Abstract
Purpose
Surgical complications such as hypoparathyroidism (HPT) or vocal cord palsy are seldom assessed when the quality of life (QOL) in thyroid cancer patients is investigated. The aim of ...this study was to measure the QOL difference in thyroid cancer survivors with and without HPT.
Methods
Participants for this analysis were enrolled in 13 countries from a study that pilot-tested a thyroid cancer–specific QOL instrument. They were included if they had been diagnosed with thyroid cancer at least 9 months previously. QOL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) and some items on HPT symptoms (eg, tingling in fingers or toes). HPT status and other clinical data were extracted from the patients’ medical charts. Comparisons of QOL domains between patients with and without HPT were performed using Mann-Whitney U test. The occurrence of HPT-related symptoms was compared using chi-square tests. Multiple ordinal regression analysis was performed to evaluate factors that might affect QOL.
Results
Eighty-nine patients participated in this study, 17 of whom were considered to have HPT. Patients in the HPT group reported significantly reduced QOL in 9 of the 15 scales of the EORTC QLQ-C30 compared to patients without HPT. Regression analysis showed that HPT was independently negatively associated with various scales of the QLQ-C30. Both groups showed a high prevalence of typical HPT symptoms.
Conclusion
Thyroid cancer patients with HPT report significantly impaired QOL compared to thyroid cancer survivors without HPT. The assessment of HPT should be considered when measuring QOL in thyroid cancer patients.
Abstract
Introduction In head and neck cancer (HNC) patients, fatigue is present throughout the course of treatment and during follow-up. Cancer-related fatigue (CRF) is a significant ...treatment-related side effect experienced by oral cancer patients during and after treatment. CRF, when coupled with other side effects of oral cavity cancer, patients who undergo definitive treatment have some of the most dramatic acute side effects, and reduced overall quality of life (QoL). Although there are upcoming intervention strategies to manage CRF, the effect of exercise intervention is explored in this study. The rationale for considering exercise to manage CRF is that it may alleviate the combined effect of toxic treatment and decreased levels of activity during the treatment that reduces the capacity for physical performance.
Objective This study was conducted to investigate the effectiveness of exercise intervention on CRF, and its influence on functional capacity and QoL among patients with oral cavity cancer during and after their primary cancer treatment.
Materials and Methods Oral cavity cancer patients (n = 223), planned for only chemoradiotherapy with curative intent were screened for CRF. Based on the inclusion criteria, 69 patients were grouped randomly into experimental (n = 35) and control (n = 34) groups. Patients in the experimental group were provided structured exercise intervention, while the control group was offered standard and routine care. Structured exercise in this present study comprised moderate-intensity walking and resistance exercises using TheraBand every day for three to five times a week. CRF was assessed using symbolic assessment of fatigue extent and the functional capacity was assessed by 6-minute walk test (6MWT), maximal oxygen uptake (VO2max), and hand dynamometer. QoL was assessed using the European Organization for Research and Treatment for Cancer-QoL (EORTC QLQ-C30) and the Head and Neck Cancer module (HN35), while distress was assessed by the National Comprehensive Cancer Network (NCCN) Distress Thermometer. Randomized patients were assessed at four points.
Result The size effects in fatigue extent (ηp
2 = 0.40) and fatigue impact (ηp
2 = 0.41) were found to be moderate, and a positive correlation between 6MWT, fatigue extent, and fatigue impact was observed.
Conclusion This study suggests that exercise intervention has a significant positive impact on CRF, most aspects of QoL, and the functional capacity of the patients.
Background:
Tobacco use contributes to almost 40% of the cancers in India. Considering the potential threat, many preventive measures have been instigated in the country. However, tobacco cessation ...for hospitalized cancer patients is an unexplored territory in India. This study aims to understand the quit status and to explore the reasons to quit or continue the use of tobacco after the diagnosis of head and neck cancer (HNC).
Methods:
HNC patients admitted between February and April 2016 were assessed for their tobacco use status. A DT was used to assess the psychological distress. Users were assessed for their readiness to quit and dependence on tobacco. An in-depth interview was conducted among 25 patients (seven current users and 18 recent quitters), and themes that emerged were discussed.
Results:
Of the 119 HNC patients, 71 were tobacco users and 48 had quit tobacco after the diagnosis. The reasons to quit were the perceived benefits of quitting, advice from the physicians, and awareness about cancer and its association with tobacco. In contrast, the reasons to continue the use of tobacco were attributed to coping mechanisms, nihilistic perception about the outcome of the cancer, and a lack of understanding about cancer and its association with tobacco.
Conclusion:
The recent quitters comprehended the benefits of quitting and were able to prioritize their needs after the diagnosis. However, one-third of the HNC patients continued to use tobacco even after the diagnosis of cancer. Hence, tobacco cessation services need to be integrated into oncology services for achieving better treatment outcomes.
The purpose of the study was to pilot-test a questionnaire measuring health-related quality of life (QoL) in thyroid cancer patients to be used with the European Organisation for Research and ...Treatment of Cancer (EORTC) core questionnaire EORTC QLQ-C30. A provisional questionnaire with 47 items was administered to patients treated for thyroid cancer within the last 2 years. Patients were interviewed about time and help needed to complete the questionnaire, and whether they found the items understandable, confusing or annoying. Items were kept in the questionnaire if they fulfilled pre-defined criteria: relevant to the patients, easy to understand, not confusing, few missing values, neither floor nor ceiling effects, and high variance. A total of 182 thyroid cancer patients in 15 countries participated (
= 115 with papillary,
= 31 with follicular,
= 22 with medullary,
= 6 with anaplastic, and
= 8 with other types of thyroid cancer). Sixty-six percent of the patients needed 15 min or less to complete the questionnaire. Of the 47 items, 31 fulfilled the predefined criteria and were kept unchanged, 14 were removed, and 2 were changed. Shoulder dysfunction was mentioned by 5 patients as missing and an item covering this issue was added. To conclude, the EORTC quality of life module for thyroid cancer (EORTC QLQ-THY34) is ready for the final validation phase IV.
Background and challenges to implementation: Section 6b of Cigarettes and Other Tobacco Products Act (COTPA)-2004 and Article 16 of Framework Convention on Tobacco Control (FCTC) insists on ...restricting the access and availability of tobacco products to children as one of the supply reduction measures. Several countries have taken initiatives restricting the sale of tobacco products near Educational Institutions (EIs) and in India it is prohibited around 100 meter radius. However, the implementation has become a major challenge as it is difficult to map the distance between EIs and tobacco outlets, and to prove the shop keepers that they are evading the law. To address this issue, an android based application called Safe Zone is designed. Intervention or response: Safe Zone is a Software tool that helps to identify tobacco outlets in and around EI. The technology used was Google MAP API, Google Maps, HTML5 / CSS3 / Java Script, GPS - Global Positioning System and GPRS - Data connection, Geo-coordinates algorithm. The details of the software are given as Figure 1. Results and lessons learnt: This software gets your current GPS location and finds all EIs within 100 meter radius nearby and flags us along with the distance. It can show us the precise DISPLACEMENT between given shop and given EI locations. This software works in almost all smart phones that have GPS and GPRS - data connection. The internals of the software Conclusions and key recommendations: This can be customized and used in any country based on their respective country law. It will help the Social activists, Government officials and Law Enforcement officers, who wants to enforce the Law of the Land in creating safe zone to take evidence based actions to curtail the sale of tobacco in the EI zones and General Public who wants to check whether their kid's school/ home is located in a tobacco free zone or not.
Routine screening for distress is a guideline prescribed by the National Comprehensive Cancer Network (NCCN) to adequately assess distress in a cancer setting. Our centre conducted routine screening ...but failed to utilize psycho-oncology services. Our aim was to assess the extent of self-reported distress, referrals to psycho-oncology services and healthcare provider perspectives about the existing distress management system and psycho-oncology services.
We conducted a record review of adult patients (n=372) who reported to the Out-patient department of the tertiary cancer centre. Semi-structured interviews were conducted with fourteen healthcare providers. We used a concurrent mixed methods study design. Adult patients were screened for distress using NCCN-Distress Thermometer and problem checklist. Healthcare providers from different oncology specialties were interviewed and the data was analysed using descriptive thematic analysis.
Patients screened for distress were found to report moderate to extreme levels of distress (53.5%). The total referrals to psycho-oncology support services were low (8.6%). Interviews with healthcare providers revealed three major themes: Enablers, barriers and solutions for utilization of distress management system and psycho-oncology services.
Moderate to extreme distress was found among patients routinely screened for distress, although there was poor utilization of distress management system and psycho-oncology support services due to time constraints, patient's negative attitudes towards mental health referrals, generic screening tools and use of own clinical judgement to make referrals by healthcare providers. Future research warrants implementation of strategies to integrate psycho-oncology services into routine cancer care by focusing on improving visibility of services.
Background: In India, opportunistic screening is routinely conducted for cervical cancer, but systematic, community-based screening is relatively new. Hence, the uptake and follow-up for ...community-based screening remain poor. Objectives: In this study, we aimed to explore the barriers to community-based screening and suggest possible solutions for mitigating the loss to follow-up among screen-positive women from the perspectives of both, the community women (CWs) and service providers (SPs). Materials and Methods: This descriptive, qualitative study conducted at a non-governmental organization in Tirunelveli district of Tamil Nadu between December 2017 and January 2018 included 11 CWs who completed various stages of screening and five SPs involved in community-based screening. The participants were purposively identified and interviewed face to face using a semi-structured questionnaire. Interviews were conducted in Tamil, following which the transcripts were validated by the participants, translated to English, and analyzed. The reporting was based on the Consolidated Criteria for Reporting Qualitative Research guidelines. Results: Unawareness and poor understanding of the screening process, fear associated with the procedures and the disease, no financial and family support, and sociocultural beliefs were identified as the barriers to follow-up. Persistent follow-up through phone calls and home visits along with increasing the awareness about the screening process and its benefits, establishing a rapport with the community, and using local community-based organizations to track the CWs are suggested as possible measures to mitigate the loss to follow-up. Conclusion: Sociocultural, economic, and psychological factors are the main barriers to follow-up after initial screening in cervical cancer screening programs. Conducting population-based systematic screening and awareness programs and keeping the local public healthcare professionals on the frontline along with incentivizing the healthcare professionals and screen-positive women are recommended to improve the adherence to follow-up.
Background: Electronic cigarette (e-cigarette) is an emerging class of electronic nicotine-delivery system claimed by the industries as a quitting aid. Laboratory testing of some refill liquids for ...e-cigarettes(e-liquids) contain impurities and toxic substances, or are not filled true to label. The additional impurities in the liquids or vapour (e.g., polyaromatic hydrocarbons (PAHs), Tobacco specific nitrosamines (TSNAs), aldehydes and acrolein), unexpected toxins and/or unreliable nicotine in different glycols mixed with concentrated flavours, warrants a thorough evaluation of the chemical constituents of these E-liquids. Previous research in the evaluation of these constituents involved gas or liquid chromatography (GC, LC) combined with mass spectrometric (MS) detection for the analysis in combination with 1H- Nuclear Magnetic Resonance (NMR) analysis. This study aimed to evaluate the chemical composition of e-liquid refills using 1H- NMR, 13C-NMR along with DEFT, GCMS and IR spectroscopic analysis. Methods: A total of 6 samples marketed and sold highly in India through online, claimed to have 0,3,6,12 and 18 milligrams of nicotine and one sample claiming no nicotine/no tar were identified and purchased. The presence of Tobacco Specific Nitrosamines (TSNAs), tobacco alkaloids, Polycyclic Aromatic Hydrocarbons (PAHs), Volatile Organic Compound (VOCs) were analysed using 1H- NMR, 13C-NMR along with DEPT, Gas Chromatography Mass Spectroscopy (GCMS) and IR spectroscopy. Results: Significant levels of VOCs were noted which included glycerin, propylene and ethylene glycol. Acrolein and PAH were not detected in the samples. However, presence of additional organic compounds including nitrosamines, and nicotine were detected by13C- NMR, DEPT and IR spectroscopy. Conclusions: NMR spectroscopy is a useful and rapid method to simultaneously detect several ingredients in e-liquids, and GCMS, IR and DEFT also provided additional information on the constituents of e-liquid products. Systematic evaluation of chemical constituents of the e-cigarette may hence throw light on its possible short term and long term health effects.
Background: After persistent civil society and judicial interventions, 85% Pictorial Health Warning (PHW) was implemented in India since April, 2016. The previous 40% PHW had negligible impact in ...preventing new users and motivating existing users to quit tobacco. The current PHW printed on smoking products is picture of a throat cancer and on smokeless tobacco products is cancer of oral cavity and this should cover 85% of the outer panel of the tobacco products. Text message as "Smoking causes cancer, Smoking kills" also printed on the packs. The present study aimed at understanding the impact of 85% PHW on motivating tobacco users to quit. Methods: Tobacco users (n=99) were chosen by convenient sampling from Chennai, Tamil Nadu. One cigarette packet and one chewing tobacco packet printed with 85% PHW was shown to them and interviewed using a semi structured questionnaire. The questions included were, their current tobacco use, comprehension of text and PHWs printed on tobacco products and its ability to motivate the users to quit. Results: Majority of the tobacco users (84.8%) noticed the health warnings on tobacco products (PHW-13.1%, Text warning-14.1%, Both-57.5%). Overall 67.6% tobacco users(Smoking-46.4%, smokeless-21.2%) were able to identify the picture correctly and 55.5% related the picture to health problems. A few users (8%) couldn't read the text warning since it was printed in English. The understanding is better if they could read the text warning also. The 52.5% of the users reported that the PHW made them to think about quitting and 72.7% reported that PHW will motivate the users to quit. The users (38.3%) reported total ban as the best measure for tobacco control. Conclusions: The 85% PHW has positive impact in motivating the tobacco users to quit. However, printing the text warning in regional language will be effective for the people who cannot read English.
PDF
