Objective: Social support is fundamentally important to the well-being of patients with cancer, and informal caregivers often wish they had better insight into how to help. The aims of this study ...were to quantify the types of social support that patients qualitatively expressed as important, and examine whether demographics and mental health symptoms explained the type of support desired.
Methods: A sample of 82 patients with cancer (Gender: 65.9% Male, Age: M = 57.5, Race/Ethnicity: 90.2% White, non-Latino/a) completed measures of demographics, health, anxiety, and depression, and responded to an open-ended question asking them to list three types of support that they desire from their caregivers. These responses were then reliably coded into 18 different categories.
Results: Most commonly, participants expressed a desire for companionship (45%). Other common requests included empathy (33%), home care support (28%), information support (16%), being treated the same (15%), and help with appointments (13%). Patients who were more anxious were more likely to desire companionship (OR = 4.41, p = .033), and younger patients were more likely to desire home care support (OR = 7.24, p = .016).
Conclusion: Findings have implications for providing individually-tailored social support to patients with cancer.
In vitro testing of the activity of chemotherapeutic agents has been suggested as 1 method to optimally select drugs for patients with ovarian cancer. There are limited prospectively obtained data ...examining the clinical utility of this approach. We sought to obtain a preliminary assessment of this strategy in a trial that examined the administration of neoadjuvant chemotherapy followed by surgical cytoreduction and intraperitoneal chemotherapy in women with advanced ovarian cancer.
Women with stage III/IV epithelial ovarian carcinoma that presented with large-volume disease were treated with neoadjuvant intravenous paclitaxel and carboplatin for three 21-day cycles followed by cytoreductive surgery. If optimally debulked, patients received intravenous paclitaxel, intraperitoneal carboplatin and intraperitoneal paclitaxel for six 28-day cycles. Tumor cloning assay results (Oncotech) were correlated with progression-free survival.
Sixty-two patients (58 eligible) were registered from March 2001 to February 2006. Thirty-six eligible patients had interval debulking and 26 received postcytoreduction chemotherapy. Twenty-two patients had tumor cloning assay results available. The clinical features of this population were similar to those of the larger group of women who entered this study. There was no difference in progression-free survival between patients whose cancers were defined as 'resistant' or 'nonresistant' to either platinum or paclitaxel.
While the small patient numbers in this trial do not permit definitive conclusions, these data fail to provide support for the argument that prospectively obtained in vitro data regarding platinum or paclitaxel resistance will be highly predictive of clinical outcome in advanced ovarian cancer.
Purpose/Objectives: Screening for distress is a key priority in cancer care, and African American patients may experience increased distress compared to White patients. However, this question has not ...yet been addressed in Louisiana. The purpose of the present study was to examine the relationship between African American race and distress at a cancer center in Louisiana.
Design/Methods: This was a retrospective study of 1,544 patients who were treated at an academic cancer center in 2015. Extracted data included patient self-reports of distress using the single-item Distress Thermometer (DT) and demographic and clinical characteristics. Hypotheses were tested using logistic regression.
Findings: Distress was present in 19.7% of the sample. In univariate analyses, African American patients were more likely than White patients to experience distress (OR = 1.38, p = .013). However, race was no longer associated with distress in a multivariate analysis that adjusted for the covariates of age, gender, cancer site, presence of metastases, and number of distress screenings (OR = 1.07, p = .670). Distress was more common in patients who were younger (OR = 2.26, p < .001), diagnosed with lung/bronchus cancer (OR = 5.28, p < .001), or screened more often (OR = 5.20, p < .001). Distress was less common among patients with female breast cancer (OR = 0.39, p = .015).
Conclusions/Implications: This study suggests that African American individuals with cancer in Louisiana are at increased risk for distress, but that this can be attributed to African American patients being younger, more likely to have lung cancer, and screened more frequently. Implications include careful consideration of patient race, age, and cancer site during distress management in cancer care.
INTRODUCTION:To determine whether progression-free and overall survival of women with cervical cancer has changed in New Orleans since Hurricane Katrina in 2005.
METHODS:All patients with cervical ...cancer diagnosed from 2000 to 2009 were identified from Tumor Registries at Tulane Cancer Center and Medical Center of Louisiana–New Orleans. Demographics, stage, progression-free, and overall survival data were collected. Statistical analysis was done using widely accepted testing methods.
RESULTS:A total of 494 patients were identified with cervical cancer during this period. Sixty-five percent (325) were diagnosed pre-Katrina (2000 to August 31, 2005) and 35% (169) were diagnosed post-Katrina (August 31, 2005–2009). No statistically significant difference in progression-free survival (27.0 compared with 31.0 months, P=.67) or overall survival (35 compared with 38 months, P=.53) was identified. Furthermore, no change was identified in incidence of stage IVB cervical cancer pre-Katrina compared with post-Katrina (23/325 7% compared with 17/169 10%; P=.29).
CONCLUSION:There was no change in outcome in patients with cervical cancer with respect to stage, progression-free, or overall survival in the years after Hurricane Katrina in New Orleans. This is in contrast to reported declines in outcome noted in other health care measures, including cardiovascular and psychiatric disorders, in the same time period. Possible reasons include the pathophysiologic course of cervical neoplasia, which typically requires decades to progress to cancer, or the relatively poor outcome associated with cervical cancer in New Orleans for many years before Hurricane Katrina. In contrast to other reported health care declines, identification of changes in cervical cancer outcomes may require much longer and more complex studies.
Abstract Objectives Changes in cognitive function have been identified in and reported by many cancer survivors. These changes have the potential to impact patient quality of life and functional ...ability. This prospective longitudinal study was designed to quantify the incidence of change in cognitive function in newly diagnosed ovarian cancer patients throughout and following primary chemotherapy. Methods Eligible patients had newly diagnosed, untreated ovarian cancer and had planned to receive chemotherapy. Web-based and patient reported cognitive assessments and quality of life questionnaires were conducted prior to chemotherapy, prior to cycle four, after cycle six, and six months after completion of primary therapy. Results Two-hundred-thirty-one evaluable patients entered this study between May 2010 and October 2011. At the cycle 4 time point, 25.2% (55/218) of patients exhibited cognitive impairment in at least one domain. At the post-cycle 6 and 6-month follow up time points, 21.1% (44/208) and 17.8% (30/169) of patients, respectively, demonstrated impairment in at least one domain of cognitive function. There were statistically significant, but clinically small, improvements in processing speed (p < 0.001) and attention (p < 0.001) but not in motor response time (p = 0.066), from baseline through the six-month follow up time period. Conclusions This was a large, prospective study designed to measure cognitive function in ovarian cancer. A subset of patients had evidence of cognitive decline from baseline during chemotherapy treatment in this study as measured by the web-based assessment; however, changes were generally limited to no more than one domain.
INTRODUCTION:Targeted cancer therapies based on tumor molecular analysis have grown exponentially in the last 5 years. Multiple gynecologic tumors can express markers that predict response to ...specific treatments. However not all insurance covers costly testing for every tumor marker, which can prevent un- or under-insured women from receiving optimal treatment. We worked with independent laboratories to provide free or cost-reduced testing. This studyʼs aim is to demonstrate the impact of a universal molecular-based therapeutic program for gynecologic cancers in a low-resource environment.
METHODS:Women with new gynecologic cancers presenting to an inner-city academic facility were identified between 1/1/18 and 6/30/18. Pedigree analysis and molecular testing of tumor specimens were done in all subjects. Data collected includesdemographics (including insurance status), tumor type and stage, and initial treatments.
RESULTS:45 women with gynecologic cancer were identified. (Cervix-18, Ovary-7, Uterus-10, Vulva/vagina-10). 5/18 cervix cancers showed Combined Predictive Score >1.0; 3/10 uterine cancers showed mismatch repair (MMR) deficiencies; 3/10 vulva/vagina showed MMR deficiencies; and 2/7 ovarian cancers showed somatic BRCA mutations. In this 6-month period, 13/45 (29%) of gynecologic malignancies diagnosed had molecular markers associated with targeted therapies, and 7/13 (53%) patients with predictive molecular markers accepted a targeted therapy.
CONCLUSION:Molecular analysis of cancer with therapy based on molecular markers is the gold standard for gynecologic cancers. 29% of the subjects had molecular markers associated with targeted therapies. While molecular testing and targeted therapies may be expensive, many laboratories and pharmaceutical companies are willing to work with patients with limited resources.
The survival of cervix cancer patients is associated with their hemoglobin (Hgb) level during radiotherapy. The Southwest Oncology Group (SWOG) conducted a phase II trial to determine whether ...recombinant human erythropoietin (rHuEPO) safely corrects anemia during chemoradiotherapy for cervix cancer.
Patients had stage IIB–IVA cervix cancer and a Hgb between 8.0 and 12.5 g/dl. All patients received rHuEPO thrice weekly and oral iron starting 10–15 days before their 5-week course of whole pelvic irradiation and weekly cisplatin followed by intracavitary brachytherapy.
Fifty-three patients from 26 institutions received the protocol treatment. The mean Hgb was 10.4 ± 1.3 g/dl on the first day of rHuEPO administration (baseline), 11.0 ± 1.6 g/dl on the first day of chemoradiotherapy, 11.6 ± 1.9 g/dl at the midpoint of chemoradiotherapy, and 11.8 ± 2.2 g/dl at the end of chemoradiotherapy. The target Hgb level of 12.5 g/dl was achieved in 40% of patients (95% CI 26–56%) by the midpoint of Chemoradiotheraphy. Change in Hgb was associated with baseline serum iron (P = 0.008) and transferrin saturation (P = 0.05) levels, but not with baseline Hgb or serum ferritin, or patient age. Seven patients developed deep vein thrombosis. Two-year progression-free survival (PFS) was 43% and overall survival (OS) was 51%. Survival was significantly associated with Hgb level at the end of chemoradiotherapy, but not with the baseline Hgb level.
rHuEPO and iron gradually increased Hgb levels in anemic women with local advanced cervix cancer during chemoradiotherapy. There was a higher than expected incidence of deep vein thrombosis. The progression-free and overall survival rates were lower than reported for women with normal Hgb levels.
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