Abstract Purpose To compare long-term health-related quality of life (QoL) in germ cell tumor survivors (GCTS) and age-adjusted men and to identify predictors of variation in long-term QoL in GCTS. ...Methods We used the Short-Form Health Survey to measure QoL in a cross-sectional sample of 164 survivors of germ cell tumors from Hamburg, Germany. QoL was compared with age-adjusted German norm data. Sociodemographic and medical data from questionnaires and medical records were used to find predictors of QoL. Results On average, patients were 44.4 years old (standard deviation = 9.6 y) and average time since first germ cell tumor diagnosis was 11.6 years (standard deviation = 7.3 y). We found significantly lower mental component scores in GCTS when compared with norm data (Hedges g =−0.44, P <0.001). An exploratory analysis by age group showed the largest difference in mental QoL in survivors aged 31 to 40 years (Hedges g =−0.67). Linear regression analysis revealed age ( β =−0.46, P <0.001), marital status ( β = 0.20, P = 0.024), advanced secondary qualifications ( β =−0.25, P = 0.001), time since diagnosis ( β = 0.17, P = 0.031), and tumor stage ( β = 0.17, P = 0.024) as statistically significant predictors of the physical component score, accounting for 22% of the variance. Statistically significant predictors of the mental component score were higher secondary qualifications ( β = 0.17, P = 0.033) and unemployment ( β =−0.21, P = 0.009), accounting for 6% of the variance. Conclusions Survivors of germ cell tumors can expect an overall long-term QoL similar to that of other men of their age.
Objective
Caregiving for a loved one is challenging and requires significant resources. Existential distress in family caregivers may include hopelessness, demoralization, fear of death, pre‐loss ...grief, or a sense of not being emotionally prepared. The aim of this systematic review is to synthesize the quantitative literature on existential distress among family caregivers of patients with advanced cancer, focusing on its prevalence, association with mental disorders, as well as with sociodemographic, disease, and treatment‐related factors.
Methods
We systematically searched electronic databases for quantitative studies of the above‐described existential distress concepts in family caregivers of patients with advanced cancer. Two independent reviewers extracted data and evaluated study quality. Data were analyzed using random‐effects meta‐analysis.
Results
We retrieved 17.587 records, of which 31 studies fulfilled inclusion criteria. 63% of the studies (n = 20) provided sufficient data for meta‐analysis for 5558 patients. We found an overall pooled prevalence of 30.6% for existential distress, 95% CI 24.2–37.0. For existential distress subconcepts, prevalence rates were 57.0%, 95% CI 37.8–76.2, for death anxiety, 13.9%, 95% CI 10.8–17.0, for demoralization, 24.0%, 95% CI 18.0–30.0, for pre‐loss grief, 18.4%, 95% CI 4.0–32.7, for hopelessness, 35.2%, 95% CI 28.2–42.2, for loneliness, and 35.6%, 95% CI 13.0–58.3, for emotional unpreparedness.
Conclusions
Approximately one third of the respondents were affected by high levels of existential distress. The review provides evidence for further development of support services that can reduce existential distress, focused on death anxiety, and improve the quality of life for family caregivers of patients with advanced cancer.
Bone metastases in germ cell tumor patients OECHSLE, Karin; BOKEMEYER, Carsten; KOLLMANNSBERGER, Christian ...
Journal of cancer research and clinical oncology,
06/2012, Letnik:
138, Številka:
6
Journal Article
Germ cell tumor (GCT) patients are at risk of venous thromboembolic events (VTEEs). A higher incidence of VTEEs has been reported in GCT patients undergoing cisplatin-based chemotherapy.
A ...retrospective analysis of the incidence of and risk factors for VTEEs in 193 GCT patients receiving platinum-based chemotherapy in Hamburg, Germany, between 2000 and 2009 was performed.
VTEEs occurred in 22 patients (11%). In only 4 patients, the VTEEs occurred during cisplatin-based chemotherapy, while 18 patients (81%) experienced VTEEs prior to initiation of chemotherapy. Pure seminoma, 'intermediate risk' (International Germ Cell Cancer Collaborative Group (IGCCCG)), retroperitoneal or supraclavicular lymph node metastases, elevated lactate dehydrogenase (LDH) levels, a central venous catheter (CVC), arterial hypertension, application of granulocyte colony-stimulating factor (G-CSF) and of ≥ 3 cycles of cisplatin-based chemotherapy could be identified as risk factors. 2 risk groups could be described: (i) VTEEs manifesting before chemotherapy in patients with seminoma, retroperitoneal tumor masses, and elevated LDH levels, and (ii) VTEEs occurring during chemotherapy applied via CVC in patients with supraclavicular lymph node metastases.
The incidence of VTEEs in GCT patients was 11%, but in the majority of patients, the VTEEs occurred before the initiation of platinum-based chemotherapy. Supraclavicular lymph node metastases and use of a CVC are risk factors for VTEEs during chemotherapy.
Abstract Background Clinical management of germ cell tumours (GCTs) relies on monitoring of serum tumour markers. However, the markers α-fetoprotein (AFP), the β-subunit of human chorionic ...gonadotropin (bHCG), and lactate dehydrogenase (LDH) are expressed in <60% of GCT cases. Objective To test the utility of the microRNAs (miRNAs) miR-371a-3p, miR-372-3p, miR-373-3p, and miR-367-3p as sensitive and specific GCT serum biomarkers. Design, setting, and participants Serum levels of miRNAs were measured in 166 consecutive patients with GCT before and after treatment and in 106 male controls. In the first 50 consecutive patients, all four miRNAs were measured. In the main study, only the most sensitive miRNA was further analysed. Outcome measurements and statistical analysis The specificity and sensitivity of the four miRNAs were studied using receiver operating characteristic curves. miRNA sensitivities were compared to those of classical markers. Statistical cross-comparisons of miRNA levels for GCT subgroups and controls were performed at various time points during treatment. Results and limitations Overall, miR-371a-3p performed best, with 88.7% sensitivity (95% confidence interval CI 82.5–93.3%) and 93.4% specificity (95% CI 86.9–97.3%) and an area under the curve of 0.94, outperforming AFP, bHCG, and LDH (combined sensitivity 50%). According to Kernel density estimation, the sensitivity and specificity were 86.3% and 92.5%, respectively. miR-371a-3p levels dropped to normal after completion of treatment. The miRNA levels correlated with treatment failure and relapse. Teratoma did not express miR-371a-3p. Conclusions The miRNA miR-371a-3p is a specific and sensitive novel serum GCT biomarker that accurately correlates with disease activity. Validation of this test in a large-scale prospective study is needed. Patient summary miR-371a-3p is a novel serum marker for germ cell tumours that is expressed by 88.7% of patients and thus is far more sensitive and specific than classical serum markers. It correlates with tumour burden and treatment results. Validation in a large patient cohort is needed.
PURPOSE OF REVIEWThe disease-related burden of patients with hematological malignancies is comparable with patients suffering from solid tumors. Palliative care offers relief from suffering ...independent of type of disease and prognosis. The prevalence of hematological malignancies is expected to increase in the next 20 years because of better therapeutic options with longer survival and because of the aging population. However, patients with hematological malignancies are underrepresented in palliative care as these diseases are associated with special care needs and prognostic uncertainty, which differ from the unambiguity of terminally ill patients with solid tumors. This review describes the recent studies and guidelines addressing the problems in palliative care for patients with hematological malignancies.
RECENT FINDINGSRecent research covers prognostic uncertainty, challenges in terms of the acute death setting, and blood transfusions in the terminally ill as well as interdisciplinary collaboration. In addition to qualitative approaches exploring reasons for these challenges, criteria that indicate the approaching end of life in hematological malignancies were systematically developed and tested. Further, the effectiveness of palliative care addressing the hematopoietic stem cell transplantation setting was further analyzed.
SUMMARYThe patients’ perspective needs to be involved in future research to examine whether the connotation of ‘palliative care’ is a barrier for patients, families or healthcare professionals. Communication culture and skills have already been identified as goals for medical training. Further studies should identify the effective elements of palliative care specific for hematological malignancies and develop feasible support models, including informal caregivers.
Antibodies targeting epidermal growth factor receptor (EGFR) have proven to be effective in patients with non-small cell lung
cancer (NSCLC) that express EGFR. We recently published a phase I study ...of weekly matuzumab plus paclitaxel. This therapy
was well tolerated and showed clinical responses in the majority of patients. Although matuzumab displays potent antitumor
activity in some patients, not all patients respond well to treatment. Whether dysregulation of EGFR-mediated pathways precludes
or sensitizes cells to paclitaxel is unknown. We sought to determine molecular predictive factors for therapy response in
a phase I/II study patient cohort treated with matuzumab ± paclitaxel. Twenty-three cases including one complete response
(CR), three partial responses (PR), 10 stable diseases (SD) were screened using immunohistochemistry (IHC), fluorescence
in situ hybridization (FISH), PCR/sequencing and denaturing wave high performance liquid chromatography (D-HPLC) for expression,
amplification, and mutation status of EGFR and downstream signaling pathways. All patients with PR or CR displayed an either
high overall or single-cell EGFR expression in the majority of cells. In addition, all of the moderate responders, who achieved
SD after at least two cycles of therapy, showed diffuse EGFR expression rates and/or strong single-cell EGFR expression. In
contrast, 44% of the nonresponders showed low overall or single-cell EGFR expression levels. No low-expressing EGFR cases
were present within the responder group. In addition, among patients with a gain-of-function mutation in KRAS primary therapy
failure and/or short responses to therapy were observed. Our data suggest that EGFR expression and KRAS mutation status is
predictive for clinical response to matuzumab ± paclitaxel in patients with advanced NSCLC. Mol Cancer Ther 2009;8(3):481–9
Rationale
The purpose of this study was to prospectively evaluate the perspectives of palliative care patients, their family caregivers, and their attending palliative care specialists on frequency, ...intensity, distress, and treatment requirement of the patient’s physical and psychological symptoms.
Patients and methods
Forty advanced cancer patients and their family caregivers were recruited through a palliative care inpatient ward within 24 h after admission. Patients, caregivers, and physicians completed a modified version of the Memorial Symptom Assessment Scale (including perceived treatment requirement).
Results
Thirty-nine patients (98 %) suffered from at least one symptom frequently or almost constantly (median number 5; range, 0–9). Most frequent symptoms were lack of energy (95 %), tiredness (88 %), and pain (80 %), which were scored correspondingly by patients, caregivers, and physicians to be the most intensive, distressing, and treatment requiring. Treatment requirement was determined by symptom intensity or distress in patients and physicians, but by distress in caregivers. Significant differences in symptom burden between patients, caregivers, and physicians were found with regard to pain (
p
= .007), tiredness (
p
= .037), lack of energy (
p
< .05), anxiety (
p
< .05), and sadness (
p
< .05). Physicians underestimated 60 % of symptom dimensions, while the caregivers overestimated 77 %; however, overall median scoring differences were limited with −.10 (range, −.55 to +.25) between patients and physicians and +.33 (range, −.78 to +.61) between patients and family caregivers.
Conclusions
While physicians tended to underestimate, family caregivers tended to overestimate the patient’s symptoms. Therefore, adequate symptom treatment can only be successful in a close dialog between patients, their caregivers, and a multidisciplinary team.
Germ cell tumors (GCTs) are the most common malignancy among men aged between 15 to 45. Despite high cure rates of >90% over all GCTs, 3 to 5% of patients will still die of platinum-refractory ...disease. New systemic treatment options are needed to improve treatment success in this challenging setting.
To review targeted treatment options and preclinical developments in platinum-refractory GCTs, a comprehensive literature search of PubMed, Medline and scientific meeting abstracts on published clinical trials and reports on molecularly targeted approaches was conducted. Outcomes of platinum-refractory disease and of patients failing high-dose chemotherapy remain poor. Currently, no molecularly targeted treatment has shown clinically meaningful activity in unselected patient populations in clinical trials, but individual patients may achieve short-lived objective responses by treatment with sunitinib, brentuximab vedotin or imatinib. Targeted trials based on molecular selection of patients have not yet been performed.
The limited activity of targeted agents in refractory GCT is disappointing. Assessment of druggable biomarkers and marker-stratified treatment may help individual patients, but is largely lacking. The low incidence and high curability of GCTs make the design of larger clinical trials difficult. The potential of novel agents, i.e. immune-checkpoint inhibitors, remains to be elucidated.
This prospective one-year cohort study aimed to assess the feasibility and outcomes of a routine psychosocial screening at patients' admittance to specialist inpatient palliative care. Patients ...admitted to an academic palliative care ward were routinely screened for self-reported distress and psychological morbidity, psychosocial stress factors, and subjective need for help from psychosocial professions. Cognitive impairments were the most common patient barrier to screening. Screenings were completed in 138 of 428 patients (32%). Based on established cutoffs, distress was indicated in 89%, depression in 51%, and anxiety in 50% of these patients. The burden on next-of-kin emerged as the most prevalent stress factor (73%). One-half of the patients disclosed a subjective need for help (53%). Possible depression (p = .023), anxiety (p < .001), and subjective need for help (p < .001) correlated positively with a higher amount of time spent by psychologists and creative arts-based therapists with small to moderate effects. Patients who completed the screening were attributed with a higher amount of time by social workers than patients who did not (p = .004), but there were no relationships between screening results and social work. Results suggest the potential of screenings for the allocation of specialist psychosocial care during specialist palliative care; however, barriers to screening do exist.
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