Abstract Chronic stress is associated with morbidity and mortality from numerous conditions, many of whose pathogenesis involves persistent inflammation. Here, we examine how chronic stress ...influences signaling pathways that regulate inflammation in monocytes. The sample consisted of 33 adults caring for a family member with glioblastoma and 47 controls whose lives were free of major stressors. The subjects were assessed four times over eight months. Relative to controls, caregivers’ monocytes showed increased expression of genes bearing response elements for nuclear-factor kappa B, a key pro-inflammatory transcription factor. Simultaneously, caregivers showed reduced expression of genes with response elements for the glucocorticoid receptor, a transcription factor that conveys cortisol’s anti-inflammatory signals to monocytes. Transcript origin analyses revealed that CD14+/CD16− cells, a population of immature monocytes, were the predominate source of inflammatory gene expression among caregivers. We considered hormonal, molecular, and functional explanations for caregivers’ decreased glucocorticoid-mediated transcription. Across twelve days, the groups displayed similar diurnal cortisol profiles, suggesting that differential adrenocortical activity was not involved. Moreover, the groups’ monocytes expressed similar amounts of glucocorticoid receptor protein, suggesting that differential receptor availability was not involved. In ex vivo studies, subjects’ monocytes were stimulated with lipopolysaccharide, and caregivers showed greater production of the inflammatory cytokine interleukin-6 relative to controls. However, no group differences in functional glucocorticoid sensitivity were apparent; hydrocortisone was equally effective at inhibiting cytokine production in caregivers and controls. These findings may help shed light on the mechanisms through which caregiving increases vulnerability to inflammation-related diseases.
Objectif : L'objectif de cette étude pilote portait sur les répercussions d'une intervention conçue pour améliorer la qualité de vie des patients nouvellement diagnostiqués d'une tumeur cérébrale ...primitive. L'intervention comprenait une seule rencontre structurée entre des patients nouvellement diagnostiqués d'une tumeur cérébrale primitive et des patients bénévoles qui avaient déjà souffert d'une tumeur cérébrale primitive et qui avaient reçu une formation dans le cadre de cette intervention. Méthodologie : Deux bénévoles ont eu une rencontre individuelle avec un total de dix patients nouvellement diagnostiqués d'une tumeur cérébrale primitive. Une combinaison de questionnaires et d'entretiens a été utilisée pour étudier les répercussions de l'intervention sur les nouveaux patients et les bénévoles. Résultats : L'intervention s'est montrée d'une valeur substantielle pour les deux groupes de participants. L'analyse a révélé que les patients nouvellement diagnostiqués en ont retiré de nombreux avantages, y compris ceux-ci : espoir accru, conseils précieux, savoir exactement de quoi il en retourne, solitude atténuée et prise de conscience sur ce qui importe vraiment. Seuls des effets indésirables mineurs et de légers problèmes ont été signalés. Conclusions : Les constats fournissent des données probantes initiales selon lesquelles l'intervention élaborée peut représenter un moyen sécuritaire et utile d'améliorer le bien-être psychosocial chez les patients nouvellement diagnostiqués d'une tumeur cérébrale primitive. La réalisation d'autres études concernant le potentiel de soutien individuel par des pairs pour les patients atteints d'une tumeur cérébrale primitive constitue une priorité importante en matière de recherche.
The purpose of this pilot study was to investigate the impact of an intervention designed to enhance quality of life in newly diagnosed primary brain tumour (PBT) patients. The intervention involved ...a structured, one time meeting between newly diagnosed PBT patients and trained volunteer "veteran" PBT patients.
Two volunteers met for a single, one-on-one meeting with a total of 10 newly diagnosed PBT patients. A combination of questionnaires and interviews were used to investigate the impact of the intervention for both the new patients and the volunteers.
The intervention appeared to be of substantial value for both groups of participants. Analysis revealed that the newly diagnosed patients experienced a range of benefits, including those related to the themes of: increased hope, valued guidance, hearing what it's really like, overcoming aloneness, and receiving a wake up call to what matters. Only relatively minor adverse effects and challenges were reported.
The findings provide initial evidence that the developed intervention has the potential to be a safe, useful means of enhancing psycho-social well-being in newly diagnosed PBT patients.Further investigation into the potential of one-to-one, peer support for brain tumour patients is an important research priority.
Sleep-wake disturbances are experienced by as many as 75% of patients with cancer and are associated with poor symptom management, lower functionality, and decreased quality of life. Although ...promising sleep interventions exist, they require extensive resources and time.
The objectives of this study were to develop a brief, self-administered sleep intervention and to evaluate the feasibility and potential efficacy of its implementation with adult patients with cancer who were about to receive, were receiving, or had received radiation therapy in an ambulatory cancer care setting.
Pre- and postintervention surveys and qualitative interviews were conducted with patients with cancer experiencing insomnia (N = 28) and receiving radiation treatment within the past six months. Patients received instruction on breathing, visualization, and intonation. Adherence and sleep quality were primary study outcomes. Analyses included descriptive statistics and repeated measure regression analysis. Thematic analysis was conducted on qualitative data.
Adherence to the sleep intervention was high (75%), and significant improvement was found in global sleep quality (p < 0.0001) regardless of level of adherence. Sleep onset latency (p = 0.0005), sleep duration (p = 0.0016), and sleep quality (p < 0.0001) were significantly improved. Age was significantly correlated with sleep quality (p = 0.0094), with older participants reporting greater benefit from the intervention. Participants reported that the intervention was easy to learn and implement and that it "calmed the mind."
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DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Des perturbations du cycle veille-sommeil, notamment l’insomnie, sont éprouvées par 30–75 % des patients en oncologie et pourtant, aucune intervention efficace n’a été conçue pour aborder, dans le ...milieu ambulatoire, ce symptôme fort pénible. En vue de répondre à une lacune cernée dans les soins, je partage de l’information sur le développement et l’évaluation d’une intervention novatrice relative au sommeil conçue spécifiquement pour le milieu ambulatoire. Nous décrivons les résultats préliminaires ainsi que le modèle informatif sous-tendant la recherche menée au point d’intervention. En tant qu’infirmières de chevet, nous avons la possibilité, et le devoir, en vertu de notre obligation morale et de notre mandat de justice sociale, d’intervenir en vue de dégager des solutions fondées sur des données probantes pour améliorer les soins aux groupes de patients lorsque ces soins comportent des lacunes.
Sleep-wake disturbances, in particular insomnia, are experienced by 30%-75% of oncology patients, yet no effective interventions have been designed to address this distressing symptom in the ...ambulatory setting. In response to an identified gap in care, I share the development and evaluation of an innovative sleep intervention designed specifically for the ambulatory setting. Preliminary findings, as well as an informative blueprint for conducting point-of-care research, are described. As a "bedside" nurse it is possible and within our moral imperative and social justice mandate to take action to find evidence-informed solutions to improve care for populations of patients experiencing gaps in care. The "I" used throughout the article refers to the lead author Surya.
Purpose: The purpose of this pilot study was to investigate the impact of an intervention designed to enhance quality of life in newly diagnosed primary brain tumour (PBT) patients. The intervention ...involved a structured, one time meeting between newly diagnosed PBT patients and trained volunteer “veteran” PBT patients.
Methods: Two volunteers met for a single, one-on-one meeting with a total of 10 newly diagnosed PBT patients. A combination of questionnaires and interviews were used to investigate the impact of the intervention for both the new patients and the volunteers.
Results: The intervention appeared to be of substantial value for both groups of participants. Analysis revealed that the newly diagnosed patients experienced a range of benefits, including those related to the themes of: increased hope, valued guidance, hearing what it’s really like, overcoming aloneness, and receiving a wake up call to what matters. Only relatively minor adverse effects and challenges were reported.
Conclusions: The findings provide initial evidence that the developed intervention has the potential to be a safe, useful means of enhancing psycho-social well-being in newly diagnosed PBT patients.
Further investigation into the potential of one-to-one, peer support for brain tumour patients is an important research priority.
Key words: cancer; brain tumour, peer support, quality of life, volunteer
Despite advances in first-line therapy, there are few data on treatment of glioblastoma multiforme (GBM) at recurrence. Temozolomide (TMZ) is well tolerated and may have activity despite prior TMZ ...exposure if novel dose schedules are used.
The authors reviewed their experience with a continuous TMZ schedule (50 mg/m(2) daily), given at progression after conventional 5-day TMZ. Patients were reported in 3 groups: 1) GBM after progression on conventional TMZ; 2) GBM at first recurrence after completion of standard concomitant and adjuvant TMZ; and 3) patients with other anaplastic gliomas at second relapse on conventional TMZ.
In Group 1, 21 patients with a median age of 54 years (range, 33 years-68 years) received a median of 3 cycles (range, 2-12 cycles) of continuous TMZ at 50 mg/m(2). Overall clinical benefit (complete response, partial response, and stable disease) was 47%, with 6-month progression-free survival (PFS) of 17%. In Group 2, 14 patients with GBM, median age 52 years (range, 38 years-62 years) received continuous TMZ at progression after initial TMZ/radiotherapy (RT) and adjuvant TMZ. The median interval after adjuvant TMZ was 3 months (range, 2 months-10 months). A median of 5 cycles of TMZ was given, and 6-month PFS was 57%. In Group 3, 14 patients with a median age of 49 years (range, 34 years-56 years) received continuous TMZ; 2 partial responses and 6 with stable disease were seen, with a 6-month PFS of 42%. Toxicities were mild and well tolerated; lymphopenia was common but no serious opportunistic infections were identified.
Although retrospective, our results demonstrate that continuous daily administration of TMZ is an active regimen despite prior TMZ therapy. The excellent tolerability of this regimen may allow future combination with other alkylating agents or with novel therapies.
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