 3) Are known mediators of neutrophil-endothelial cell adhesion, such as the granule membrane protein-140 (GMP-140) and the platelet activating factor (PAF), also involved in tumor cell adhesion to thrombin stimulated endothelium. In this report, we demonstrate a rapid and transient increase in the adhesiveness of two oncogenically transformed rat liver epithelial (RLE) cell lines (7), but not of the nonneoplastic parent cells, to thrombin treated endothelium. The mechanism responsible for this rapid tumor cell adhesion to thrombin treated endothelium is still unknown.