Problem In Cancer Patients Research Articles

Mental health literacy, treatment preferences and the lived experience of mental health problems in an Australian cancer sample

The prevalence rates for mental health (MH) problems in cancer patients is high, although reduced uptake of services may be influenced by mental health literacy (MHL). The objective of this study was to investigate the MHL for depression and panic disorder (PD), including treatment preferences in Australian adults who had been diagnosed and treated for cancer, and whether MHL and treatment preferences was influenced by sex, age, and individuals' lived MH experience. A total of 421 cancer survivors (n = 378 females) completed a self-report survey. Participants were asked to specify whether they had a lived experience with anxiety and/or depression, and to indicate treatment preferences for managing cancer-related distress. Two vignettes were administered to assess MHL for depression and PD. The MHL accuracy for depression was higher than PD. Accuracy rates were higher for females with a lived experience with anxiety and/or depression; although the accuracy rate for PD was significantly lower in males. A high proportion of individuals preferred exercise and in-person counselling to manage depression and PD. Internet-based therapies were not strongly preferred for managing MH problems. The MHL for depression and PD is moderate for adult cancer survivors, with higher levels indicated for individuals with a personal lived experience with anxiety and/or depression. Public health campaigns for enhancing MHL should broaden to include individuals experiencing comorbid physical health conditions. Health providers also need to take into account client preferences for evidence-based therapies.

1816MO ICES (International Carboplatin Emesis Survey) for the evaluation of the emetogenicity of carboplatin-based chemotherapy – with a focus on nausea. MASCC Antiemetic Study Group survey

Chemotherapy induced nausea and vomiting (CINV) following carboplatin containing chemotherapy regimen remains a considerable problem for cancer patients (pts) despite standard antiemetic prophylaxis. This MASCC study was undertaken to prospectively evaluate the incidence of CINV in pts undergoing carboplatin-based chemotherapy receiving guidelines consistent CINV prophylaxis (GCCP). All sites did not prescribe NK1-RA as it is not included in all institutional guidelines. The study enrolled 207 pts undergoing carboplatin-based chemotherapy, the current analysis evaluated cycle 1 of the first 155 pts. Pt diaries were used to collect data from day 1-10 beginning with cycle 1. Nausea was reported by the pts using a visual analog scale (VAS) with the end-point being no nausea. Vomiting episodes were recorded in the pts’ diaries. There were 103 females and 52 males, with a mean age of 64 (30-85). The overall incidence of acute and delayed nausea for was 17% and 25% respectively. The incidence of nausea of entire population was significantly higher than vomiting (58% vs. 14%; Chi2 22.271 p<0.000). The use of NK1-RA was associated with a significant decrease in time to first vomiting for cycle 1 (p<0.041) and subsequent cycle 2-6 (p<0.0075). Time to first nausea was not significant for cycle 1 or subsequent cycles. In a logistic regression model factors associated with acute nausea in cycle 1 included history of motion sickness (p< 0.0090), comorbidities (p< 0.0084), history of morning sickness (p< 0.0090), previous chemotherapy (p< 0.0096), anemia (p< 0.0209). A separate logistic regression analysis for delayed nausea in cycle 1 showed that prior radiotherapy (p<0.0093) and a history of morning sickness (p<0.0195) were significant. Despite GCCP and the usage of NK1-RA, carboplatin induced nausea remains a major unmet medical need in cancer pts. Further research should focus on management of nausea, risk factors and the impact of nausea on quality of life and in pts undergoing carboplatin-based treatment.

953P Sarcopenia as predictive factor of response to nivolumab in recurrent-metastatic head and neck (RM-SCCHN) cancer patients

Sarcopenia is an emerging problem in cancer patients (pts), significantly higher in SCCHN pts. Aim of this study is to analyze the impact of sarcopenia on efficacy of Nivolumab in RM-SCCHN cancer pts after platinum failure. We retrospectively reviewed clinical and radiological data of 24 RM-SCCHN pts undergoing Nivolumab at Modena University Hospital from 2016 to 2019. Sarcopenia was assessed using abdominal computed tomography scan (CT) before Nivolumab starting and after 8-12 weeks of therapy. Skeletal Muscle Mass (SMI cm2/m2) at L3 levels, Subcutaneous Fat Index (SFI cm2/m2), Visceral Fat Index (VFI cm2/m2) were considered for the analysis; variables were correlated with survival (short vs long survivors, SS vs LS, considering mOS <6month vs ≥ 6mo) and disease control (responders, R, considered as OR + SD vs non-responders, nR). In a subgroup of pts, we described the variation of SMI between the first and the second CT and correlate it with survival and response. 20 pts were evaluable for analysis: 15 (75%) were male; median age: 61 y-o (52-77), most of them had oropharynx (7, 35%) or oral cavity cancers (5, 25%) as primary sites; 13 pts (65%) had a normal BMI before starting Nivolumab. Median OS was 3 mo (0-11): 13 pts (65%) were SS, 7 (35%) LS; R vs nR were 13 (65%) and 7 (35%), respectively. At univariate analysis, no correlation between baseline SMI, SFI, VFI and survival was observed. On the contrary, we found a correlation between mean baseline values of SMI, SFI, VFI and response, in particular for SMI 55,4 in R vs 42,82 in nR, p=0,0008; SFI 61,79 in R vs 38,59 in nR, p=0,0009; for VFI 65,33 in R vs 44,77 in nR, p=0,0431. If we consider 15 pts evaluable for both CTs, 11 pts (73%) had a reduction of SMI at the second CT: mOS was 4 mo (2-9), 7 pts (64%) were SS and 7 pts (64%) were nR. Oppositely, 4 pts (27%) had an increase of SMI: mOS was 10 mo (0-11), 3 pts (75%) were LS and 2 (50%) were R. Sarcopenia is a widespread, but underestimated problem of SCCHN; it may be simply assessed using CT, generally employed for disease evaluation. Detection of body composition and identification of sarcopenia may be a suitable tool to predict response to immunotherapy of SCCHN.

Epidemiology of mental health problems among patients with cancer during COVID-19 pandemic

The current study aimed to explore mental health problems in patients diagnosed with cancer during the COVID-19 pandemic. A cluster sampling, cross-sectional survey with 6213 cancer patients was conducted in one of the largest cancer centers in China. The socio-demographic and clinical characteristics, psychosomatic conditions, interpersonal relationships and social support, COVID-19 infection-related psychological stress, and mental health status were measured. Medical conditions were extracted from patients’ electronic healthcare records. Among the 6213 cancer patients, 23.4% had depression, 17.7% had anxiety, 9.3% had PTSD, and 13.5% had hostility. Hierarchical liner regression models showed that having a history of mental disorder, excessive alcohol consumption, having a higher frequency of worrying about cancer management due to COVID-19, having a higher frequency feeling of overwhelming psychological pressure from COVID-19, and having a higher level of fatigue and pain were the predominant risk factors for mental health problems in cancer patients. However, there were only 1.6% of them were seeking psychological counseling during COVID-19. We also revealed the protective factors associated with lower risk of mental health problems among cancer patients. The present study revealed a high prevalence of mental health problems and gaps in mental health services for cancer patients, which also indicated high distress from COVID-19-elevated risks. We call for systematic screening of mental health status for all cancer patients, and developing specific psychological interventions for this vulnerable population.

Self-reported memory problems in adult-onset cancer survivors in the United States with or without: Type 2 diabetes mellitus, hypertension and hyperlipidemia.

e24062 Background: Cancer and chronic diseases (CD) are independent predictors of cognitive dysfunction, especially memory problems that can impact patients’ psychosocial functioning and quality of life. We examined the prevalence of memory problems in cancer patients with or without CD, including Type 2 Diabetes mellitus (DM), hypertension (HTN) and hyperlipidemia (HLD). Methods: We examined data from people who completed the US National Health and Nutrition Examination Survey from 2009 to 2016 to determine the prevalence of memory problems in cancer survivors vs. non-cancer survivors with and without a history of CD. Participants answered the ‘yes’ or ‘no’ question: “Are you limited in any way because of difficulty remembering or because you experience periods of confusion?” History of Cancer, DM, HTN and HLD were self-reported. We used Rao-Scott Modified Chi-Square Test (X2test) for cross-classified categorical data from complex sample survey. Age, sex, race-ethnicity, education, poverty, and general health were controlled using logistic regression. Results: The sample included 21813 adults, ³ 20 years old, and ≈52% female. There were 40% Whites, 22% Blacks, 25% Mexican American/Other Hispanics, and 13% other race/multi-racial. About 46% graduated high School/had a GED (21.2%) or completed less than high school (24.4%). Of those with cancer ( N= 2025), memory problems were associated with DM (17.72%; X2test, p= 0.003) and (HTN, 13.42%; X2test, p= 0.007), but not HLD (11.66%; X2test, p= 0.786). Of those without cancer, memory problems were associated with DM, HTN and HLD (all p&lt; 0.0001). Prevalence of CD was much greater in cancer survivors with memory problems ( p&lt; .05). Conclusions: Strategies to mitigate memory problems in cancer survivors should consider the implications of DM, HTN and HLD, particularly given the prevalence of these chronic morbidities in cancer populations.

Prevalence of Asymptomatic Bacteriuria and Antibiotic Susceptibility Patterns of Bacterial Isolates among Cancer Patients and Healthy Blood Donors at the University of Gondar Specialized Hospital.

Background Urinary tract infections are the common types of infections in the community and health care settings. Despite the widespread availability of antibiotics, urinary tract infection remains a worldwide therapeutic problem. It is a continuous and significant problem in cancer patients. Methods A hospital-based comparative cross-sectional study was conducted on 240 study participants from January to June 2019. Sociodemographic data were collected by a predesigned questionnaire and midstream urine samples collected using simple random sampling technique by using clean, sterile plastic cups and then inoculated onto CLED agar plates and incubated at 37°C for 24 hours. Urine culture was considered significant bacteriuria when colony forming units ≥105/mL of voided urine and a single pure colony suspended in nutrient broth and then subcultured onto a blood agar plate and MacConkey agar plate, incubated at 37°C for 24 hours for identification. Identification was done by using standard microbiological methods. Modified Kirby–Bauer disk diffusion technique was applied for antimicrobial susceptibility testing in accordance with CLSI 2018 criteria. Data were entered, cleared, and checked using Epi Info version 7 and exported to SPSS version 20 for analysis. The results were displayed using tables and figures. p value <0.05 at 95% CI was considered as statistically significant. Results The overall prevalence of asymptomatic bacteriuria in cancer patients was 23.3% while 6.7% in apparently healthy blood donors. E. coli (32.1%) was the commonest isolated uropathogenic bacteria followed by Klebsiella species (25.0%), S. aureus (21.4%), Enterococcus species (10.7%), Serratia species (7.1%), and Enterobacter aerogenes (3.6%) in cancer patients. In apparently healthy blood donors, E. coli, Klebsiella species, and S. aureus were isolated from 75%, 12.5%, and 12.5%, respectively. Most Gram-negative bacteria were more sensitive to ceftazidime, cefoxitin, nalidixic acid, nitrofurantoin, norfloxacin, ciprofloxacin, and tobramycin, whereas highly resistant to ampicillin, penicillin, tetracycline, and ceftazidime. S. aureus isolates were 100% susceptible to nitrofurantoin. Conclusions This study showed a high prevalence of asymptomatic bacteriuria among cancer patients (23.3%) compared to apparently healthy blood donors (6.7%). E. coli was isolated predominately. Nitrofurantoin and ciprofloxacin should be used to treat asymptomatic bacteriuria in the study area.

Sleep problems in cancer patients: a comparison between the Jenkins Sleep Scale and the single-item sleep scale of the EORTC QLQ-C30

BackgroundSleep problems are frequent in cancer patients. Multiple questionnaires and one-item scales have been developed for measuring sleep quality. The aim of this study was to test the Jenkins Sleep Scale (JSS) in comparison with the one-item sleep scale of the quality of life questionnaire (EORTC QLQ-C30), and to examine the relationship between sleep quality and age, gender, clinical variables, and several domains of quality of life. MethodsA sample of 1216 cancer patients who were treated in an oncological rehabilitation clinic were examined with the JSS, the EORTC QLQ-C30, and several other questionnaires (t1). Participants’ sleep quality was then assessed a second time six months later (t2). ResultsThe cancer patients reported severe sleep problems, with t1 mean scores of 11.6 (JSS) and 51 (EORTC QLQ-C30 Sleep item). The reliability of the JSS was good (Cronbach's alpha = 0.84). Sleep problems were associated with gender (more problems in females), with several cancer treatment methods, and with all domains of quality of life. The JSS performed only marginally better than the EORTC QLQ-C30 Sleep item in detecting sleep problems. ConclusionsBecause of the high prevalence and the strong associations with all quality of life dimensions, sleep problems should be taken into account in cancer care. The one-item sleep instrument of the EORTC QLQ-C30 is sufficient for investigations conducted on a group level.

THE RELATIONSHIP BETWEEN THE STAGE OF NASOPHARYNGEAL CARCINOMA WITH ANEMIA AND NUTRITIONAL STATUS IN WEST NUSA TENGGARA GENERAL HOSPITAL

Introduction:&#x0D; Nasopharyngeal carcinoma is the most common malignant tumor in the ENT-HNS were the highest of all malignant tumors of the head and neck. Malnutrition and cachexia is a common problem in cancer patients and impact on quality of life and survival. Anemia is a major problem in patients with nasopharyngeal cancer receiving chemotherapy or radiotherapy.&#x0D; Objective:&#x0D; Determine the relationship of nasopharyngeal carcinoma stage with anemia and nutritional status.&#x0D; Material and methods:&#x0D; This study used cross sectional analytic method. Data were obtained from medical records of patients with nasopharyngeal carcinoma who were treated in province hospital West Nusa Tenggara period January 2018 to December 2018. Data collected include the identity, diagnosis, hemoglobin value, weight and height. Having analyzed the data collected are looking for is there a relationship between stage nasopharyngeal carcinoma with anemia and nutritional status.&#x0D; Results:&#x0D; In this study, Shapiro-Wilk normality test. Anova is then performed to analyze the relationship stage nasopharyngeal carcinoma with anemia status obtained 95% CI, p value 0.847, there is no difference between stage nasopharyngeal carcinoma with anemia. Kruskal Wallis test to analyze the relationship with BMI (body mass index) with stage nasopharyngeal carcinoma obtained 95% CI, p value 0.565. There is no difference in BMI with stage nasopharyngeal carcinoma.&#x0D; Conclusion:&#x0D; There is a tendency to lower Hb in patients with nasopharyngeal cancer further stage although there is no significant difference between each stage. The same thing was found in BMI, BMI decreased tendency in patients with advanced nasopharyngeal cancer although there was no statistically significant difference.

Malnutrition in Older Patients With Hematological Malignancies at Initial Diagnosis - Association With Impairments in Health Status, Systemic Inflammation and Adverse Outcome.

Poor nutritional status is a common problem in cancer patients at advanced age, but the prevalence and impact of malnutrition in hematological malignancies remains underinvestigated. To evaluate nutritional status in older adults over age 70 with newly diagnosed hematological malignancies, we enrolled 147 patients and assessed weight loss, food intake, Mini Nutritional Assessment (MNA), and BMI. We compared nutritional status with demographic data, inflammation markers, and restrictions in multidimensional geriatric assessment. MNA classified 43% of patients being at risk of, and 15% having manifest malnutrition. A moderate/severe decrease in food intake was reported by 24% or 16%, a recent weight loss of 1 to 3 kg or >3 kg by 19% or 31%, and a BMI <23 kg/m2 by 29%. Lowered serum albumin (<3.5 g/dL) was prevalent in 14% of patients, and in 38% Glasgow Prognostic Score indicated hyperinflammation. Principal component analysis clustered malnutrition with inflammation markers and pronounced impairments, that is, fatigue, depression, comorbidities, reduced functional capacities. Severe decrease in food intake (HR: 3.3 (1.9-5.8), p < 0.001), >3 kg weight loss (HR: 2.3 (1.4-3.9), p = 0.001), impaired MNA (HR: 2.8 (1.3-6.2), p = 0.010), and low serum albumin (HR: 2.1 (1.1-4.0), p = 0.030) were significantly associated with shortened overall survival. Recent weight loss >3 kg (HR: 2.2 (1.1-4.3), p = 0.022), and low BMI (HR: 3.3 (1.8-6.0), p < 0.001) remained independent adverse parameters in multivariate Cox proportional hazard regression analyses. Malnourishment at initial diagnosis is frequent in older patients with hematological malignancies and represents an adverse prognosticator. Clustering of malnutrition with impairments and systemic inflammation suggests an underlying common pathway.

Role of Cresp® in the management of chemotherapy-induced anemia in cancer patients: A real-world clinical practice audit.

Introduction:Anemia is a common, underestimated problem in cancer patients receiving myelosuppressive chemotherapy and has significant adverse effect on the quality of life and outcome. Darbepoetin has been shown to be effective in this setting, but controversy surrounds it actual use.Methods:We analyzed prospectively collected clinical practice data of patients receiving darbepoetin in a real-world setting for this retrospective audit. Patients with baseline hemoglobin (Hb) of <11 g/dl were included in this analysis. Their medical records were audited using a predetermined 35-point pro forma.Results:There were a total of 274 patients with advanced cancer receiving myelosuppressive chemotherapy who had baseline Hb <11 g/dl and who were given darbepoetin. Head-and-neck squamous cell carcinoma, lung cancer, and breast cancer were the most common cancers. Their median baseline Hb was 8.9 g/dl which rose to 11.2 g/dl at the end of commenced therapy, along with improved symptomatology. There were no new toxicities, and only two patients required discontinuation of darbepoetin due to toxicity.Conclusion:Darbepoetin is safe and effective in the prevention and management of anemia among patients receiving myelosuppressive chemotherapy.

Identificación de un conjunto de categorías CIF representativas del funcionamiento al egreso hospitalario de personas adultas tratadas por cáncer: consenso nacional de expertos

IntroductionThe International Classification of Functioning, Disability and Health (ICF) provides a standardised language and conceptual framework for health and health-related conditions, aiming to unify communication between different disciplines. ObjectiveTo describe the process of selecting (through national expert consensus) ICF categories representative of functioning problems in cancer patients at hospital discharge. MethodWe conducted a descriptive qualitative and quantitative study that used the expert consensus method to design a clinical instrument. The study included 21 experts, consisting of 2 patients and 19 health professionals from different disciplines. A total of 208 ICF categories obtained in a previous stage through a systematic review and linking process were evaluated in 3 rounds. Participants evaluated each code and classified it as: highly relevant, relevant, slightly relevant, and not relevant at all. Only those codes assessed as «highly relevant» by more than 50% of the experts were included (cut off). In addition, another 143 ICF categories were evaluated in the second round. ResultsIn all, 24 ICF categories were obtained: 10 corresponded to the body function component, 11 to activities and participation, and 3 to environmental factors. ConclusionsConsensus using the common language of the ICF resulted in the selection of 24 representative categories of the main health problems related to functioning at hospital discharge in adults treated for cancer.

Mystery Behind the Outcome of Febrile Neutropenia in Indigent Cancer Patients: A “U-Turn” in Mortality through a State-Sponsored Scheme in India

Background: Febrile neutropenia is among the most common symptoms of oncology patients presenting to the emergency department (ED). Timely antibiotic therapy is key to successful management. Little is known, however, about the extent of this problem in cancer patients in developing countries, especially those who live below the poverty line. We utilized a statewide database, Dr. NTR Vaidyaseva Trust, to report on the status of care for febrile neutropenia in the State of Andhra Pradesh, India.

Meta-analysis: Exercise intervention for sleep problems in cancer patients.

Sleep problems cause physical and mental distress and may influence the survival of cancer patients. This study aimed to explore the efficacy of exercise intervention to improve sleep in cancer patients. Published papers from 1980 to 2018 were searched. The major findings included (a) exercise intervention had small positive effects on enhancing total subjective sleep quality (TSSQ; g=0.38, 95% CI=0.21-0.54) and objective sleep onset latency (g=0.21, 95% CI=0.01-0.41). (b) The characteristics in subgroups in regarding the small to large effects of an exercise programme on sleep were identified. First, the groups of a home-based exercise and a supervised exercise combined with a home-based exercise had a medium effect on TSSQ than the usual group. Second, interventions with aerobic exercise, especially the 4- to 8-week programmes and those with weekly volume of 80-149min per week for cancer patients with ongoing or completed treatment also had a medium to large positive effect on TSSQ. Finally, patients with breast cancer and haematologic malignancies contributed a small effect in this meta-analysis. Maintaining regular aerobic exercises, even of different durations and weekly volumes, benefits patient sleep quality.

Extraction, phytochemical screening and quantitative determination of phenols and flavonoids in extract of Kalanchoe pinnata and Pongamia pinnata.

Medicinal plants have bioactive compounds which are used for curing of various human diseases and also play an important role in healing. Secondary constituents contain alkaloids, flavonoids, phenol, saponin, steroids and tannins. Medicinal plants have anticancer, antimicrobial, antidiabetic, antidiuretic and anti-inflammation activities. The increasing interest in powerful biological activity of secondary metabolites outlined the necessity of determining their contents in medicinal plants. Pongamia pinnata (L.) Pierre (P. pinnata, Fabaceae) popularly known as Karanj or Karanja in Hindi, and Indian beech in English, is a medium-sized glabrous tree. Traditionally, different parts of P. pinnata such as bark, leaves, seeds, roots, flowers and stem have been utilized in the native medicine systems of different civilizations. Kalonche pinnata (K. pinnata, Crassulaceae) known as Patharchata in hindi, is a succulent plant. It has many pharmacological uses like a suitable treatment in sleep problems in cancer patients. Also called as wonder of life K. pinnata is used to treat diabetic foot infections. The aim of the present study is to examine leaf of K. pinnata and seed of P. pinnata for phytochemical profile. Qualitative analysis of various phytochemical constituents and quantitative analysis of total phenolics and flavonoids were determined by the well-known test protocol available in the literature. Quantitative analysis of phenolic and flavonoids was carried out by Folins Ciocalteau reagent method and aluminium chloride method respectively. Phytochemical analysis revealed the presence of phenols, flavonoids, tannins, saponins, alkaloids, fixed oil and fats. The total phenolics content of hydroalcoholic extract of K. pinnata was (0.952 mg/100mg), followed by flavonoids (0.640mg/100mg) respectively. The total flavonoids content of hydroalcoholic extract of P. pinnata was (1.398mg/100mg). The present study concluded that the crude extract of K. pinnata and P. pinnata is a rich source of secondary phytoconstituents which impart significant antioxidant potential. The findings of the present study will be helpful to phytochemists, pharmacologists and pharmaceutical industries. Keywords: Pongamia pinnata, Kalonche pinnata, Phytochemical, Folins ciocalteau reagent

Flower-like curcumin-loaded folic acid-conjugated ZnO-MPA- βcyclodextrin nanostructures enhanced anticancer activity and cellular uptake of curcumin in breast cancer cells.

Non-spherical structures are beneficial to advance drug delivery effectiveness compared with common spherical ones, due to increased drug loading capability, improved bonding to a vascular wall, enhanced cellular uptake efficacy and prolonged circulation times. In this study, flower-like Zinc oxide-βcyclodextrin (βCD) nanostructures functionalized by 3-mercaptopropionic acid (MPA) as a non-spherical delivery system was successfully synthesized for aqueous delivery of curcumin (CUR) to enhance its targeting, bioavailability, and release profile. Terminal carboxyl functional groups were used for the conjugation of folic acid (FA) with the aim of active targeting to folate overexpressing breast cancer cells. The in vitro experimental study and mathematical modeling of CUR release revealed a sustained release with Fickian diffusion as the major release mechanism. MTT, colony formation and Annexin-V FITC/PI assays showed the superior anticancer effect of the system compared to free CUR against breast cancer cell line MDA-MB-231 by promoting the apoptotic respond with no cytotoxic effect on HEK293 normal cells. The efficacy of targeting strategy with FA moieties was demonstrated using the augmented cellular uptake of the FA-conjugated system on overexpressed folate receptor alpha (FRα) cells (MDA-MB-468 breast cancer cell line). Furthermore, loading of CUR to the delivery systems significantly lowered the MIC values (2.5 to 5-fold) against S. aureus and E. coli the infections of which are serious problems in cancer patients. According to the results of this study, the system can serve as a promising non-spherical delivery vehicle for enhancing bioavailability and targeting of hydrophobic anticancer agents in the future.

Identifying psychosocial distress in cancer patients in a community center.

e23193 Background: Psychosocial distress is common in cancer patients. It can cause decreased treatment adherence, lesser treatment satisfaction, low quality of life, and lower survival rate. Distress management is critical to improving cancer survivorship. National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) is widely used to assess psychosocial problems in cancer patients in five categories - practical, family, emotional, spiritual and physical problems. The aim of our study is to identify the distress pattern in cancer patients undergoing chemotherapy in our center using DT adapted from the NCCN. Methods: This is a retrospective study. Total 192 cancer patients undergoing chemotherapy were included, who were screened with DT at initial visit. Patients were asked to rate their level of distress from 0-10 on DT and select categories. We collected data on distress score, selected categories, age, gender, and primary cancer site. Distress score &lt; 4 were defined as low and = &gt; 4 as high. Our objective was to evaluate distress categories and if distress level (high vs low) is dependent on age ( &lt; 65 vs = &gt; 65), gender, and primary cancer site (top 7 cancer types in our clinic by volume). Statistical test used - Chi-square. Results: Median age - 66.5 years (range: 29-96); Gender: Male/Female - 44.3%/55.7%. Median distress score - 3. Low distress was reported by 55.2% and high distress by 44.8%. Cancer types: Breast (29.7%); Lung (17.7%); Prostate (10.9%); Hematological malignancies (7.3%); Lymphoma (6.7%); Urothelial (6.7%); Head and Neck (6.2%); Others (13.4%). Overall, physical problems were the most common (63.5%) followed by emotional (56.3%), practical and family (32.3%), and spiritual (2.1%). Among patients with high distress, 84.9% reported emotional problems, while 83.7% reported physical problems. Distress level was not dependent on age, gender and primary cancer site. Conclusions: Emotional and physical problems are the most common problems among our study population with high distress level which requires further interventions/referrals. Identifying psychosocial needs of cancer patients with DT can help optimize their care.

Dietary Turmeric Bisdemethoxycurcumin Suppresses Wilms’ Tumor 1 and CD34 Protein Expressions in KG-1a Leukemic Stem Cells

Leukemic cells remaining in the body is the main problem for cancer patients, and these cells are called Leukemic Stem Cells (LSCs). Many studies have revealed that the overexpression of the Wilms’ tumor 1 (WT1) protein is related to leukemogenesis. Curcuminoids (curcumin, demethoxycurcumin, and bisdemethoxycurcumin) from Thai turmeric (Curcuma longa Linn.) are the focus of this study because they have been previously been reported to show potent antileukemic activity. This study aims to investigate the cytotoxic effect of in-house curcuminoids on the human leukemic stem cell line (KG-1a) when compared to other leukemic cell lines (KG-1 and K562). MTT assays were used to determine the cytotoxicity of curcuminoids at various concentrations. Curcumin exhibited the strongest cytotoxic activity on KG-1a cells with IC50 values of 13.6 ± 1.9 µM. To determine the effect of curcuminoids on WT1 and CD34 protein expressions by Western blotting, KG-1a cells were treated with noncytotoxic concentrations (IC20 value). Bisdemethoxycurcumin showed the strongest suppression of WT1 and CD34 protein expressions with 73.3 ± 1.4 and 82.9 ± 2.0%, respectively. In summary, curcuminoids, especially bisdemethoxycurcumin, could inhibit WT1 and CD34 protein expressions. Thus, bisdemethoxycurcumin is a compound that calls for further studies of its process in the inhibition of WT1 and CD34 expressions in LSCs for the leukemia treatment.

A lung cancer patient with deep vein thrombosis:a case report and literature review

BackgroundVenous thromboembolism (VTE) is a common problem in cancer patients and the incidence is increasing, especially for patients with lung cancer. Common features of these patients, like advanced stage, male gender, old age and chemotherapy, are risk factors of VTE. Here we reported a case in which the patient with lung cancer developed deep vein thrombosis (DVT) when receiving chemotherapy.Case presentationA 53-year-old male who was diagnosed with lung cancer with multiple metastasis developed severe DVT during chemotherapy. Despite the use of aspirin, warfarin and low molecular weight heparin (LMWH) for anticoagulant and thrombolytic therapy, the condition was still deteriorating, resulting in amputation finally.ConclusionsIt’s rare that the conditions of cancer patients who develop venous thromboembolism (VTE) keep deteriorating despite the administration of aspirin, warfarin and low weight molecular heparin. Both early diagnosis and prophylactic use of anticoagulants are suggested for cancer patients to improve the prognosis.

Intérêt des variants génétiques dans la prédiction du risque de thrombose associée au cancer

Venous thromboembolism (VTE) is a major public health problem in cancer patients and there is a clear need to precisely define the risk of VTE and to administer thromboprophylaxis specifically to the group of high-risk patients who have a favourable risk-benefit ratio. Current risk assessment models (RAM) for identifying high-risk cancer patients, who could benefit from primary thromboprophylaxis, are based solely on clinical and laboratory parameters. Khorana score (KS) is the best validated RAM and recommended by the main clinical guidelines. All current RAM, including KS, have low positive predictive value and limited clinical applicability. Our group was the first to determine that VTE, a multifactorial and complex disease, has a large genetic component with 60% heritability. We showed that the combination of genetic and clinical factors of thrombotic risk improves the predictive capacity of RAM of VTE in the general population. In this way, we have been pioneers in the development of a predictive tool to determine thromboembolic risk in general population, which is already being used in clinical practice. From these results and aware of the importance of the genetic base in the risk of VTE in general population, we wonder what role this genetic base already known could have in the increased risk of VTE in cancer patients. In cancer patients none of the current RAM to estimate the risk of VTE has taken into account the genetic factors of thrombotic risk, although some prothrombotic mutations such as Factor V Leiden and the G20210A mutation in the prothrombin gene have been associated with an increased risk of VTE in cancer patients (Vienna CATS study and the Tromso cohort). The first data of our project indicate that a risk score including clinical and genetic data of the cancer patients at 6 months of clinical follow-up significantly improves KS in the identification of cancer patients undergoing out-of-hospital chemotherapy at high risk of suffering thromboembolic events. At this point in the study, the KS applied to our patients had a very low predictive capacity, in terms of discrimination, (AUC) of 0.58 (95% CI 0.51–0.65). However, the score developed from our study significantly increased the predictive capacity of thrombosis risk with the incorporation of genetic and clinical risk factors for thrombosis (AUC 0.73, 95% CI 0.67–0.79, P With these results, we can conclude that our score has a better predictive capacity than the KS to identify cancer patients treated with chemotherapy at high risk of thrombosis, potentially, reducing the morbidity and mortality associated with this pathology. Therefore, our results have a direct applicability that may change the clinical practice.

Psychiatric Symptoms and Psychosocial Problems in Cancer Patients

Psychiatric Symptoms and Psychosocial Problems in Cancer Patients