Journal Issue: Vol.4, No.2 - April 2005

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Editorial: Ethical Principles in Cancer Care

Prof. Sigridur Halldorsdottir PhD (MD. Dr.) Among the foremost ethical principles in cancer care, and in health care in general, are non-maleficence (do no harm), and beneficence (do good). This refers not only to the therapy that is being given, but also to the human encounters between patients and health professionals. In light of this, it is alarming that cancer patients sometimes report disempowering encounters with health professionals- encounters, which left them feeling disheartened and down-broken. Human suffering is often the hidden dimension of illness and in the case of cancer patients the suffering is also existential. This makes the cancer patient more vulnerable and sensitive and in greater need for caring and compassion than before the invasion of the cancer. It also means that uncaring in its many different forms can have deeper effect on them than the average patient. Unfortunately, hospitals can be very alienating and dehumanizing places. This means that health professionals have to make a special effort in humanizing the hospital stay of the patient. If they do not, patients can lose their sense that they matter to someone and that their recovery is important and may feel processed by a system that can be both cold and unkind. In Iceland we have a common saying: ?Be careful in the presence of a human soul?. This old wisdom has been supported by studies, which have shown the links between emotions, the brain, the immense system and health through the new interdisciplinary science of psycho-neuroimmunology. Through this highly complex area of research we know that chronic stress is clearly associated with down-regulation of a number of measures of cellular immune function with a shift in immunity from predominantly a Th1 to a Th2 type. Furthermore, we know that there is a triangular relationship between mood (brain monoamines), the immune system and the HPA axis. When one of the corners of this triangle becomes disregulated the others are inevitably affected.1 The human aspect of cancer care can, therefore, not be overestimated. Research has clearly indicated that support or lack of support, perceived caring and uncaring have great impact on the human being eg., by decreasing or increasing stress. If the virtue of caring is a human trait common to and inherent in all people, then uncaring can be some sort of burn-out. Burn-out an occur over time and in stages. It implies that individuals can undergo basic transformation during the development of burn-out and thus become qualitatively different. I have proposed from my own research that the burnt-out health professional progress through the stages of disinterest, insensitively, coldness, inhumanity and maleficence. From this point of view disinterest in cancer patients can be seen as a warning sign. Just as there can be a progression in burn-out with ever increasing uncaring, coldness and maleficence there can also be a progression in true compassion and genuine concern - this transformative and beneficent element in human encounters. In the presence of a truly compassionate health professional, who is genuinely concerned for the patient, the patient feels safe and in good hands, stress is decreased and the patient feel empowered which increases his or her sense of well-being and health. I sincerely hope that beneficence may increasingly be patients? experience in their encounters with heath professionals and that we may progress towards the elimination of all shades of maleficence and dehumanization within health care. Professor Sigridur Halldorsdottir, PhD (Md. Dr.) Faculty of Health Sciences, University of Akureyri, Iceland. 1. See e.g. Mind, Immunity and Health: The Science of Psychoneuroimmunology by Professor Phil Evans, Dr. Frank Hucklebridge and Dr. Angela Clow ? the senior members of the University of Westminster?s Psychophysiology and Stress Research Group. Free Association Books: London, 2000.


Profile - Prof. Simon Gandevia

Profile: Prof. Simon Gandevia Prof. Simon Gandevia (DSc MD PhD FAA FRACP) an internationally ? reputed physiologist, clinical neuro-physiologist and science administrator is currently the Deputy Director of Prince of Wales Medical Research Institute. He was one of the four founders of this Institute in 1991. Prof. Ganadevia is a medical graduate with an extensive record of health and medical research. He completed of PhD during his medical training and was subsequently awarded a DSc by the University of New South Wales. His research involves human subjects and patients and virtually all his work has been conducted in Sydney, Australia. His work continues to be focused on three areas: the central and peripheral control of human muscles, kinaesthesia and propriception, and the neural control of human muscles, kinaesthesia and propriception, and the neural control of human respiration. Many techniques including electrical stimulation of the central nervous system, microneurography, twitch interpolation, recordings of respiratory performance, and total neuromuscular paralysis have been used in innovative ways, and some new techniques developed. His work has provided insights into pathophysiological mechanisms in several branches of medicine including neurology, rehabilitation medicine and cardiorespiratory medicine. One emphasis has been the development of appropriate tests of human neuromuscular function and, where possible, their application to understand pathological changes in patients. One example has been clinical research with his colleagues into neuromuscular diseases, particularly the long-term pathophysiology of poliomyelitis. In recognition of his scientific work, he was elected a Fellow of the Australian Academy of Science in 1998 and received a Centenary medal in 2003. He has served on many editorial boards including the Journal of Physiology and the Journal of Applied Physiology and has edited four research books. He has published extensively including more than 70 papers in the Journal of Physiology with many others in major specialist and clinical journals. He has also helped train many doctoral students and to develop concepts about the ethics of experimental studies in human beings.


Effect of an Information Leaflet on the Improvement of Oral Cancer Knowledge Among the General and the High Risk Population

Dr Stefano Petti

  1. Dr Stefano Petti
    Department of Public Health Sciences, \"G Sanarelli\", University \"La Sapienza\"

Background: Investigating whether information leaflets increase knowledge of oral cancer, one of the least heard of cancers by public. Methods: 97 adults (=40yrs) complied a questionnaire investigating cancer knowledge level before and 12-48 hours after they were given the information leaflet. The effect of gender, age, educational level on improvement and final knowledge levels were assessed. Results: Final knowledge score was 88.6% of the highest score, with a 26.2% improvement. Improvement and final knowledge was not effected by the investigated variables. Conclusions: Information Leaflets might contribute to increase oral cancer knowledge among the general population and the risk groups.

Advantages of Applying a Multifactoral Approach to Estimating the Contribution of Indoor Radon to Lung Cancer Risk

Dr Vladimir Lezhnin, Dr Eugene Polzik, Dr Vladimir Kazantsev

  1. Dr Vladimir Lezhnin
    Ural Scientific Practical Center for Medical, Social and Economics, Problems (SPC \"Uralmedosteconomproblem\"),
  2. Dr Eugene Polzik
    Ural Scientific Practical Center for Medical, Social and Economics, Problems (SPC \"Uralmedosteconomproblem\"),
  3. Dr Vladimir Kazantsev
    Ural Scientific Practical Center for Medical, Social and Economics, Problems (SPC \"Uralmedosteconomproblem\"),

Epidemiologic studies based on multifactoral analytical methods have been implemented in two cities of the Sverdlovsk Region to establish the relationship between indoor exposure to radon and thoron and the risk of lung cancer posed to their population. Both cities, Pervouralsk and Karpinsk, are situated in high radon background ares with a radiation exposure dose of 5to 12 R/hr, and are characterized by high cancer incidence rates of 323.1 and 364.6 cases per 100,000 of population, respectively. Volumetric activity concentrations of indoor radon in Pervouralsk and Karpinsk averaged 23Bq/m3 and 75Bqm3 (while 395 Bq/m3 and 739 Bqm3 were Registered in some dwellings), whereas equivalent concentrations of thoron were 0.6Bq m3 and 2.5Bqm3 (with maximum values of 5Bqm3 and 13Bqm), respectively. The multifactoral analysis of 22 risk factors of lung cancer based on mathematical methods of pattern recognition showed that the contribution of radon and thoron in the disease was insignificant and equaled 0.5% and 0.6%, respectively. When in the same data were fed in the BEIR VI model, the estimated contribution was in the range of 11 to 16% in Pervouralsk and 35 to 52% in Karpinsk. Arguments for a better reliability and adequacy of multifactoral analytical methods of estimating radiation risk against the traditional monofactoral approach are provided in the discussion of results.

Beyond PSA: New Serum Markers for Improved Diagnosis and Management of Prostate Cancer

Dr Kevin Mark Slawin, Dr Shahrokh F Shariat, Dr Eduardo I Canto, Dr Michael W Kattan, Dr Thomas M Wheeler

  1. Dr Kevin Mark Slawin
    Associate Professor, Scott Department of Urology, Baylor College of Medicine; Director, The Baylor Prostate Cancer
  2. Dr Shahrokh F Shariat
    Scott Department of Urology, Baylor College of Medicine; Director, The Baylor Prostate Cancer
  3. Dr Eduardo I Canto
    Scott Department of Urology, Baylor College of Medicine; Director, The Baylor Prostate Cancer
  4. Dr Michael W Kattan
    Department of Pathology, Baylor College of Medicine, and The Methodist Hospital, and Epidemiology and Biostatistics Memorial Sloan Kettering Cancer Centre, New York, NY
  5. Dr Thomas M Wheeler
    Scott Department of Urology, Baylor College of Medicine; Director, The Baylor Prostate Cancer

The discovery of PSA, and its widespread clinical use in the late 1980?s, had a profound impact on the diagnosis and management of prostate cancer. PSA is a 33-kDa serine protease that is part of the 15 member Kallikrein family. PSA, also known as human kallikrein 3, had an inauspicious initial history. It was first reported in the Journal of Forensic Science as a useful marker of human seminal plasma in the 1970?s. Gerald Murphy and colleagues first purified it from the prostate gland in 1979. Shortly thereafter, it was found to be a useful marker for prostate cancer by the same group. PSA is made primarily by the same group. PSA is made primarily by the prostatic epithelium and periurethral glands in males, but it has also been detected in endomatrium, breast cancer breast milk, and female serum. In the normal prostate, the prostatic epithelium secretes PSA into the seminal fluid, where it reaches mg/ml concentrations and contributes to the liquefactin of seminal fluid by cleaving semenogelins 1 and 2.5.

A Combination of Ondansetron, Metoclopramide, Dexamethazone and Lorazepam for the Prevention of Irinotecan Induced Nausea and Vomiting

Dr Gerasimos Aravantinos, Dr I Sgouros, Dr M Kostopoulou, Dr V Kostopoulos, Dr A Zafiropoulos, Dr A Konstantinidou, Dr J Janinis, Dr D Makridaki

  1. Dr Gerasimos Aravantinos
    Karaoli Dimitriou 11,
  2. Dr I Sgouros
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital
  3. Dr M Kostopoulou
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital
  4. Dr V Kostopoulos
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital
  5. Dr A Zafiropoulos
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital
  6. Dr A Konstantinidou
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital
  7. Dr J Janinis
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital
  8. Dr D Makridaki
    3rd Dept of Internal Medicine and Clinical Oncology, \"Ag. Anargiri\' Cancer Hospital

Background: Irinotecan (CPT-11) has been proven effective in colorectal cancer and other tumors. Therefore its use is increasing. Unfortunately Irinotecan is highly emetogenic. This study was conducted to evaluated the effectiveness of the combination of ondansetron, metoclopramide, dexamethasone and lorazepam in the prevention of CPT-11 induced nausea and vomiting. Patients and Methods: Patients with metastatic colorectal cancer who received CPT-11at the dose of 350mg/m2 every three weeks were entered in the study. The anti-emetic regimen consisted of 16mg Ondansetron, 8mg dexamethasone, 8mg dexamethasone and 2.5 mg lorazepam prior to the administration of the chemotherapy on day 1 and the administration of 16mg ondansetrom and 30mg metocloprmide daily for the days 2-4. Results: twenty-nine patients were enrolled. Complete control of nausea and vomiting was achieved in 15 patients (52%). Three patients (10%) experienced grade 1 and 14 Conclusion: The combination of ondansetron, metoclopramide, dexamethasone and lorazepam gives promising results in the control of nausea and vomiting in patients with metastatic colorectal cancer treated with CPT-11.

The Effect of Epigallocatechin Galleate, Black Tea Extract and Sarcophytol A on DNA Strand Breakage Induced by Tobacco-Specific Nitrosamines and Stimulated Human Phagocytes

Dr Alan B Weitberg, Dr Donna Corvese

  1. Dr Alan B Weitberg
    Chairman of Medicine, Roger Williams Medical Center
  2. Dr Donna Corvese
    Division of Heamatology/Oncology, Roger Williams Medical Center and The Departments of Medicine Brown University School of Medicine and Boston University Medical Center

The tobacco-specific nitrosamines (TSNAs) are metabolites of nicotine and are major carcinogens in cigarette smoke. Chronic inflammation may promote the carcinogenic effect of these nitrosamines through the generation of oxygen radicals as evidenced by an increase in DNA strand breakage in cultured human lung cells treated with stimulated human phagocytes and TSNAs. Sarcophytol A(SaA), a simple monohydroxycem-bratetraene isolated from marine soft coral - epigallocatechin galleate (EGCG), one of the main constituents of green tea, and black tea extract (BTE) all inhibit tumor promotion. To evaluate their effect on TSNA-induced genetic damage, cultured human lung cells were pretreated with SaA, EGCG, or BTE, and then exposed to the TSNA -4- (N-methyl-N-nitrosamino )-1-(3pyridyl)-1- butanone (NNK) and stimulated human phagocytes and then assayed for single strand DNA breaks. SaA, EGCG and BTE provided significant protection against the induction of genetic damage in these cells and proved useful in the chemo-prevention of tobacco-induced carcinogenesis.

Self as Female: Womens' Experiences Following Treatment for Breast Cancer or Uterus Cancer

Dr Carina Bertero

  1. Dr Carina Bertero
    Associate Professor, Department of Medicine and Care, Division of Nursing Science; Faculty of Health Sciences, Linkoping University

The purpose of the present study was to identify and describe the impact of breast cancer or uterus cancer from the perspective of the women's lived experiences, on their body image and intimate Relationships. Eighteen women diagnosed with these forms of cancer were interviewed. Verbal transcripts were analysed using an interpretive phenomenological approach influenced by Heidegger, i.e understanding something as something. Self as female emerged as the principal theme, which is turn, was influenced by four minor themes; existential fear, loss of female attraction, changed emotions and sensations, and intimacy or concern. Existential fear showed that the women were more preoccupied with the potential fatal nature of the cancer that had been diagnosed than they were with the implications of the treatment and its effects on their body image. Loss of female attraction identified concerns about loss of fertility and anxiety about their desirability as a sexual partner. This theme illuminated both apparent and invisible loss of female attraction. Changed emotions and sensations showed that in the area of sexuality /intimate relationships some of the women experienced changed emotions and changed perceptions with respect to physical touch but also changed feelings and desire. Finally intimacy and concern revealed that the women include not only include physical pleasure but also a sense of themselves as women in the context of their lives, their relationships, and their emotions. As nursing practice continues to address issues of breast cancer and/ or uterus cancer across the care continuum, nurses could significantly improve women's body image and facilitate the women's intimate relationships by addressing these aspects. The nurse is in unique position to provide the reliable resources the woman needs during this revolutionary time in her life.

Progress in Radiation Therapy for Esophageal Cancer

Dr Yasumasa Nishimura

  1. Dr Yasumasa Nishimura
    Department of Radiation Oncology; Kinki University School of Medicine,

In this review , recent progress in radiation therapy (RP) for esophageal cancer was presented. First, Radio-sensitization by concurrent use of chemotherapy (CT) was clinically proved by several randomized clinical trials for locally advanced esophageal cancer. At present, concurrent 5-FU /cisplatin combined with RT is standard CT-RT regimen for advanced esophageal cancer. Second, improvement in spatial dose distribution for esophageal cancer was obtained by intraluminal brachytherapy (IBT)and conformal RT including intensity modulated RT (IMRT). IBT boost following external Rtis an effective modality in the treatment of superficial esophageal cancer. IMRT is an ideal boost technique for locally advanced cervical and upper thoracic esophageal cancers to exclude the spinal cord. Third improvement in time-dose-fractionation was achieved by accelerated hyperfractionation (AHF). Shortening overall treatment time by AHF is an effective strategy for esophageal cancer.

Basic Principles of Cancer Care: From the Cancer Patients' Perspective

Prof Sigridur Halldorsdorttir

  1. Prof Sigridur Halldorsdorttir
    PhD (Med. Dr.)
    Faculty of Health Sciences, University of Akureyri

What is the essential in professional cancer care from the patient's perspective? The beginning of a new millennium is a good time to analyze and discuss some of the basic principles of cancer care in the light of research conducted from the patient's perspective since it is logical to presume that the best informant about the patient is the patient. In this chapter I will, firstly, emphasize the importance of the health professional acknowledgement of the existential suffering involved in the cancer experience. Secondly, I will analyse and discuss cancer patient /health professional relations and encounters from the cancer patient's perspective and the cancer patient's need for professional caring involving competence, caring and connection. Thirdly, I will emphasize the need for professional wisdom, as a key ingredient in professional cancer care from the cancer patient's perspective. Finally, I will discuss the ethical principles of cancer care, especially the need to honor the dignity of each person who is a cancer patient. In this paper I will argue that these are the four basic principles of professional cancer care as seen in the light of research conducted from the cancer patient's perspective.

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