Journal Issue: Vol.10, No.1 - January 2011

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Common Symptoms Experienced Among Patients with Colorectal Cancer and Barriers to Reporting Symptoms or Distress: The Staff Perspective

Dr Carina Bertero, Dr Sussanne Borjeson, Dr Hans Starkhammar

  1. Dr Carina Bertero
    RNT, PhD
    Professor, Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Link?ping University
  2. Dr Sussanne Borjeson
    RN, PhD
    Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, rnDepartment of Oncology,
  3. Dr Hans Starkhammar
    Department of Oncology, Linköping University Hospital

The present study was designed to qualitatively identify and describe, from the staff members? perspective, the most common symptoms among patients diagnosed with colorectal cancer, and discover if there were any barriers to reporting symptoms or distress. Four focus groups were arranged with staff members working with chemotherapy in patients with colorectal cancer. The focus groups were audio-taped and verbatim transcribed. All the transcripts were analysed through a continuous process of reading the text and following the principles of qualitative content analysis. The analysis identified six symptoms/forms of distress as the most common among patients with colorectal cancer, whereas four symptoms were typically somatic. The symptoms/forms of distress were fatigue, changed bowel habit, changed sense of taste/nausea, painful distress, change as a person, and uncertainty. The barriers reported by the staff members were related to: how you ask the answers given, and time as an obstacle. These barriers give a clear picture about the difficulties in handling more mental and existential issues, especially highlighting that there are no guidelines to follow and the time aspect is a hindrance in certain ways.

Breast Cancer Chemoprevention Overview

Dr Jennifer Eng-Wong

  1. Dr Jennifer Eng-Wong
    MD MPH
    Lombardi Cancer Center, Georgetown University

The selective estrogen receptor modulators, tamoxifen and raloxifene reduce the risk of breast cancer by approximately 50% in high risk women. The agents also have favorable effects on bone density and cholesterol, however the undesirable side effects of increased risk of thrombo-embolic disease and endometrial cancer (tamoxifen only) have limited clinical use of these agents. Aromatase inhibitors are under study as possible prevention agents and are promising. These agents all target the estrogen pathway and estrogen receptor positive breast cancer is prevented, but not estrogen receptor negative breast cancer.

Recent Achievements in the Treatment of Chronic Lymphocytic Leukemia

Prof Tadeusz Robak

  1. Prof Tadeusz Robak
    Department of Hematology, Medical University of Lodz,, rn

Current treatment approaches in chronic lymphocytic leukemia include alkylating agents, purine nucleoside analogs and monoclonal antibodies (mAb).Recently, several new agents have been explored and have shown promise in treating CLL. These treatments include new mAbs, agents targeting the antiapoptotic bcl-2 family of proteins, receptors involved in mediating survival signals from the microenvironment, antisense oligonucleotides and other agents. The most promising are new mAbs targeted CD20 molecule, lumiliximab, and anti-CD40 mAbs. Oblimersen , flavopiridol, thalidomide, lenalidomide are also being evaluated both in pre-clinical studies and in early clinical trials. This review summarizes current treatment options and novel therapies that are being evaluated in patients with CLL.

Malignant Epithelioid Angiomyolipoma of Kidney in a Tuberous Sclerosis Patient: A Case Report

Dr Manas R Baisakh, Dr Maneesh Sinha, Dr Rajesh Mohanty, Dr Radhika Narayan, Dr Minakshi Mishra, Dr Harpreet Singh, Dr Deepak K Mishra

  1. Dr Manas R Baisakh
    Senior Registrar, Tata Main Hospitalrn
  2. Dr Maneesh Sinha
    Associate Specialist, Department of Urosurgery
  3. Dr Rajesh Mohanty
    Associate Specialist, Department of Pathology
  4. Dr Radhika Narayan
    Associate Specialist, Department of Pathology
  5. Dr Minakshi Mishra
    Associate Specialist, Department of Pathology
  6. Dr Harpreet Singh
    Associate Specialist, Department of Pathology
  7. Dr Deepak K Mishra
    Head & Chief Medical Support Services, Department of Pathology

Tuberous sclerosis (TSC) is an autosomal dominant disorder characterized by hamartomatous lesions of multiple organ system. Renal angiomyolipoma is a well known entity associated with TSC. However, malignant epithelioid angiomyolipoma is a recently described entity characterized by its aggressive behavior & poor prognosis. Immunohistochemistry is a useful diagnostic adjunct for proper characterization of tumor. We report an 18 year male diagnosed with tuberous sclerosis who developed large bilateral renal masses. Total nephrectomy of left kidney revealed a malignant epithelioid angiomyolipoma.

Concurrent Cisplatin with Irradiation in Locally Advanced Cervical Carcinoma: Response and Toxicity

Dr Ehab Abdou, Mohamed Gaafar, Khalid Al-Shahat

  1. Dr Ehab Abdou
    Lecturer, Department of Radiation Oncology, Faculty of Medicine, Al-Azhar University
  2. Mohamed Gaafar
  3. Khalid Al-Shahat

Background: Cervical cancer is the second most frequent cancer among women worldwide and the most frequent cancer among women in Africa, Asia, and South America. Cervical cancer continues to be a significant health burden worldwide. Globally, the majority of cancers are locally advanced at diagnosis; hence, radiation remains the most frequently used therapeutically effective modality. Currently, the value of adding Cisplatin or Cisplatin-based chemotherapy to radiation for treatment of locally advanced cervical cancer is strongly supported by randomized studies and meta-analyses. In our study, we retrospectively assessed the response and toxicity profile of concurrent Cisplatin with irradiation in patients with locally advanced cervical carcinoma. Patients and Method: This study included 20 patients with locally advanced histologically proved squamous cell carcinoma of the cervix. All patients had performance status 0-2, normal liver and renal function with adequate bone marrow reserve and function. Patients received radical radiotherapy included external radiotherapy 40 Gy/20 fractions followed by single application of low dose rate intra-cavitary brachytherapy using Cs-137 to deliver 40 Gy equivalents to point A then parametrial boost 10 Gy in 5 fractions. Cisplatin weekly was given concurrently with external beam radiotherapy as 40 mg/m.2 Results: There were grade III/IV acute hematologic toxicity occurred in 6% of patients. GIT toxicity grade III/IV was noticed in 10% of patients. The late complications of the rectum and small bowel were noticed in 20% and 10% of patients respectively. The urinary bladder late toxicities were not detected in none of patients. Grade III-V rectum reported in 3% of patients while this level of toxicity was not reported in any of patients with small bowel or urinary bladder late toxicities. We had 2 patients (10%) developed local and loco-regional failure. one patient developed distant metastases (5%). While 3 patients (15%) from each group developed local and distant metastases. Three-year overall survival was 80%. The overall survival was 75% while 3-years survival was 70%. Clinical stage was the only significant variable for overall survival. Conclusion: In our study we confirmed the established rule for concurrent Cisplatin with radiotherapy. There is good toxicity profile and manageable side effects. Regarding the chemotherapeutic radio sensitizer, Cisplatin still the best is such aspect.

Chemoimmunotherapy May Overcome the Adverse Prognostic Significance of 11q Deletion in Previously Untreated Patients with Chronic Lymphocytic Leukemia

Apostolia-Maria Tsimberidou, Constantine Tam, Lynne Abruzzo, Susan O'Brien, William Wierda, Susan Lerner, Hagop Kantarjian, Michael Keating

  1. Apostolia-Maria Tsimberidou
  2. Constantine Tam
  3. Lynne Abruzzo
  4. Susan O'Brien
  5. William Wierda
  6. Susan Lerner
  7. Hagop Kantarjian
  8. Michael Keating

Background: An 11q22 deletion is considered an independent factor predicting poor survival in chronic lymphocytic leukemia (CLL). Methods: We searched the electronic CLL database for consecutive patients who presented to the M. D. Anderson Cancer Center Department of Leukemia from October 2003 to April 2007 with untreated CLL and who had an 11q22 deletion, detected by fluorescence in situ hybridization (FISH) analysis of bone marrow samples. FISH analysis was performed using the following probes: trisomy 12 (12p11.1-q11), TP53 (17p13.1), ATM (11q22.3), LAMP1 (13q34), and D13S319 loci (13q14.3). Results: Sixty-nine patients with untreated CLL with an 11q22 deletion were identified. The median patient age was 59 years (range, 26-81 years); 80% were men, 53% had Zubrod performance status >0, and 13% had Rai stage III-IV disease. Lymphadenopathy (massive), splenomegaly, anemia, and thrombocytopenia were present in 96% (12%), 19%, 9%, and 4%, respectively. Additionally, 62% of patients had deletions in 13q, and 3% had trisomy 12. Forty patients required therapy for progressive disease. The overall response rates for FCR (fludarabine, cyclophosphamide, and rituximab), CFAR (FCR plus alemtuzumab), and R-GMCSF were 100%, 100%, and 33%, respectively. The 11q22 deletion was undetectable in 25 of 27 patients monitored after treatment using FISH analysis. The median follow-up was 17 months. At 1 and 3 years, the survival rates were 97% and 91%, respectively, and the relapse-free survival rates were 100% and 77%, respectively. Conclusions: CLL with an 11q22 deletion was associated with high rates of response, survival, and relapse-free survival when treated with chemo-immunotherapy.

Effectiveness of a three-day Training the Trainers Course in Improving Participants’ Confidence in Teaching Communication Skills Courses to SeniorHealthcare Professionals Working with Cancer Patients

Dr S Wilkinson, Dr L Linsell, Dr K Blanchard, Dr Anita Roberts

  1. Dr S Wilkinson
    PhD, MSc, RN, RM, RNT, RCNT, Adv. Dip Nurs. Aroma Cert. Oncology, Cert. Counselling Dip.,
    Senior Lecturer, Palliative Care Department of Mental Health Sciences Royal Free and University CollegernMedical School ,rn
  2. Dr L Linsell
    MSc., Medical Statistician
    Centre for Statistics in Medicine, Wolfson College Annexe, Oxford University,
  3. Dr K Blanchard
    MA, BA, RSA Cambridge CELTA. Research Assistant
    Department of Mental Health Sciences, Royal Free and University College Medical School
  4. Dr Anita Roberts
    MSc, BSc (Hons), RGN, RSCN, Learning and Teaching Lead
    Marie Curie Palliative Care Institute

Effective communication is a core clinical skill which can be taught. Communication skills training is dependant upon adept facilitation by trained facilitators. There is a dearth of literature addressing facilitator training. This study evaluated the effectiveness of a three-day Training the Trainers course in its ability to change participants’ confidence in facilitating an advanced 3 day communication skills course for senior healthcare professionals in cancer care (ACST). Fifty-six cancer care healthcare professionals participated in a multi-centred survey in 6 different locations across the UK. The primary outcome was the change post-course in the participants’ level of confidence. The secondary outcome was the course evaluation. There was a significant increase in total confidence scores from 6.5 pre-course to 7.9 post-course (t=9.9, p<0.001). Forty-eight (91%) participants had improved confidence scores, 1 the same and 4 had worse. The course was well evaluated.

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