Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM.
Intensity-modulated radiotherapy with simultaneous modulated accelerated boos...Enrique Moreno Gonzalez
To present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).
Anti-lymphangiogenic properties of mTOR inhibitors in head and neck squamous ...Enrique Moreno Gonzalez
Tumor dissemination to cervical lymph nodes via lymphatics represents the first step in the metastasis of head and neck squamous cell carcinoma (HNSCC) and is the most significant predictor of tumor recurrence decreasing survival by 50%. The lymphatic suppressing properties of mTOR inhibitors are not yet well understood.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
Protons Compared to Photons in Pediatric PatientsDanielle Buswell
Proton radiation therapy may reduce risks of late side effects compared to photon therapy for pediatric patients with medulloblastoma. Proton therapy decreases exit dose which can cause toxicities like heart problems, hearing loss, and neurocognitive deficits. Studies found proton therapy resulted in fewer neurocognitive deficits and lower risks of secondary cancers. While proton therapy may have better outcomes, its higher cost must be considered compared to photon therapy for each patient.
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Incidence of pneumonia and risk factors among patients with head and neck can...Enrique Moreno Gonzalez
This study investigated the incidence and patient- and treatment-related risk factors related to pneumonia acquired during radiotherapy (PNRT) in head and neck cancer (HNC) patients.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
Intensity-modulated radiotherapy with simultaneous modulated accelerated boos...Enrique Moreno Gonzalez
To present our experience of intensity-modulated radiotherapy (IMRT) with simultaneous modulated accelerated radiotherapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC).
Anti-lymphangiogenic properties of mTOR inhibitors in head and neck squamous ...Enrique Moreno Gonzalez
Tumor dissemination to cervical lymph nodes via lymphatics represents the first step in the metastasis of head and neck squamous cell carcinoma (HNSCC) and is the most significant predictor of tumor recurrence decreasing survival by 50%. The lymphatic suppressing properties of mTOR inhibitors are not yet well understood.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
Protons Compared to Photons in Pediatric PatientsDanielle Buswell
Proton radiation therapy may reduce risks of late side effects compared to photon therapy for pediatric patients with medulloblastoma. Proton therapy decreases exit dose which can cause toxicities like heart problems, hearing loss, and neurocognitive deficits. Studies found proton therapy resulted in fewer neurocognitive deficits and lower risks of secondary cancers. While proton therapy may have better outcomes, its higher cost must be considered compared to photon therapy for each patient.
This document discusses reirradiation in recurrent head and neck cancer. It notes that radiation therapy plays a central role in head and neck cancer treatment but recurrence still occurs in 20-35% of patients. Reirradiation presents challenges due to prior radiation exposure and damage to normal tissues. The document discusses treatment options, appropriate patient selection, techniques like IMRT to minimize dose to organs at risk, optimal timing and dosing of reirradiation, and management of toxicities.
Incidence of pneumonia and risk factors among patients with head and neck can...Enrique Moreno Gonzalez
This study investigated the incidence and patient- and treatment-related risk factors related to pneumonia acquired during radiotherapy (PNRT) in head and neck cancer (HNC) patients.
1. Re-irradiation involves delivering a second course of radiation to patients who develop recurrent or new primary tumors in an area previously treated with radiation. It requires careful patient selection and consideration of normal tissue tolerance to minimize toxicity risks.
2. A multidisciplinary evaluation is necessary to determine if re-irradiation provides a survival or palliative benefit over other treatment options like chemotherapy or surgery. Factors like tumor type, initial treatment details, disease control, and patient performance status must be considered.
3. Advanced radiation techniques like IMRT can help spare nearby organs-at-risk and lower toxicity when used for re-irradiation. Close monitoring during treatment is still needed to watch for normal tissue complications.
Malnutrition is common in cancer patients, affecting 40-80% during their disease course. It negatively impacts treatment outcomes, mortality, and quality of life. Early screening and nutritional interventions can help prevent weight loss and treatment interruptions. A multidisciplinary team approach is needed to address nutritional status from diagnosis onward through cancer treatment. Screening tools help identify at-risk patients who need comprehensive assessment and individualized nutritional support through diet, oral supplements, enteral feeding, or parenteral nutrition as needed. Exercise should also be encouraged to preserve muscle mass. Prioritizing nutritional care represents good clinical practice that can optimize cancer treatment.
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
Reirradiation can provide local tumor control for recurrent head and neck cancer when surgery is not possible. Modern radiation techniques like IMRT allow higher radiation doses to be safely delivered to the tumor while minimizing risks of severe toxicity. Outcomes from reirradiation include a median survival of 10-12 months and 2-year local control rates of 40-64%. Patient selection is important to balance potential benefits of local tumor control against risks of treatment-related side effects.
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
A convenient clinical nomogram for small intestine adenocarcinomanguyên anh doanh
The document describes a study that developed a nomogram to predict cancer-specific survival for patients with small-intestine adenocarcinoma. Researchers analyzed data on 4,971 patients from the SEER database and identified 8 factors associated with survival: age, sex, marital status, insurance status, grade, stage, surgery status, and chemotherapy. These factors were used to create a nomogram that assigns a score to each variable to predict 3- and 5-year survival probabilities. Validation tests found the nomogram predicted survival more accurately than the AJCC staging system and closely matched actual survival rates.
This document discusses salvage radiotherapy for locally recurrent prostate cancer after primary radiation. It notes that while salvage brachytherapy is commonly used, studies have shown high rates of severe toxicity and disappointing cancer control. New diagnostic techniques like MRI and PET scans, along with improved biopsy methods, now allow localization of recurrent tumors, enabling focal salvage techniques. This is expected to reduce toxicity while maintaining cancer control. The document provides selection criteria for salvage treatment, noting it may benefit carefully selected patients with pathology-proven local recurrence at least 2-3 years after primary treatment and limited tumor presentation.
This document discusses hypofractionation in the treatment of head and neck cancers. It begins by outlining outcomes for different stages of disease, then discusses how fraction size, total dose, and treatment time impact treatment. Hypofractionation can counter tumor repopulation and improve local control. Studies show hypofractionation is effective for early disease, palliative cases, and can be safely delivered using simultaneous integrated boost with IMRT. Severe toxicity is low while disease control remains high. Extreme hypofractionation with SBRT also provides good local control with acceptable toxicity.
Ultrasound Technology as a Novel Treatment Strategy in Pancreatic Cancer_Crim...CrimsonpublishersCancer
Adenocarcinoma of the pancreas (PDAC) accounts for 2.4% of all cancers diagnosed and is the fourth leading cause of cancer death, with almost equal rates of incidence and mortality [1]. By 2030, pancreatic cancer is projected to be the second leading cause of cancer-related death [2], surpassing breast, prostate and colorectal cancer. The overall survival at 5 years of around 7.2% as the majority of patients present with advanced disease at diagnosis. Patients with localized disease are treated with surgery, with or without neoadjuvant chemotherapy/ radiotherapy, followed by adjuvant chemotherapy. The majority (around 80%) of patients are treated only with chemotherapy as they have an advanced disease. Patients are treated in the first line with gemcitabine-abraxane or Folfirinox and with Naliri plus 5FU in the second line. There have been few clinical advances in PDAC treatment over the last 20 years and chemotherapy is the only treatment option available for the majority of patients. These tumours are also resistant to many targeted therapies such as anti-EGFR therapy like cetuximab [3] due to the presence of a KRAS mutation in the majority of primary tumors. Personalized medicine strategies have not yet been established in pancreatic cancer as in other more common tumour types. Thus, novel anti-tumour strategies are an important clinical need in order to improve survival rates.
34320294 jak inhibitors more than just glucocorticoids (1)EVELIN LÁZARO
This editorial discusses recent trials investigating immunomodulatory therapies for COVID-19. It finds that treatment with glucocorticoids (dexamethasone) and JAK inhibitors reduces mortality in hospitalized patients receiving supplemental oxygen or ventilation. Combining JAK inhibitors with glucocorticoids may widen the window of benefit compared to either treatment alone. The editorial concludes that anti-inflammatory therapies reduce mortality in COVID-19 patients with moderate to severe disease, and that JAK inhibitors are a particularly promising option due to their oral administration, safety profile, and potential for combination with glucocorticoids.
Optimal Treatment for Clinically Node Positive Prostate Cancer -A Brief Analy...Kanhu Charan
1. The document discusses the optimal treatment for clinically node positive prostate cancer, which is a controversial issue due to lack of randomized trial data.
2. It analyzes guidelines from the NCCN, results from the RTOG 85-31 trial, and studies from the national cancer database which all suggest that androgen deprivation therapy (ADT) plus radiation therapy provides better survival outcomes than ADT alone.
3. While most evidence comes from retrospective studies, the findings indicate that ADT plus radiation should be the standard treatment, and a randomized controlled trial is still needed to confirm potential survival benefits seen in previous analyses.
This document describes the development of a novel intratumoral drug delivery system using interstitial chemotherapy devices. The system aims to deliver chemotherapy drugs directly into solid tumors via implantable polymeric devices to achieve higher drug concentrations and more homogeneous distribution compared to systemic chemotherapy. The document outlines the design of biodegradable polymer implants loaded with cisplatin as a model drug. In vitro studies show sustained release of cisplatin from the implants over 1 month in a rate dependent on drug loading. The system has the potential for localized treatment with fewer systemic side effects.
Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally ad...Enrique Moreno Gonzalez
Current standard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy, and, variably per institution, postoperative adjuvant chemotherapy. Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both randomized and observational studies. The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer, hepatic metastases from colorectal cancer and is currently tested in primary colon cancer.
16 cco korean perspectives of nasopharynx cancer managementYong Chan Ahn
This document discusses nasopharynx cancer (NPC) in Korea. It begins by providing background on NPC epidemiology and the association between NPC subtypes and Epstein-Barr virus prevalence. It then discusses the establishment of a Korean NPC database and findings from analyses of the database. Key findings include improvements in survival over time associated with advances in imaging, radiation technique, and use of concurrent chemotherapy. Studies from the database found concurrent chemoradiation is optimal for stage II NPC and that neoadjuvant or adjuvant chemotherapy did not provide additional benefits when added to concurrent chemoradiation for advanced stages.
Discuss the principles guiding the use of radiotherapy in surgeryAbdullahi Sanusi
The document discusses the principles guiding the use of radiotherapy in surgery. It covers topics such as the physical and biological basis of radiotherapy, indications and contraindications, treatment planning, technical aspects, and complications. Radiotherapy is an important clinical discipline for treating cancer and some benign diseases. About 60% of cancer patients require radiotherapy during their treatment course. The principles of radiotherapy are based on understanding the physical and biological effects of ionizing radiation on tumors and normal tissues. [END SUMMARY]
This document provides an overview of palliative radiation therapy for cancer patients. It discusses the fundamentals of how radiation works and advances that have allowed it to more effectively treat cancer. It then focuses on how palliative radiation can effectively relieve symptoms from bone metastases, lung cancer, bleeding, and other cancers in 1-3 fractions rather than longer courses of treatment. Studies show short fractionation schedules provide pain relief comparable to longer schedules with fewer side effects and greater convenience. The document provides guidance on discussing palliative radiation options with radiation oncologists to help simplify the process for hospice patients.
1) The document discusses the case of a 38-year-old Hindu male patient from Visakhapatnam presenting with a 2x1cm ulcer on the right lateral border of his tongue.
2) It describes his medical history including a history of ill-fitting dentures and dying during an MRI evaluation due to an allergic reaction to contrast.
3) The oncologist discusses potential treatment options with the patient including radiation therapy to preserve his tongue and avoid surgery, as well as interviews with ENT specialists and a dentist.
The cysteinyl leukotriene 2 receptor contributes to all-trans retinoic acid-i...Enrique Moreno Gonzalez
Cysteinyl leukotrienes (CysLTs) are potent pro-inflammatory mediators that are increased in samples from patients with inflammatory bowel diseases (IBDs). Individuals with IBDs have enhanced susceptibility to colon carcinogenesis. In colorectal cancer, the balance between the pro-mitogenic cysteinyl leukotriene 1 receptor (CysLT1R) and the differentiation-promoting cysteinyl leukotriene 2 receptor (CysLT2R) is lost. Further, our previous data indicate that patients with high CysLT1R and low CysLT2R expression have a poor prognosis. In this study, we examined whether the balance between CysLT1R and CysLT2R could be restored by treatment with the cancer chemopreventive agent all-trans retinoic acid (ATRA).
Nitroglycerin 0.4% ointment vs placebo in the treatment of pain resulting fro...Enrique Moreno Gonzalez
This randomized, double-blind, placebo-controlled study compared nitroglycerin (NTG) 0.4% ointment to placebo for treating pain from chronic anal fissures. 247 patients applied either NTG or placebo ointment twice daily for 21 days. The primary outcome was change in pain levels from days 14-18. While the prespecified analysis found no difference, post hoc analyses found NTG reduced pain more than placebo. Headache was the most common side effect. This was the first such study to control for analgesics used to treat NTG-induced headaches, finding NTG 0.4% effectively reduced chronic anal fissure pain compared to placebo.
Fatty liver index correlates with non-alcoholic fatty liver disease, but not ...Enrique Moreno Gonzalez
Fatty liver index (FLI) was recently established to predict non-alcoholic fatty liver disease (NAFLD) in general population, which is known to be associated with coronary artery atherosclerotic disease (CAD).
This study aims to investigate whether FLI correlates with NAFLD and with newly diagnosed CAD in a special Chinese population who underwent coronary angiography.
Sox2 suppresses the invasiveness of breast cancer cells via a mechanism that ...Enrique Moreno Gonzalez
Sox2, an embryonic stem cell marker, is aberrantly expressed in a subset of breast cancer (BC). While the aberrant expression of Sox2 has been shown to significantly correlate with a number of clinicopathologic parameters in BC, its biological significance in BC is incompletely understood.
Sticky siRNAs targeting survivin and cyclin B1 exert an antitumoral effect on...Enrique Moreno Gonzalez
Melanoma represents one of the most aggressive and therapeutically challenging malignancies as it often gives rise to metastases and develops resistance to classical chemotherapeutic agents. Although diverse therapies have been generated, no major improvement of the patient prognosis has been noticed. One promising alternative to the conventional therapeutic approaches currently available is the inactivation of proteins essential for survival and/or progression of melanomas by means of RNA interference. Survivin and cyclin B1, both involved in cell survival and proliferation and frequently deregulated in human cancers, are good candidate target genes for siRNA mediated therapeutics.
Chemokine (C-X-C) ligand 1 (CXCL1) protein expression is increased in aggress...Enrique Moreno Gonzalez
This study examined CXCL1 protein expression in 152 bladder tissue samples, including 142 cancer samples and 10 benign samples, using immunohistochemical staining. The key findings were:
1) CXCL1 protein expression was present in cancerous bladder tissues but entirely absent in benign bladder tissues.
2) CXCL1 expression was significantly higher in high-grade and high-stage tumors compared to low-grade and low-stage tumors.
3) Increased CXCL1 expression was associated with reduced disease-specific survival and overall survival.
So in summary, this study found that CXCL1 protein expression is increased in more aggressive bladder cancers and associated with poorer survival outcomes. This suggests CXCL1 may play a
Malnutrition is common in cancer patients, affecting 40-80% during their disease course. It negatively impacts treatment outcomes, mortality, and quality of life. Early screening and nutritional interventions can help prevent weight loss and treatment interruptions. A multidisciplinary team approach is needed to address nutritional status from diagnosis onward through cancer treatment. Screening tools help identify at-risk patients who need comprehensive assessment and individualized nutritional support through diet, oral supplements, enteral feeding, or parenteral nutrition as needed. Exercise should also be encouraged to preserve muscle mass. Prioritizing nutritional care represents good clinical practice that can optimize cancer treatment.
This document discusses the options and challenges for reirradiating recurrent brain tumors. It may be considered for gliomas or brain metastases if the prior radiation tolerance doses of critical structures like the optic pathways, brainstem and whole brain have not been exceeded. Differentiating tumor recurrence from treatment effects like necrosis or pseudoprogression is important prior to reirradiation. Short interval since prior radiation and large tumor volume predict poor outcomes. With smaller recurrences in favorable locations, reirradiation using techniques like stereotactic radiosurgery may be offered if the radiation interval is over 6 months. A multidisciplinary discussion weighing risks and benefits is needed for each case.
Reirradiation can provide local tumor control for recurrent head and neck cancer when surgery is not possible. Modern radiation techniques like IMRT allow higher radiation doses to be safely delivered to the tumor while minimizing risks of severe toxicity. Outcomes from reirradiation include a median survival of 10-12 months and 2-year local control rates of 40-64%. Patient selection is important to balance potential benefits of local tumor control against risks of treatment-related side effects.
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
A convenient clinical nomogram for small intestine adenocarcinomanguyên anh doanh
The document describes a study that developed a nomogram to predict cancer-specific survival for patients with small-intestine adenocarcinoma. Researchers analyzed data on 4,971 patients from the SEER database and identified 8 factors associated with survival: age, sex, marital status, insurance status, grade, stage, surgery status, and chemotherapy. These factors were used to create a nomogram that assigns a score to each variable to predict 3- and 5-year survival probabilities. Validation tests found the nomogram predicted survival more accurately than the AJCC staging system and closely matched actual survival rates.
This document discusses salvage radiotherapy for locally recurrent prostate cancer after primary radiation. It notes that while salvage brachytherapy is commonly used, studies have shown high rates of severe toxicity and disappointing cancer control. New diagnostic techniques like MRI and PET scans, along with improved biopsy methods, now allow localization of recurrent tumors, enabling focal salvage techniques. This is expected to reduce toxicity while maintaining cancer control. The document provides selection criteria for salvage treatment, noting it may benefit carefully selected patients with pathology-proven local recurrence at least 2-3 years after primary treatment and limited tumor presentation.
This document discusses hypofractionation in the treatment of head and neck cancers. It begins by outlining outcomes for different stages of disease, then discusses how fraction size, total dose, and treatment time impact treatment. Hypofractionation can counter tumor repopulation and improve local control. Studies show hypofractionation is effective for early disease, palliative cases, and can be safely delivered using simultaneous integrated boost with IMRT. Severe toxicity is low while disease control remains high. Extreme hypofractionation with SBRT also provides good local control with acceptable toxicity.
Ultrasound Technology as a Novel Treatment Strategy in Pancreatic Cancer_Crim...CrimsonpublishersCancer
Adenocarcinoma of the pancreas (PDAC) accounts for 2.4% of all cancers diagnosed and is the fourth leading cause of cancer death, with almost equal rates of incidence and mortality [1]. By 2030, pancreatic cancer is projected to be the second leading cause of cancer-related death [2], surpassing breast, prostate and colorectal cancer. The overall survival at 5 years of around 7.2% as the majority of patients present with advanced disease at diagnosis. Patients with localized disease are treated with surgery, with or without neoadjuvant chemotherapy/ radiotherapy, followed by adjuvant chemotherapy. The majority (around 80%) of patients are treated only with chemotherapy as they have an advanced disease. Patients are treated in the first line with gemcitabine-abraxane or Folfirinox and with Naliri plus 5FU in the second line. There have been few clinical advances in PDAC treatment over the last 20 years and chemotherapy is the only treatment option available for the majority of patients. These tumours are also resistant to many targeted therapies such as anti-EGFR therapy like cetuximab [3] due to the presence of a KRAS mutation in the majority of primary tumors. Personalized medicine strategies have not yet been established in pancreatic cancer as in other more common tumour types. Thus, novel anti-tumour strategies are an important clinical need in order to improve survival rates.
34320294 jak inhibitors more than just glucocorticoids (1)EVELIN LÁZARO
This editorial discusses recent trials investigating immunomodulatory therapies for COVID-19. It finds that treatment with glucocorticoids (dexamethasone) and JAK inhibitors reduces mortality in hospitalized patients receiving supplemental oxygen or ventilation. Combining JAK inhibitors with glucocorticoids may widen the window of benefit compared to either treatment alone. The editorial concludes that anti-inflammatory therapies reduce mortality in COVID-19 patients with moderate to severe disease, and that JAK inhibitors are a particularly promising option due to their oral administration, safety profile, and potential for combination with glucocorticoids.
Optimal Treatment for Clinically Node Positive Prostate Cancer -A Brief Analy...Kanhu Charan
1. The document discusses the optimal treatment for clinically node positive prostate cancer, which is a controversial issue due to lack of randomized trial data.
2. It analyzes guidelines from the NCCN, results from the RTOG 85-31 trial, and studies from the national cancer database which all suggest that androgen deprivation therapy (ADT) plus radiation therapy provides better survival outcomes than ADT alone.
3. While most evidence comes from retrospective studies, the findings indicate that ADT plus radiation should be the standard treatment, and a randomized controlled trial is still needed to confirm potential survival benefits seen in previous analyses.
This document describes the development of a novel intratumoral drug delivery system using interstitial chemotherapy devices. The system aims to deliver chemotherapy drugs directly into solid tumors via implantable polymeric devices to achieve higher drug concentrations and more homogeneous distribution compared to systemic chemotherapy. The document outlines the design of biodegradable polymer implants loaded with cisplatin as a model drug. In vitro studies show sustained release of cisplatin from the implants over 1 month in a rate dependent on drug loading. The system has the potential for localized treatment with fewer systemic side effects.
Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally ad...Enrique Moreno Gonzalez
Current standard for most of the locally advanced rectal cancers is preoperative chemoradiotherapy, and, variably per institution, postoperative adjuvant chemotherapy. Short-course preoperative radiation with delayed surgery has been shown to induce tumour down-staging in both randomized and observational studies. The concept of neo-adjuvant chemotherapy has been proven successful in gastric cancer, hepatic metastases from colorectal cancer and is currently tested in primary colon cancer.
16 cco korean perspectives of nasopharynx cancer managementYong Chan Ahn
This document discusses nasopharynx cancer (NPC) in Korea. It begins by providing background on NPC epidemiology and the association between NPC subtypes and Epstein-Barr virus prevalence. It then discusses the establishment of a Korean NPC database and findings from analyses of the database. Key findings include improvements in survival over time associated with advances in imaging, radiation technique, and use of concurrent chemotherapy. Studies from the database found concurrent chemoradiation is optimal for stage II NPC and that neoadjuvant or adjuvant chemotherapy did not provide additional benefits when added to concurrent chemoradiation for advanced stages.
Discuss the principles guiding the use of radiotherapy in surgeryAbdullahi Sanusi
The document discusses the principles guiding the use of radiotherapy in surgery. It covers topics such as the physical and biological basis of radiotherapy, indications and contraindications, treatment planning, technical aspects, and complications. Radiotherapy is an important clinical discipline for treating cancer and some benign diseases. About 60% of cancer patients require radiotherapy during their treatment course. The principles of radiotherapy are based on understanding the physical and biological effects of ionizing radiation on tumors and normal tissues. [END SUMMARY]
This document provides an overview of palliative radiation therapy for cancer patients. It discusses the fundamentals of how radiation works and advances that have allowed it to more effectively treat cancer. It then focuses on how palliative radiation can effectively relieve symptoms from bone metastases, lung cancer, bleeding, and other cancers in 1-3 fractions rather than longer courses of treatment. Studies show short fractionation schedules provide pain relief comparable to longer schedules with fewer side effects and greater convenience. The document provides guidance on discussing palliative radiation options with radiation oncologists to help simplify the process for hospice patients.
1) The document discusses the case of a 38-year-old Hindu male patient from Visakhapatnam presenting with a 2x1cm ulcer on the right lateral border of his tongue.
2) It describes his medical history including a history of ill-fitting dentures and dying during an MRI evaluation due to an allergic reaction to contrast.
3) The oncologist discusses potential treatment options with the patient including radiation therapy to preserve his tongue and avoid surgery, as well as interviews with ENT specialists and a dentist.
The cysteinyl leukotriene 2 receptor contributes to all-trans retinoic acid-i...Enrique Moreno Gonzalez
Cysteinyl leukotrienes (CysLTs) are potent pro-inflammatory mediators that are increased in samples from patients with inflammatory bowel diseases (IBDs). Individuals with IBDs have enhanced susceptibility to colon carcinogenesis. In colorectal cancer, the balance between the pro-mitogenic cysteinyl leukotriene 1 receptor (CysLT1R) and the differentiation-promoting cysteinyl leukotriene 2 receptor (CysLT2R) is lost. Further, our previous data indicate that patients with high CysLT1R and low CysLT2R expression have a poor prognosis. In this study, we examined whether the balance between CysLT1R and CysLT2R could be restored by treatment with the cancer chemopreventive agent all-trans retinoic acid (ATRA).
Nitroglycerin 0.4% ointment vs placebo in the treatment of pain resulting fro...Enrique Moreno Gonzalez
This randomized, double-blind, placebo-controlled study compared nitroglycerin (NTG) 0.4% ointment to placebo for treating pain from chronic anal fissures. 247 patients applied either NTG or placebo ointment twice daily for 21 days. The primary outcome was change in pain levels from days 14-18. While the prespecified analysis found no difference, post hoc analyses found NTG reduced pain more than placebo. Headache was the most common side effect. This was the first such study to control for analgesics used to treat NTG-induced headaches, finding NTG 0.4% effectively reduced chronic anal fissure pain compared to placebo.
Fatty liver index correlates with non-alcoholic fatty liver disease, but not ...Enrique Moreno Gonzalez
Fatty liver index (FLI) was recently established to predict non-alcoholic fatty liver disease (NAFLD) in general population, which is known to be associated with coronary artery atherosclerotic disease (CAD).
This study aims to investigate whether FLI correlates with NAFLD and with newly diagnosed CAD in a special Chinese population who underwent coronary angiography.
Sox2 suppresses the invasiveness of breast cancer cells via a mechanism that ...Enrique Moreno Gonzalez
Sox2, an embryonic stem cell marker, is aberrantly expressed in a subset of breast cancer (BC). While the aberrant expression of Sox2 has been shown to significantly correlate with a number of clinicopathologic parameters in BC, its biological significance in BC is incompletely understood.
Sticky siRNAs targeting survivin and cyclin B1 exert an antitumoral effect on...Enrique Moreno Gonzalez
Melanoma represents one of the most aggressive and therapeutically challenging malignancies as it often gives rise to metastases and develops resistance to classical chemotherapeutic agents. Although diverse therapies have been generated, no major improvement of the patient prognosis has been noticed. One promising alternative to the conventional therapeutic approaches currently available is the inactivation of proteins essential for survival and/or progression of melanomas by means of RNA interference. Survivin and cyclin B1, both involved in cell survival and proliferation and frequently deregulated in human cancers, are good candidate target genes for siRNA mediated therapeutics.
Chemokine (C-X-C) ligand 1 (CXCL1) protein expression is increased in aggress...Enrique Moreno Gonzalez
This study examined CXCL1 protein expression in 152 bladder tissue samples, including 142 cancer samples and 10 benign samples, using immunohistochemical staining. The key findings were:
1) CXCL1 protein expression was present in cancerous bladder tissues but entirely absent in benign bladder tissues.
2) CXCL1 expression was significantly higher in high-grade and high-stage tumors compared to low-grade and low-stage tumors.
3) Increased CXCL1 expression was associated with reduced disease-specific survival and overall survival.
So in summary, this study found that CXCL1 protein expression is increased in more aggressive bladder cancers and associated with poorer survival outcomes. This suggests CXCL1 may play a
Antibiotic exposure and the development of coeliac disease: a nationwide case...Enrique Moreno Gonzalez
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.
Clinical features and outcome of cryptogenic hepatocellular carcinoma compare...Enrique Moreno Gonzalez
Cryptogenic hepatocellular carcinoma (HCC) is thought to arise due to non-alcoholic fatty liver disease (NAFLD). This study investigated the prevalence, clinical features, and outcomes of cryptogenic HCC and compared them with those of HCC related to hepatitis B virus infection (HBV-HCC), hepatitis C virus infection (HCV-HCC), and alcohol (ALCHCC) in Korea.
Association between variations in the fat mass and obesity-associated gene an...Enrique Moreno Gonzalez
It is clear that genetic variations in the fat mass and obesity-associated (FTO) gene affect body mass index and the risk of obesity. Given the mounting evidence showing a positive association between obesity and pancreatic cancer, this study aimed to investigate the relation between variants in the FTO gene, obesity and pancreatic cancer risk.
A phase I/II trial to evaluate the safety, feasibility and activity of salvag...Enrique Moreno Gonzalez
The current standard treatment of patients with relapsed or refractory diffuse large cell B-Cell lymphoma (DLBCL) primarily consists of intensified salvage therapy and, if the disease is chemo-sensitive, high dose therapy followed with autologous stem cell transplantation. In the rituximab era however, this treatment approach has shown only limited benefit. In particular, patients relapsing after rituximab-containing primary treatment have an adverse prognosis, especially if this occurs within the first year after therapy or if the disease is primarily refractory. Therefore there is an ultimate need for improved salvage treatment approaches.
Intraepithelial lymphocyte distribution differs between the bulb and the seco...Enrique Moreno Gonzalez
Evaluation of intraepithelial duodenal lymphocytosis (IDL) is important in celiac disease (CD). There is no established cut-off value for increased number of IELs in the bulb. We therefore investigated the relation between IEL counts in the bulb and duodenal specimens in non-celiac subjects.
Frizzled-8 receptor is activated by the Wnt-2 ligand in non-small cell lung c...Enrique Moreno Gonzalez
This document summarizes a research study that investigated the activation of Wnt-2 signaling through the Frizzled-8 receptor in non-small cell lung cancer (NSCLC). The study found a correlation between increased expression of Wnt-2 and Frizzled-8 in lung cancer tissue samples. A novel dominant-negative Wnt-2 construct (dnhWnt-2) inhibited Wnt-2 signaling activation and reduced colony formation of NSCLC cells in vitro and tumor growth in a mouse xenograft model. The dnhWnt-2 construct may provide a new therapeutic approach for targeting the Wnt pathway in lung cancer.
Implication from thyroid function decreasing during chemotherapy in breast ca...Enrique Moreno Gonzalez
Thyroid hormones have been shown to regulate breast cancer cells growth, the absence or reduction of thyroid hormones in cells could provoke a proliferation arrest in G0-G1 or weak mitochondrial activity, which makes cells insensitive to therapies for cancers through transforming into low metabolism status. This biological phenomenon may help explain why treatment efficacy and prognosis vary among breast cancer patients having hypothyroid, hyperthyroid and normal function. Nevertheless, the abnormal thyroid function in breast cancer patients has been considered being mainly caused by thyroid diseases, few studied influence of chemotherapy on thyroid function and whether its alteration during chemotherapy can influence the respose to chemotherapy is still unclear. So, we aimed to find the alterations of thyroid function and non-thyroidal illness syndrome (NTIS) prevalence druing chemotherapy in breast cancer patients, and investigate the influence of thyroid hormones on chemotherapeutic efficacy.
Overexpression of peptide deformylase in breast, colon, and lung cancersEnrique Moreno Gonzalez
Human mitochondrial peptide deformylase (PDF) has been proposed as a novel cancer therapeutic target. However, very little is known about its expression and regulation in human tissues. The purpose of this study was to characterize the expression pattern of PDF in cancerous tissues and to identify mechanisms that regulate its expression.
Induction of chromosome instability and stomach cancer by altering the expres...Enrique Moreno Gonzalez
There are strong indications for a causal association between areca-nut consumption and cancers. In Meghalaya, India, the variety of areca-nut is used as raw and unprocessed form whose chemical composition and pharmacological actions have been reported. Yet we know little on the initial pathway involved in areca-nut associated carcinogenesis since it is difficult to assess its effects on genetic alterations without interference of other compounding factors. Therefore, present study was undertaken in mice to verify the ability of raw areca-nut (RAN) to induce cancer and to monitor the expression of certain genes involved in carcinogenesis. This study was not intended to isolate any active ingredients from the RAN and to look its action.
Optimal schedule of Bacillus Calmette-Guerin for non-muscle-invasive bladder ...Enrique Moreno Gonzalez
To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).
Changes in quality of life among jordanian colorectal cancer patients a quali...Alexander Decker
The document summarizes a qualitative study that explored how a colorectal cancer diagnosis and treatment impacted patients' quality of life in Jordan. Ten Jordanian patients diagnosed with colorectal cancer participated in semi-structured interviews. Analysis of the interviews identified four main categories reflecting changes in patients' quality of life: 1) perceptions of quality of life such as diminished physical fitness and treatment side effects, 2) cancer as a source of distress through emotions, outlook on the future, and lost confidence, 3) changing roles like dependencies and altered responsibilities, and 4) changes in social life including isolation and disrupted family life. The study provides insight into how colorectal cancer affected patients' lives physically, psychologically, and socially.
Impact of a designed nursing intervention protocol on myocardial infarction p...Alexander Decker
This study examined the impact of a designed nursing intervention protocol on myocardial infarction patients' outcomes at a university hospital in Egypt. Forty adult myocardial infarction patients were included. The study found that after exposure to the nursing intervention protocol, patients had significantly higher total mean knowledge scores and total mean practice scores. It also found that patients had medium to high levels of compliance to lifelong instructions. The results support the hypotheses that the nursing intervention protocol improved patients' knowledge, practices, and compliance. The study concluded that a nursing intervention protocol can have a positive impact on myocardial infarction patient outcomes.
Cancer patients’ physical activity levels are thought to decline by at least one third following diagnosis and are often not recovered several years post treatment. Only 29.6% of cancer survivors are meeting the American Cancer Society’s and Public Health’s guidelines of 150 min of moderate intensity exercise per week. Previous research suggested that adherence to physical activity recommendations might be the most important lifestyle behavior associated with lower mortality and higher quality of life in cancer survivors.
CATCH ESR2 Gabriel Signorelli
The Effect of Surgery Type on the Quality of Life in Breast Cancer Patients:...Crimsonpublishers-IGRWH
The Effect of Surgery Type on the Quality of Life in Breast Cancer Patients: A Mini Review by Kefayat Chaman Ara in Investigations in Gynecology Research & Womens Health
The document discusses challenges in survivorship care and improving support for cancer patients after initial treatment. It notes the growing population of cancer survivors and issues around long-term health, quality of life, and unmet needs. Additionally, it examines evidence for interventions like physical activity programs, smoking cessation, and cognitive behavioral therapy in managing late and long-term effects of cancer treatment.
C L I N I C A L S T U D YValidation of the Mishel’s uncert.docxhumphrieskalyn
C L I N I C A L S T U D Y
Validation of the Mishel’s uncertainty in illness
scale-brain tumor form (MUIS-BT)
Lin Lin • Alvina A. Acquaye • Elizabeth Vera-Bolanos •
Jennifer E. Cahill • Mark R. Gilbert •
Terri S. Armstrong
Received: 4 May 2012 / Accepted: 3 September 2012 / Published online: 11 September 2012
� Springer Science+Business Media, LLC. 2012
Abstract The Mishel uncertainty in illness scale (MUIS)
has been used extensively with other solid tumors throughout
the continuum of illness. Interventions to manage uncer-
tainty have been shown to improve mood and symptoms.
Patients with primary brain tumors (PBT) face uncertainty
related to diagnosis, prognosis, symptoms and response.
Modifying the MUIS to depict uncertainty in PBT patients
will help define this issue and allow for interventions to
improve quality of life. Initially, 15 experts reviewed the
content validity of the MUIS-brain tumor form (MUIS-BT).
Patients diagnosed with PBT then participated in the study to
test validity and reliability. Data was collected at one point in
time. Six out of 33 items in the original MUIS were modified
to better describe PBT patients’ uncertainty. 32 of the 186
patients in the second-stage of the study were newly diag-
nosed with PBT, 85 were on treatment, and 69 were fol-
lowed-up without active treatment. The validity of the
MUIS-BT was demonstrated by its correlations with mood
states (P \ 0.01) and symptom severity (P \ 0.01) and
interference (P \ 0.01). The MUIS-BT measures four con-
structs: ambiguity/inconsistency, unpredictability of disease
prognosis, unpredictability of symptoms and other triggers,
and complexity. Cronbach’s alphas of the four subscales
were 0.90, 0.77, 0.75 and 0.65, respectively. The 33-item
MUIS-BT demonstrated adequate select measures of valid-
ity and reliability in PBT patients. Based on this initial val-
idation and significant correlations with symptom distress
and mood states, further understanding of uncertainty and
evaluation of measures to help manage patients’ uncertainty
can be evaluated which in turn may improve coping and
quality of life.
Keywords Brain tumors � Quality of life �
Self-report instruments � Symptoms � Uncertainty
Introduction
Primary brain tumors (PBTs) such as gliomas are a heter-
ogenous group of neoplasms associated with significant
morbidity and mortality. Glioblastoma multiforme (GBM)
is the most common and aggressive malignant glioma, and
treatment includes surgical resection, combined radiation
and temozolomide chemotherapy and then with monthly
cycles of temozolomide for up to one year [1, 2]. Once
initial treatment is completed, patients then undergo peri-
odic clinical follow-up with MRI to evaluate disease status.
At the time of recurrence, repeat tumor resection or che-
motherapy may be prescribed. Typically for recurrent
tumors, treatment is continued again until tumor progresses
or clinical symptoms mandate a change in thera ...
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
The document discusses enhancing quality of life as an important goal for cancer treatment. It notes that while treatments have increased survival rates, they can also cause chronic health issues for survivors that reduce quality of life. More research is needed to better understand and prevent these toxic side effects, through identifying biomarkers and mitigation strategies. The authors call for increased priority and resources for quality of life research to both improve existing treatments and enable more patients to benefit from new therapies.
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
Physiotherapists in primary care in the Republic of Ireland were surveyed about their assessment and management of lifestyle risk factors. The survey found that physiotherapists most commonly assessed physical activity levels, followed by dietary status. Few assessed smoking status or alcohol consumption. The main barriers to assessing these factors were lack of time, limited knowledge and expertise, and a perception that it was not part of their role. The study highlights opportunities for physiotherapists to play a greater role in addressing lifestyle risk factors through more systematic assessment and management. Training is needed to help overcome barriers identified in the survey.
This document discusses the need for geriatric assessments (GAs) in older cancer patients undergoing treatment. GAs evaluate patients' functional status, medical conditions, cognition, nutrition, social support and medications. The document aims to analyze evidence on how GAs impact treatment decisions and patient outcomes. It describes how GAs may alter treatments in up to 49% of patients by identifying age-related vulnerabilities. Studies show GAs correlate with survival rates, quality of life and toxicity risks. While GAs provide useful information, more research is still needed on their optimal use in oncology.
Effect of cardiac rehabilitation program on lifestyle pattern of patients wit...Alexander Decker
This document summarizes a study that examined the effect of a cardiac rehabilitation program on lifestyle practices of patients who had a myocardial infarction. The study included 50 adult patients admitted to hospitals in Mansoura, Egypt. Patients completed a questionnaire before and after a cardiac rehabilitation program that provided education on managing risk factors and lifestyle. The results found that after the program, patients showed highly statistically significant improvements in various lifestyle practices like nutrition, exercise, medical follow-up, health management skills, and coping with stress/emotions. This suggests that cardiac rehabilitation programs can positively influence lifestyle changes in patients with myocardial infarction.
Development and validation of chemotherapy induced alopecia distress scale (c...Jean Singh
This document describes the development and validation of the Chemotherapy-induced Alopecia Distress Scale (CADS) to measure distress from hair loss in breast cancer patients undergoing chemotherapy. Researchers developed questions through qualitative interviews with patients, then administered surveys to 305 patients to test the scale's structure and validity. Exploratory and confirmatory factor analyses identified a 17-item scale across 4 domains with good model fit. The CADS showed adequate reliability and validity when correlated with other psychosocial measures and in a validation study with 428 additional patients. The CADS is a reliable and valid tool for assessing distress from chemotherapy-induced hair loss in breast cancer patients.
This document reports on a study that evaluated factors associated with delayed patient appraisal of colorectal cancer symptoms. The study used a cross-sectional mixed methods design to collect data through 252 patient interviews and medical record reviews. Structural equation modeling tested relationships between symptoms, financial barriers, cognitive barriers, and delays in patients seeking care. The results found that experiencing cognitive barriers directly predicted longer delays in care-seeking. Financial barriers and symptoms were also found to indirectly influence delays through increasing cognitive barriers like symptom minimization. This suggests that financial concerns can impact how patients interpret their symptoms.
- The study systematically reviewed physical activity interventions for adolescent cancer patients and survivors. Four controlled trials involving physical activity during or after cancer treatment were identified.
- The limited evidence available suggests physical activity is safe for adolescent cancer patients, but more high-quality studies are needed to determine effectiveness on health outcomes due to few existing studies.
- Future research should investigate optimal timing, settings, durations and intensities of physical activity interventions as well as potential moderating factors like age, gender and cancer type.
Physical Activity Levels and Health Quality of Life in Spanish Young Adults w...semualkaira
To understand how healthy lifestyle behaviors patterns change across key phases of the disease in young adults. The main purposes were to evaluate change in minutes of physical activity in young adults with cancer across two timepoints: prior to and after cancer diagnosis, and to assess physical activity habits and HrQOL across the two timepoints.
Physical Activity Levels and Health Quality of Life in Spanish Young Adults w...semualkaira
To understand how healthy lifestyle behaviors patterns change across key phases of the disease in young adults. The main purposes were to evaluate change in minutes of physical activity in young adults with cancer across two timepoints: prior to and after cancer diagnosis, and to assess physical activity habits and HrQOL across the two timepoints.
Older patients commonly have health status issues that can affect cancer outcomes. The Comprehensive Geriatric Assessment (CGA) is an evaluation tool used by geriatricians to assess overall health status in domains like functional status, comorbidities, cognition, nutrition, and social support. Studies have shown impairments in these domains predict morbidity and mortality in older cancer patients. The CGA can help oncologists predict outcomes and select appropriate treatment, but it requires significant time. Screening tools are being researched to help identify patients that may benefit from further assessment. This chapter reviews the components and predictive value of the CGA in older cancer patients and how it can be practically incorporated into clinical oncology practice.
Similar to Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study (20)
Gene expression analysis of a Helicobacter pyloriinfected and high-salt diet-...Enrique Moreno Gonzalez
Helicobacter pylori (H. pylori) infection and excessive salt intake are known as important risk factors for stomach cancer in humans. However, interactions of these two factors with gene expression profiles during gastric carcinogenesis remain unclear. In the present study, we investigated the global gene expression associated with stomach carcinogenesis and prognosis of human gastric cancer using a mouse model.
Acute myeloid leukemia (AML) is a hematopoietic malignancy with a dismal outcome in the majority of cases. A detailed understanding of the genetic alterations and gene expression changes that contribute to its pathogenesis is important to improve prognostication, disease monitoring, and therapy. In this context, leukemia-associated misexpression of microRNAs (miRNAs) has been studied, but no coherent picture has emerged yet, thus warranting further investigations.
Recently, a phase II clinical trial in hepatocellular carcinoma (HCC) has suggested that the combination of sorafenib and 5-fluorouracil (5-FU) is feasible and side effects are manageable. However, preclinical experimental data explaining the interaction mechanism(s) are lacking. Our objective is to investigate the anticancer efficacy and mechanism of combined sorafenib and 5-FU therapy in vitro in HCC cell lines MHCC97H and SMMC-7721.
Differences in microRNA expression during tumor development in the transition...Enrique Moreno Gonzalez
The prostate is divided into three glandular zones, the peripheral zone (PZ), the transition zone (TZ), and the central zone. Most prostate tumors arise in the peripheral zone (70-75%) and in the transition zone (20-25%) while only 10% arise in the central zone. The aim of this study was to investigate if differences in miRNA expression could be a possible explanation for the difference in propensity of tumors in the zones of the prostate.
Multicentric and multifocal versus unifocal breast cancer: differences in the...Enrique Moreno Gonzalez
This study compared the expression of E-cadherin, β-catenin, and MUC1 in multicentric/multifocal breast cancers versus unifocal breast cancers of identical tumor size and grade. The study found significantly downregulated expression of E-cadherin in multicentric/multifocal cancers compared to unifocal cancers. In contrast, no significant differences were seen in β-catenin expression between the two groups. Within the unifocal group, E-cadherin and β-catenin expression were positively correlated, but this was not seen in the multicentric/multifocal group. The results suggest multicentric/multifocal and unifocal breast cancers differ in E-
The life in sight application study (LISA): design of a randomized controlled...Enrique Moreno Gonzalez
It is widely recognized that spiritual care plays an important role in physical and psychosocial well-being of cancer patients, but there is little evidence based research on the effects of spiritual care. We will conduct a randomized controlled trial on spiritual care using a brief structured interview scheme supported by an e-application. The aim is to examine whether an assisted reflection on life events and ultimate life goals can improve quality of life of cancer patients.
Clinical and experimental studies regarding the expression and diagnostic val...Enrique Moreno Gonzalez
Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a multifunctional Ig-like cell adhesion molecule that has a wide range of biological functions. According to previous reports, serum CEACAM1 is dysregulated in different malignant tumours and associated with tumour progression. However, the serum CEACAM1 expression in nonsmall-cell lung carcinomas (NSCLC) is unclear. The different expression ratio of CEACAM1-S and CEACAM1-L isoform has seldom been investigated in NSCLC. This research is intended to study the serum CEACAM1 and the ratio of CEACAM1-S/L isoforms in NSCLC.
Assessment of preoperative exercise capacity in hepatocellular carcinoma pati...Enrique Moreno Gonzalez
Cardiopulmonary exercise testing measures oxygen uptake at increasing levels of work and predicts cardiopulmonary performance under conditions of stress, such as after abdominal surgery. Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. This study examined the relationship between preoperative exercise capacity and event-free survival in hepatocellular carcinoma (HCC) patients with chronic liver injury who underwent hepatectomy.
Overexpression of YAP 1 contributes to progressive features and poor prognosi...Enrique Moreno Gonzalez
Yes-associated protein 1 (YAP 1), the nuclear effector of the Hippo pathway, is a key regulator of organ size and a candidate human oncogene in multiple tumors. However, the expression dynamics of YAP 1 in urothelial carcinoma of the bladder (UCB) and its clinical/prognostic significance are unclear.
CXCR7 is induced by hypoxia and mediates glioma cell migration towards SDF-1a...Enrique Moreno Gonzalez
Glioblastomas, the most common and malignant brain tumors of the central nervous system, exhibit high invasive capacity, which hinders effective therapy. Therefore, intense efforts aimed at improved therapeutics are ongoing to delineate the molecular mechanisms governing glioma cell migration and invasion.
Abnormal expression of Pygopus 2 correlates with a malignant phenotype in hum...Enrique Moreno Gonzalez
Pygopus 2 (Pygo2) is a Pygo family member and an important component of the Wnt signaling transcriptional complex. Despite this data, no clinical studies investigating Pygo2 expression in lung cancer have yet been reported.
Differentiation of irradiation and cetuximab induced skin reactions in patien...Enrique Moreno Gonzalez
In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before.
Cholestasis induces reversible accumulation of periplakin in mouse liverEnrique Moreno Gonzalez
Periplakin (PPL) is a rod-shaped cytolinker protein thought to connect cellular adhesion junctional complexes to cytoskeletal filaments. PPL serves as a structural component of the cornified envelope in the skin and interacts with various types of proteins in cultured cells; its level decreases dramatically during tumorigenic progression in human epithelial tissues. Despite these intriguing observations, the physiological roles of PPL, especially in noncutaneous tissues, are still largely unknown. Because we observed a marked fluctuation of PPL expression in mouse liver in association with the bile acid receptor farnesoid X receptor (FXR) and cholestasis, we sought to characterize the role of PPL in the liver and determine its contributions to the etiology and pathogenesis of cholestasis.
Functional p53 is required for rapid restoration of daunorubicin-induced lesi...Enrique Moreno Gonzalez
This document summarizes a research article that studied the role of p53 in daunorubicin (DNR)-induced lesions in the spleen. The key findings were:
1) DNR treatment caused more rapid cell death and weight loss in the spleens of wild type mice compared to p53-null mice.
2) While wild type mouse spleens recovered normal morphology 8 days after DNR treatment, p53-null mouse spleens still had large necrotic lesions.
3) DNR treatment increased p21 levels in wild type mice but not p53-null mice, indicating p53 is required for p21 induction.
4) The results suggest p53
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation car...Enrique Moreno Gonzalez
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
Impaired mitochondrial beta-oxidation in patients with chronic hepatitis C: r...Enrique Moreno Gonzalez
Hepatic steatosis is often seen in patients with chronic hepatitis C (CH-C). It is still unclear whether these patients have an impaired mitochondrial β-oxidation. In this study we assessed mitochondrial β-oxidation in CH-C patients by investigating ketogenesis during fasting.
Este documento presenta la laudatio del Dr. Enrique Moreno González, quien recibe el grado de Doctor Honoris Causa de la Universidad de Málaga. Resalta la trayectoria académica y profesional del Dr. Moreno, incluyendo sus logros en cirugía hepática y de trasplantes, sus cargos y distinciones, y su dedicación a la enseñanza. El orador destaca al Dr. Moreno como pionero quirúrgico, maestro, y persona comprometida con mejorar la atención médica a través
Environment inside even a small tumor is characterized by total (anoxia) or partial oxygen deprivation, hypoxia. It has been shown that radiotherapy and some conventional chemotherapies may be less effective in hypoxia, and therefore it is important to investigate how different drugs act in different microenvironments. In this study we perform a large screening of the effects of 19 clinically used or experimental chemotherapeutic drugs on four different cell lines in conditions of normoxia, hypoxia and anoxia.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. Perceived benefits and barriers to exercise for
recently treated patients with multiple myeloma: a
qualitative study
Melinda J Craike1*
*
Corresponding author
Email: Melinda.Craike@deakin.edu.au
Kaye Hose2
Email: myeloma@leukaemia.org.au
Kerry S Courneya3
Email: Kerry.Courneya@ualberta.ca
Simon J Harrison4,5
Email: Simon.Harrison@petermac.org
Patricia M Livingston1
Email: Trish.Livingston@deakin.edu.au
1
Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, VIC 3125,
Australia
2
Leukaemia Foundation Australia, Ground Floor, 205 Bell St, Preston, VIC
3072, Australia
3
Behavioral Medicine Laboratory, Faculty of Physical Education and Recreation,
E-488 Van Vliet Center, University of Alberta, Edmonton, AB T6G 2H9, Canada
4
Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A’beckett St,
Melbourne, VIC 8006, Australia
5
Sir Peter MacCallum Department of Oncology, University of Melbourne,
Parkville, VIC 3010, Australia
Abstract
Background
Understanding the physical activity experiences of patients with multiple myeloma (MM) is
essential to inform the development of evidence-based interventions and to quantify the
benefits of physical activity. The aim of this study was to gain an in-depth understanding of
the physical activity experiences and perceived benefits and barriers to physical activity for
patients with MM.
3. Methods
This was a qualitative study that used a grounded theory approach. Semi-structured
interviews were conducted in Victoria, Australia by telephone from December 2011-February
2012 with patients who had been treated for MM within the preceding 2–12 months.
Interviews were transcribed and analysed using the constant comparison coding method to
reduce the data to themes. Gender differences and differences between treatment groups were
explored.
Results
Twenty-four interviews were completed. The sample comprised 13 females (54%), with a
mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem
cell transplant (ASCT). All participants currently engaged in a range of light to moderate
intensity physical activity; walking and gardening were the most common activities.
Recovery from the symptoms of MM and side effects of therapy, psychological benefits,
social factors and enjoyment were important benefits of physical activity. Barriers to physical
activity predominately related to the symptoms of MM and side effects of therapy, including
pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women
participated in a more diverse range of physical activities than men and there were gender
differences in preferred type of physical activity. Women were more likely to report
psychological and social benefits; whereas men reported physical activity as a way to keep
busy and self-motivation was a barrier. Patients treated with a ASCT more often reported
affective benefits of participation in physical activity and fatigue as a barrier. Patients treated
with other therapies (e.g., chemotherapy, radiotherapy) were more likely to report pain as a
barrier.
Conclusions
Patients with MM experience debilitating effects of their condition and therapy, which
influences their level and intensity of physical activity participation. Physical activity
programs should be individualised; take into consideration gender differences and the impact
of different types of therapy on physical activity; and focus on meeting the psychological,
coping and recovery needs of patients.
Keywords
Cancer, Oncology, Multiple myeloma, Physical activity, Exercise
Background
Multiple myeloma (MM) is an incurable malignancy of plasma cells. In 2010 in Australia, it
was estimated that 1,400 people were diagnosed with MM, representing 1.2% of all cancer
diagnoses. MM is more common in men than women; the average age at diagnosis is 70
years [1]. Although there is currently no cure for MM, modern therapy can control the
disease for prolonged periods and the 5-year survival rates for MM have increased from 26%
to 42% from 1985–1989 to 2005–2009 in Victoria, Australia [2].
4. The preferred therapy for patients with MM depends on their age, functional status and
comorbidities. In Australia, guidelines recommend that autologous stem cell transplantation
(ASCT) should be the standard of care in patients up to 65–70 years following induction
therapy. This therapy comprises an induction regimen incorporating novel agents
(thalidomide, bortezomibor or lenalidomide) designed to preserve the capacity to harvest
haematopoietic stem cells. Patients older than 65 years with poor performance status, or
younger patients with comorbidities are not eligible for ASCT due to increasing toxicity,
regimens usually combine melphalan and steroids with novel agents. Supportive therapy may
include the use of bisphosphonates and erythropoietin as per updated guidelines [3].
The treatment regimens for MM are complex and demanding [3]. The impact of the
underlying disease and the side effects of treatment include chronic pain, fatigue, nausea and
vomiting, recurrent infections and anaemia [4,5]. Patients also frequently suffer from
osteoporosis and osteolytic bone lesions, putting them at increased risk of pathological
fracture [6,7]. These outcomes reduce the quality of life of patients and are often associated
with increased incidence of depression, anxiety and distress [4,5,8].
Physical activity has been shown, through randomised controlled trials, to improve physical
and psychological outcomes among patients with solid tumours [9-11]. This has led to
interest in how participation in physical activity may be facilitated for cancer survivors [12-
14]. Physical activity behaviors, and the factors that influence these behaviors, vary by cancer
diagnosis [15-17], patient demographics [6,7,15], and stage in the cancer journey [15,16].
Thus it is important to examine the barriers to physical activity and benefits of participation
in physical activity for specific cancer groups, such as MM, and at a defined stage in the
illness trajectory.
Examination of the specific benefits of physical activity for people with MM is a relatively
new area of research, but one that is gaining increasing attention as the prevalence of MM
increases and lifestyle behaviors, such as physical activity, are recognised as important
factors in overall patient outcomes [18-20]. Research to date, albeit limited, has shown that
physical activity is safe and feasible before, during and following treatment for MM; can
alleviate some of the side effects of treatment, including fatigue; and can enhance the quality
of life of patients [18,21,22]. Despite these promising findings, the pathophysiology of MM
and associated therapies may make physical activity uptake and adherence a challenge for
this group. Participation in physical activity is lower for people with MM than other cancer
types [18,23]. In addition, Coleman et al. reported a high exercise attrition rate of 42% in
MM patients who participated in a randomised trial [22].
One way of increasing our understanding of physical activity in the lives of people with MM
is to examine participation experiences and the perceived benefits of and barriers to
participation. This information is essential to inform the development of evidence-based
interventions to encourage physical activity uptake and adherence and to quantify the benefits
of physical activity for this group. The aim of this study was to gain new insights in to the
physical activity experiences, perceived benefits, and barriers to participation for patients
who were treated for MM within the preceding 2–12 months. Due to limited research in this
area and the exploratory nature of this study, a qualitative approach that examined physical
activity experiences within the context of the patient’s broader life and from the patient’s
perspective, was selected.
5. Methods
This study was approved by the Human Research Ethics Committee at Deakin University.
Research participants
Male and female patients who completed treatment for MM were interviewed for this study.
Inclusion criteria were people living in Victoria Australia, aged 18 years and over; a
diagnosis of symptomatic MM who had completed therapy (chemotherapy, radiotherapy,
induction therapy and/or transplant) 2-12 months prior; and with the ability to speak English
and complete English-language versions of the patient-completed measures.
Procedure
A purposive sampling technique was used to select patients who were living in Victoria,
Australia. The patient database maintained by the Leukaemia Foundation of Australia was
used to identify potential participants. The database was screened for patient names, cancer
diagnosis, age and address details as well as approximate date(s) of treatment for MM.
Potential participants were sent a cover letter and Participant Information and Consent Form,
which provided an overview of the study, eligibility criteria, and an explanation of what
participation in the study would involve. If patients deemed themselves eligible and wished to
participate, they were asked to complete the consent form and return it. Once received, the
interviewer rang the patient to confirm that they met the eligibility criteria and an interview
time was arranged.
A self-administered questionnaire was mailed to participants prior to the telephone interview.
Participants were asked to complete the questionnaire before completing the interview and
could use it as a reference point during the interview. On completion of the interview,
participants were asked to return the questionnaire using a reply paid envelope.
Telephone interviews were conducted from December 2011-February 2012. The interviews
were conducted with a nurse counsellor with knowledge of MM and extensive experience in
conducting interviews with cancer patients. Interviews were conducted by telephone and
were recorded (with the permission of participants). Interviews continued until saturation was
reached. A summary of the research findings was sent to the participants once the study was
completed.
Measures
The questionnaire completed prior to the interview measured patient and clinical
characteristics, including date of birth, highest level of education, postcode, living
arrangements, treatment type and length of time since treatment. Current and pre diagnosis
physical activity was measured using an adapted version of the Leisure Time Exercise
Questionnaire developed by Godin et al. [24,25]. Participants recorded their average weekly
physical activity prior to diagnosis (pre diagnosis physical activity) and their average weekly
physical activity in the past month (current physical activity). The Leisure Time Exercise
Questionnaire assesses average frequency and duration of light (e.g., easy walking), moderate
(e.g., brisk walking) and vigorous (e.g., running) physical activity. It has been used in studies
of cancer survivors [26,27] and patients with MM [18].
6. A grounded theory approach was taken in this study [28]. Interviews were semi-structured
and follow up questions and probes facilitated a deeper understanding of the participants’
perceptions and experiences of physical activity. The interview prompts focused on
participation in physical activity before, during and after treatment and any perceived barriers
and benefits of participation. The interview was guided by a series of pre-determined
prompts, with flexibility in the order in which they were covered to allow the interview to
flow. Prompts included: “Can you describe your participation in exercise before during and
after treatment?”; “What things stop or limit your participation in exercise?”; and “What
things motivate you to exercise?”
One interviewer conducted all of the interviews. Author one briefed the interviewer about the
aims and purpose of the interviews and listened to and gave feedback on interviewing style.
Regular meetings were held between author one and the interviewer to discuss important
themes, the point at which saturation was reached and any logistical issues.
Data analysis
Descriptive statistics were used to analyse the questionnaire data, including the demographic
and clinical characteristics and participation in physical activity
In terms of qualitative data, the interviews were transcribed verbatim and the accuracy of the
transcripts was verified, with 80% checked by the researchers against the interview
recordings. Data from the interviews were analysed using the nVivo software package.
Pseudonyms were assigned to participants so that they could not be identified.
The analysis process was inductive and coding was used to reduce the data into meaningful
themes [29]. The coding procedures applied the “constant comparison” method [30]. The
constant comparison method utilises three stages of coding. For the initial stage, a relevant
code was applied to ideas in the transcripts to develop categories which captured the meaning
of the idea [31]. Under the supervision of authors one and five, a research assistant coded the
data. As a way of validating the codes, three interviews were independently coded by author
one to check the interpretations of the coder and validate the themes. There was agreement
between both researchers as to the dominant themes and their interpretation of the meaning
from the ideas represented in the interviews.
The second stage of coding involved reducing codes through grouping similar codes into
broader, more encompassing themes and comparing them to one another and cross checking
back to the original interview text. In the final stage, categories were delimited to gain
parsimony and focus on the aims of the study [31]. At this stage, comparisons were made
based on gender and type of therapy (ASCT or other therapies, including chemotherapy,
radiotherapy). Examination of different therapy groups was important as treatment with or
without ASCT may influence the functional status of the patient, which may have an impact
on their physical activity. During the coding processes, the authors and interviewer met to
discuss the themes that were emerging from the interviews.
In the Results section, the gender, age and main treatment type of participants are included in
parentheses following direct quotes. Only the main treatment type has been included here;
participants may also have been treated with a range of induction and supportive therapies
including thalidomide and steroids (e.g., prednisolone and zometa)
7. Results
Sample and clinical characteristics
Thirty-two patients responded to the initial mail out, of which eight did not complete the
interview due to ineligibility (i.e. had not received therapy for MM in the past 2–12 months; n
= 5), too unwell or emotionally distressed (n = 2), or lack of interest in completing interview
(n = 1). In total, 24 interviews were completed, 13 were female (54%). The age of the sample
ranged from 48–78 years, with a mean age of 62 years (SD = 8.8; see Table 1).
Table 1 Sample and clinical characteristics
n (%)
(N = 24)
Gender
Male 11 (46)
Female 13 (54)
Age
Mean (SD) 62 (8.8)
Living Arrangements
Partner/spouse 16 (67)
Partner/spouse and children 6 (25)
Alone 2 (8)
Highest Level of Education
University degree or higher 10 (42)
Certificate or diploma 8 (33)
Secondary school 5 (21)
Primary school 1 (4)
Region
Metropolitan area 11 (46)
Regional/rural area 13 (54)
Treatment
Autologous Stem Cell Transplant 16 (67)
Chemotherapy 6 (25)
Radiotherapy 5 (21)
Other (e.g., steroids, Thalidomide/Revlimid) 17 (71)
Time Since Treatment Completion
2-4 months ago 4 (17)
5-7 months ago 9 (37.5)
8-10 months 2 (8)
11-12 months 4 (17)
Over 12 months 1 (4)
Ongoing (e.g., thalidomide) 4 (17)
Table 1 the majority of participants lived with either a partner/spouse 16 (67%); or a
partner/spouse and children (own or partners) (n = 6; 25%). In terms of highest level of
education, 10 (42%) had a University degree or higher and 8 (33%) had a certificate or
8. diploma. There were more participants from regional/rural areas (n = 13, 54%) than
metropolitan areas (n = 11, 46%).
Two-thirds of participants had been treated with a stem cell transplant (n = 16; 67%) and
most participants had completed treatment 5–7 months ago (n = 9; 37.5%), followed by 2–4
months ago (n = 4; 17%) or11-12 months (n = 4; 17%).
Current participation in physical activity and change from Pre-diagnosis
Current type and intensity of physical activity
None of the participants had participated in vigorous intensity physical activity on an average
week in the past month; 56.2% participated in some moderate intensity physical activity (M =
84 minutes per week, SD = 104.9); and 69.6% participated in some light intensity physical
activity (M = 85 minutes per week, SD = 85.9). Overall 26% of participants were meeting the
recommended guidelines of 150 minutes of moderate-vigorous intensity physical activity per
week.
Walking, followed by gardening were the most common physical activities. A range of other
activities were also discussed, including bike riding, yoga, swimming, stretching, tennis,
pilates, tai chi, table tennis and strength training. Most of these activities were of light to
moderate intensity. Participants also spoke about trying to increase their level of physical
activity after their therapy. For some, this meant increasing the length of time they walked
each day. Participants also spoke about their level of physical activity varying depending on
how they were feeling, which was a function of their health and motivation as well as
external factors like the weather.
…Yeah, well I try to walk every day. I’ve never been really a sporty person but
I’ve always enjoyed walking prior to my myeloma and all of that. I enjoy
gardening a lot. So as I say, I try to walk, I won’t say every day but probably
five out of seven days a week and I’ll definitely go off for about 30 to 60
minutes, depends on the day and the weather and how I’m feeling, what sort of
energy I’m at, that sort of level. (‘Francisa
’, Female, 54 years, treated with a
stem cell transplant)
Change from physical activity prior to diagnosis
Most participants in the interviews reported that the intensity and/or frequency of physical
activity had reduced since their diagnosis. This was consistent with the questionnaire data
which showed that participation in moderate and vigorous physical activity had reduced.
Prior to diagnosis, 21.7% participated in vigorous physical activity and the mean number of
minutes per week was 32.6 minutes (compared to 0 minutes now); 60.9% had participated in
moderate physical activity and the mean number of minutes per week was 318.2 minutes
(compared to 56.2% and 84 minutes per week now). Although the percent of participants who
were currently participating in light intensity physical activity was similar to prior to
diagnosis (69.6% compared to 65.2%), average minutes per week had reduced from 162
minutes (prior to diagnosis) to 85 minutes per week now.
9. Some participants were not able to do any sort of physical activity; while others continued
with lighter intensity or less frequent physical activity compared to before their diagnosis, as
illustrated in the following quote.
Yeah, look, I wouldn't be doing as intense exercise as I was previously. I
physically probably can't do it to the same level that I had. So in terms of
quantity it's probably dropped off slightly but there hasn't been a large
difference there. It's probably more just the intensity at which I do it
(‘Michael’, Male, 48 years, treated with a stem cell transplant)
There were some participants who were back to or close to their pre diagnosis level of
physical activity and two actually participated in more physical activity now.
Both men and women participated in walking, however there were gender differences in
other types of physical activity. Women participated in a wider range of activities than men
and were more likely to report participating in aquatics, gym work, pilates, yoga and Tai Chi.
Men were more likely to report participation in golf, gardening, bike riding and bowls.
Perceived benefits of physical activity
Almost all respondents reported that physical activity was beneficial to them. These benefits
were reported as predominantly related to their recovery from treatment and coping with
symptoms of MM as well as psychological benefits. Other benefits included physical
improvements such as appearance, weight loss, enjoyment and social interaction.
Recovery from treatment/disease
Recovery was defined by participants in terms of physical, psychological recovery and also
getting back in to a normal routine that they enjoyed prior to their diagnosis. Physical
recovery was focused on the prevention of deterioration in physical health and function.
There was a sense that physical activity facilitated participants to regain a routine and
normality after what, for many, was a traumatic diagnosis and treatment regimen.
I think it gives you a more positive outlook if anything. You can get back to
normality and you can do things you know…..(‘Sophie’, Female, 57 years,
treated with a stem cell transplant)
Not all participants, however, saw the benefits of exercise in their recovery because the
symptoms that they experienced were so extreme and constant that nothing seemed to relieve
them:
Well I'd like to think that it was helping. But it doesn't seem to be - I just don’t
seem to be able to do anything that is helping it [pain in lower body]. …… It's
consistently there all the time, lesser or more, depending on the time of day.
The more I seem to walk, the worse it gets (‘Frank’, Male, 64, treated with a
stem cell transplant)
10. Psychological health
Many participants spoke about the psychological benefits of physical activity. This was more
prevalent than the discussion of physical health benefits. There were several dimensions to
the perceived psychological health benefits, these included (1) cognitive improvements of
being more alert, keeping the mind healthy and fresh, and improvements in concentration;
and (2) affective changes including feeling good, a sense of accomplishment, helping
emotionally, helping to cope with MM.
In terms of cognitive improvement:
Well I suppose it just keeps you going. Certainly my job is very sedentary and
I know that if I don't start the day with some exercise it's harder to concentrate
and things like that…(‘Anne’, Female, 58 years, treated with a stem cell
transplant)
Affective changes that were bought on through physical activity, including feeling better and
keeping the mind from worrying are demonstrated through this quote:
Oh. Put it this way, I was quite depressed when I was in the house after the
stem cells transplant and, of course, after the two VAD chemo. I find myself if
I go out and did a bit of walking, I feel a little bit better, so I go from there
(‘Jane’, Female, 60 years, treated with a stem cell transplant)
Although the psychological benefits were noted among both men and women, there were
some differences. Men reported being motivated to ‘do something’ and keep busy, whereas
women more often reported the psychological benefits of physical activity and feeling better.
Affective changes, particularly ‘feeling good’ were more often reported by those who had an
ASCT compared to other those who had other types of therapy.
Enjoyment
Most of the participants said they enjoyed being physically active; this was often intertwined
with the psychological benefits of participation and ‘feeling better’ and also the sense of
accomplishment that comes with being physically active:
Oh I enjoy it actually - particularly a long walk - as I said before 300 odd
kilometres - when you finish a walk like that you feel very - as if you've
accomplished something really good (‘Andrew’, Male, 78 years, treated with
Thalidomide).
Social factors
Social factors were another motivation for physical activity. Although some participants
enjoyed being physically active and having time to themselves, others saw it as an
opportunity to be involved with family and friends. Physical activity was also seen as a way
of connecting with other people, avoiding isolation, getting back in to life after MM and
making new friendships. This could be with people with MM or other friends. Both men and
women enjoyed the social aspects of participation; however this was discussed more by
women than men.
11. I'm always better to have done exercise in a group, basketball, netball, all of
that. The oncology rehab, going there twice a week and the girls right now
we'll go for a walk, now we'll do this, now we'll do that. I need someone to
push me a little (‘Tina’, Female, 65 years, treated with a stem cell transplant)
Perceived barriers to physical activity
MM symptoms and side effects of treatment
The most prevalent barriers to physical activity were symptoms of MM and side effects of
treatment. Barriers either limited physical activity or stopped it completely. These included
fatigue (low energy levels, little stamina and tiredness); pain (particularly bone pain);
concerned about bone fractures/bones; low immune system and subsequent fear of infections
in public exercise locations, particularly gyms; taking medications in a timely manner; self-
conscious about appearance after treatment (weight gain, loss of hair); anaemia; back pain;
and foot weakness.
Fatigue, both physical and mental, was the most prominent barrier. Participants also
experienced effects on concentration and keeping their mind focused on tasks, and sometimes
felt ‘unsure about what you are doing’. One participant described this as having a ‘tired
head’. Participants reported that fatigue was felt over their entire body and they experienced
extreme tiredness. .
… I get tired. I’m ready for bed at 8:30, nine o’clock every night, you
know…as soon as the sun goes down I’m ready for bed and I’ll go and jump
into bed… So I don’t know whether it’s the drugs or whether it’s the myeloma.
The physicians told me it’s probably mainly the drugs that has done it.
Hopefully the myeloma is under control at the moment (‘Charles’, Male, 51
years, treated with chemotherapy)
Pain was also a barrier that limited or prohibited physical activity. This pain was mostly
related to bone pain in various parts of the body, including the back, neck, elbows and hips.
As pain levels were more debilitating on some days than others, it had the effect of either
limiting or completely preventing any sort of physical activity. The intensity and ongoing
nature of the pain was wearing on participants and made it difficult to continue on with their
day to day life.
… I’ve got pains in the back and look, I’m all right at the moment, touch
wood, but you know, pains in the back and hip, one of my elbows and they’re
just sort of – I don’t know, it just grinds you down, I suppose, and makes you
come to a stop or in my case anyway (‘Charles’, Male, 51 years, treated with
chemotherapy)
However, pain was not experienced as much by some participants, who felt that it was not a
barrier for them:
I'm lucky. I don’t feel that much pain related to the myeloma, but if I'm really
painful, well, I'll stop a day or two and see how it goes. If it doesn't go away, I
know something's wrong, so I go to see my doctor (‘Jane’, Female, 60 years,
treated with a stem cell transplant)
12. Fatigue was more commonly reported by people who had been treated with an ASCT;
however pain as a barrier to physical activity was more often reported by people who had
been treated with other types of therapy such as chemotherapy and/or radiotherapy.
Low self motivation and lack of interest in physical activity
Low self motivation and interest in physical activity were barriers identified by participants.
Low self motivation was identified by participants who may have had an interest in being
involved in physical activity, however they experienced a general lack of motivation. This
was intertwined with finding it difficult to ‘get going’, particularly in the morning. Males
reported having low self motivation more often than females. Low interest in physical
activity was more related to lack of interest in physical activity itself and therefore not
participating.
…. two things that stop me probably doing a lot of exercise. One is I probably
wouldn't be interested in it but the other one - I don’t have any problem with
my heart, I'm sure I could do a bit of jogging or running, but it's no interest to
me (‘Dean’, Male, 65 years, treated with a stem cell transplant)
Discussion
The purpose of this study was to explore the physical activity experiences of people with MM
and perceived benefits and barriers to participation. Patients overwhelmingly reported that
physical activity was beneficial; the most prominent benefits were in symptom control and
recovery from the side affects of MM therapy and the psychological benefits of participation.
The main barriers to physical activity related to the symptoms of MM and side effects of
therapy and low self-motivation. There were some gender differences in type of physical
activity that participants engaged in and benefits and barriers; and there were also some
differences in benefits and barriers according to type of therapy.
Participation in physical activity decreased since prior to diagnosis, confirming the findings
of previous research with MM patients [18,23] and other cancer survivors [32,33]. Physical
activity was of light to moderate intensity, and walking was the most popular type of activity,
followed by gardening. These findings are similar to population-based studies, which show
that walking is the most popular physical activity among older adults [34]. Walking was the
most popular physical activity for both men and women, however there were some
differences between men and women in physical activity participation. For example, women
participated in aquatics, gym work and pilates, whereas men participated in golf, gardening
and bike riding. These are consistent with gender differences in physical activity participation
in the general population of adults and older adults [34,35].
One-quarter of participants were meeting the recommended guidelines of 150 minutes of
moderate-vigorous intensity physical activity per week; this was similar to previous studies of
people with multiple myeloma [25,36]. This compares with 30-45% of other cancer survivor
groups who met the guidelines for sufficient levels of physical activity [6,18,30]. Our
findings reinforce that MM may be more debilitating than some other types of cancer, which
represents additional challenges to performing regular physical activity for people with MM.
13. None of the participants from this study engaged in vigorous physical activity. We found that
participating in light to moderate intensity physical activity is likely to be the most feasible
for patients with MM who experience a range of physical limitations that effect mobility, and
who are also at increased risk of bone fractures and infections [6,7]. These findings suggest
that patients with MM may find it difficult to meet the American College of Sports Medicine
guidelines for cancer survivors, which advise that cancer survivors avoid inactivity and
follow the age-appropriate guidelines for aerobic activity; the accumulation of 150 minutes
per week of moderate to vigorous intensity physical activity. However, in recognition of the
specific needs of some cancer groups, the panel acknowledged that there should be some
cancer site-specific alterations for patients and caution was advised for those at increased risk
of fracture and infection [37].
In this study, the social context of the physical activity was important for MM patients and
social interactions were important to the overall physical activity experience; this was
particularly so for women. This finding supports the findings of previous research which
demonstrates that having an exercise role model or partner is positively associated with
physical activity participation for patients with MM [38], as well as other cancer groups,
including prostate cancer survivors [39] and breast cancer survivors [40].
One of the main reported benefits of physical activity was helping to overcome the impact of
MM treatment and symptoms. This might be a mechanism through which physical activity
contributes to quality of life and psychological health, as previous research has demonstrated
the association between symptom distress, quality of life and depression [41].
The psychological benefits of physical activity, including cognitive, affective and coping
with cancer were frequently reported by interview participants in our study. These
psychological benefits are particularly important for people with MM, as depression and low
quality of life are frequently reported [4,8]. Although no randomised controlled trials have
been conducted with MM patients, two recent meta analyses of studies of cancer survivors
(primarily breast cancer) concluded that physical activity had a positive affect? on
psychological health [42,43]. However, other studies have shown no association between
physical activity and depression and anxiety for breast cancer survivors [10,44] or colorectal
cancer survivors [45].
There is evidence that the intensity of physical activity plays an important role in outcomes
[46]. The effect of level of intensity on quality of life and psychological health outcomes is
complex and there is debate about the optimal intensity, particularly for psychological health
[47]. A cross-sectional study of patients with MM by Jones et al. showed that during off
treatment periods, minutes of participation in moderate plus vigorous intensity physical
activity, was associated with overall quality of life and all components of quality of life
except physical wellbeing, as well as reductions in fatigue and depression [18]. Further
examination of the effect of physical activity at various intensity levels on psychological
health and quality of life outcomes for patients with MM is warranted.
Symptoms of MM and side effects of treatment, particularly fatigue and pain, were the
predominant barriers to physical activity. Evidence suggests that symptoms of fatigue, sleep
disturbances, pain and loss of appetite were significantly worse for MM patients than those
with lymphoma [48]. Fatigue and pain have been identified as barriers to physical activity in
other studies of cancer survivors [27,49] and people with MM [23]. Research has shown that
higher levels of fatigue are associated with lower levels of physical activity for patients with
14. MM [18]. However, a small randomised controlled trial by Coleman et al. demonstrated that
physical activity reduced fatigue for patients with MM [21]. We found that the extent to
which pain and fatigue were barriers to participation differed by treatment type, with pain
experienced more by people who had been treated with therapies including chemotherapy
and/or radiotherapy and fatigue experienced more by people who had a ASCT. These
associations and their impact on physical activity experiences requires further investigation.
Lack of self-motivation was also a barrier in our study, particularly for men and for those
who were treated with chemotherapy and/or radiotherapy. Lack of self-motivation has also
been identified in other studies of cancer survivors [49],
The strengths of this study were the inclusion of MM patients who were recently treated,
which facilitated recall of physical activity prior to diagnosis and the experience of treatment.
The selection of participants from a population-based database? increased the possibility of
gaining perspectives from people from a range of backgrounds and localities.
Limitations of the study also need to be considered when interpreting the findings. This study
was cross sectional and comprised a small sample size, involving younger patients (mean age
= 62 years) than the population of MM patients (mean age at diagnosis of 70 years [1]) and
findings can therefore not be generalized to the population. Participants were at least
somewhat physically active; with voluntary participation, this self-selection bias is difficult to
avoid. Participants had difficulty recalling their treatment regimen and we are not able to
verify the accuracy of patient treatment status. The measure of pre-treatment level of physical
activity was retrospective, which increases the possibility of recall error [50]. However, the
main focus of this study was on the participants’ description and lived experience of physical
activity. Given these limitations, the findings of our study should be further examined
through a population-based quantitative study examining the determinants of physical activity
and potential outcomes such as improved quality of life (particularly levels of fatigue and
pain), anxiety and depression.
Conclusions
Patients with MM predominantly participate in light to moderate intensity physical activity;
this may be at least partly attributed to the side effects of their condition and treatment.
Physical activity programs should focus on meeting the psychological and recovery needs of
patients, while being conscious of the limitations that are faced by people with MM. An
individualised US or UK spelling? program design that considers gender and treatment
related differences is warranted. The involvement of specialists who understand MM is
important so that side effects and cancer symptoms are taken in to account in the design of
physical activity programs.
Endnotes
a
Participant pseudonyms have been used.
Competing interests
The authors declare that they have no competing interests.
15. Authors’ contributions
MJC conceived of the study, participated in its design and coordination, contributed to the
data analysis and interpretation and drafted the manuscript. KH contributed to the study
design, development of interview questions, participant recruitment and assisted in the
drafting of the manuscript, PML contributed to the study design, data analysis and
interpretation and drafting of the manuscript; KSC contributed to the study design, drafting of
interview prompts, interpretation and drafting of the manuscript; SH contributed to the study
design, drafting of the manuscript and provided expert advice on MM and treatments. All
authors read and approved the final manuscript.
Acknowledgements
We would like to acknowledge the contribution of Ms Josephine Mascaro for assisting with
data entry and data analysis and Ms Suzi Grogan for conducting the interviews with patients.
We also acknowledge the contribution of the study’s steering committee members, including
Ms Haley King, Professor Mari Botti, Ms Trish Joyce, Dr Amanda Hordern, Dr Caderyn
Gaskin and Ms Sandra Wilson.
This project was funded by a Centre for Quality and Patient Safety Research Seeding Grant
(No 2011-07-002).
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