Advanced Cancer Patients’ Perceptions of Dignity

Purpose:

The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics.

Methods:

The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory–Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS).

Results:

Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity.

Conclusions:

Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

Psychometric Properties of the Greek Version of the Patient Dignity Inventory in Advanced Cancer Patients

CONTEXT

The patient dignity inventory (PDI) is an instrument to measure dignity distressing aspects at the end of life.

OBJECTIVES

The aims of the present study were the translation of the PDI in Greek language as well as to measure its psychometric aspects in a palliative care unit.

METHODS

A back-translation method was obtained at the Greek version. One hundred twenty advanced cancer patients completed the Greek version of the PDI, the Greek hospital anxiety and depression scale, the Greek schedule of attitudes toward hastened death (SAHD-Gr), and the Greek 12-item short form health survey.

RESULTS

Confirmatory factor analysis failed to fit to the original instrument's structure and exploratory factor analysis was conducted revealing five factors ("Psychological Distress," "Body Image and Role Identity," "Self-Esteem," "Physical Distress and Dependency," and "Social Support"). The psychometric analysis of the PDI-Gr demonstrated a good concurrent validity, and the instrument discriminated well between subgroups of patients regarding age differences. Cronbach α were between 0.71 and 0.9 showing a good internal consistency.

CONCLUSION

The Greek version of the PDI showed good psychometric properties in advanced cancer patients, supported the usefulness of the instrument assessing the sense of dignity distressing aspects of the terminally ill cancer patients.

Assessing Spirituality and Religiousness in Advanced Cancer Patients

The aim of this study was to translate the Spiritual Involvement and Beliefs Scale into the Greek language and validate its psychometric properties in a sample of advanced cancer patients treated in a palliative care unit. The scale was translated into Greek with the “forward-backward” procedure. It was administered twice, with a 3-day interval, to 82 patients with advanced cancer. Patients completed the Spiritual Involvement and Beliefs Scale and the Greek Hospital Anxiety and Depression Scale. The scale had an overall Cronbach α of 0.89. Overall test-retest reliability was satisfactory at P < .0005. Satisfactory construct validity was supported between the Spiritual Involvement and Beliefs Scale subscales and Hospital Anxiety and Depression subscales. Interscale and interitem correlations were found satisfactory at P < .0005. These results support that the Spiritual Involvement and Beliefs Scale is an instrument with satisfactory psychometric properties and is a valid research tool for spirituality in advanced cancer patients.

A prospective randomized controlled clinical trial of zoledronic acid for bone metastases

In this study, we assessed the safety, tolerability, and effectiveness of two therapeutic regimens relating to the frequency of zoledronic acid (ZOL) infusion. Sixty adult patients with bone metastases were randomly assigned to two study groups. The first group (group A) received 4 mg ZOL every two weeks, and the second group (group B) received 4 mg ZOL every four weeks. Assessment measures included C-telopeptide (CTX) rate, the Greek Brief Pain Inventory (GBPI), the linear analogue scale assessment (LASA) of quality of life, and biochemical markers. Assessments were made at weeks 12, 24, 36, and 48. Clinical endpoints included effective decrease in bone resorption markers, pain relief, and improvement of mobility status. The follow-up period was 48 weeks. No statistically significant differences between groups A and B were found in overall profile of biochemical markers, Eastern Cooperative Oncology Group (ECOG) performance status, and GBPI score at the end of the follow-up period. Assessment of bone metastases revealed a slight difference between the two groups, however this difference was not statistically significant. These findings indicate that administering zoledronic acid at four rather that two weeks has no significant impact on overall outcome.

The Attitudes of Greek Physicians and Lay People on Euthanasia and Physician-Assisted Suicide in Terminally Ill Cancer Patients

The purpose of this article is to explore the attitudes of lay people and physicians regarding euthanasia and physician-assisted suicide in terminally ill cancer patients in Greece. The sample consisted of 141 physicians and 173 lay people. A survey questionnaire was used concerning issues such as euthanasia, physician-assisted suicide, and so forth. Many physicians (42.6%) and lay people (25.4%, P = .002) reported that in the case of a cardiac and/or respiratory arrest, there would not be an effort to revive a terminally ill cancer patient. Only 8.1% of lay people and 2.1% of physicians agreed on physician-assisted suicide ( P = .023). Many of the respondents, especially physicians, supported sedation but not euthanasia or physician-assisted suicide. However, many of the respondents would prefer the legalization of a terminally ill patient's hastened death.

Bone Density as a Marker of Response to Radiotherapy in Bone Metastatic Lesions: A Review of the Published Data

Metastases to the bone are presenting in a great percentage of patients with cancer, causing a variety of symptoms, affecting the quality of life and survival of patients. A multidisciplinary approach from different health providers is required for treatment, including radiation oncologists, medical oncologists and surgeons. The role of radiotherapy in the management of bone metastases has long been established through multiple randomized trials. The estimation of response to the therapy is subjective and is based on the palliation of the symptoms that the patients report. However, a quantification of the tumor burden and response to the treatment with the use of an objective method to measure those parameters is a clinical expectation in oncology. The change in bone density in affected areas (mainly lytic) after local radiotherapy, representing the cellular changes that have occurred, is a promising marker of response to treatment.

Death and Grief in the Greek Culture

None would disagree that death is the great separator. Death has many meanings, and they change with culture and society. In the Greek mythology, the dead journeyed to the Afterlife, ruled by Hades. Death was not perceived as an end in and by itself, but rather as another “world” to belong to. By Classical times there was a rise to burial rituals and commemorative practices, carried out throughout the centuries. Christian religion attempted to change the way the dead were mourned, and preached the immortality of the soul and resurrection of the dead. Nevertheless, the way people grieved and buried their dead has not changed much. The only change is a difficulty in the receptiveness of burial procedures, observed in large cities and in younger population. Today in Greece, the perceptions and practices on grief and death derive both on the ancient and the Christian Orthodox traditions.

Attachment orientations of Greek cancer patients in palliative care. A validation study of the Experiences in Close Relationships scale (ECR-M16)

PURPOSE

Health-care professionals may serve as attachment figures, nevertheless little research has been made in the palliative context. The psychometric properties of the brief ECR-M16 in Greek cancer patients were explored.

METHODS

The ECR-M16 was translated into Greek (G-ECR-M16), and was administered to 100 patients before starting palliative care and 7 days later to test its stability. Patients (N=35) also completed the EORTC QLQ-C30 scales.

RESULTS

Cronbach's alphas for the discomfort for closeness, anxiety and avoidance scales were 0.871, 0.762, and 0.761, respectively. Test-retest reliability was very satisfactory (p< 0.0005). Factor analysis yielded three factors (58.75% of the variance). Known-groups validity showed that discomfort with closeness had a statistically significant correlation with advanced disease stage (p=0.022).

CONCLUSIONS

The G-ECR-M16 is a valid research tool for the attachment patterns' impact in Greek cancer patients.

Psychometric Properties of the Patients' Satisfaction Instrument FAMCARE-P13 in a Palliative Care Unit

PURPOSE

To investigate the psychometric properties of the Greek 13-item measure of patients' satisfaction (FAMCARE-P13) in palliative care setting.

METHODS

A hundred patients completed the FAMCARE-P13. Exploratory factor analysis and confirmatory factor analysis (CFA) have been conducted. Two factors' solution was revealed from CFA. The questionnaire was administered to an initial validation sample and then for test-retest in a sample of 40 patients 3 days later. The Rosenberg Self-Esteem Scale measuring global self-esteem has been also used as a gold standard for construct validity. Subscale and known groups validity have also been tested for FAMCARE-P13s' validity.

RESULTS

A reduced 13-item version of our measure (FAMCARE-P13) possessed 2-factor structure with high reliability. Patient satisfaction was correlated with physical distress, communication and relationship with health-care providers, and caregiver satisfaction.

CONCLUSIONS

We recommend the use of the Greek FAMCARE-P13 to assess care satisfaction of patients with advanced-stage cancer.

Hypothesis: Is heroin a 'barrier' against cancer? A retrospective analysis of heroin-addicted individuals untreated for opioid dependence between 2001-2010

PURPOSE

The findings of previous studies attracted our interest in searching and defining the percentage of deaths from cancer in 'heroin regular addicts' i.e. those who had never stopped taking the drug since they started.

METHODS

The archives of the Greek Reitox Focal Point of the years 2001 to 2010 were retrospectively searched, focusing on the number of deaths from cancer of the regular heroin addicts.

RESULTS

The records from 2,321 regular heroin addicts showed that none of them died from cancer. It seems that heroin might act as a "barrier" against cancer.

CONCLUSION

Further studies are needed to confirm our results and to explore the potential cause for this surprising finding.

Splenic irradiation as palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis: a multi-institutional experience

PURPOSE

To evaluate the impact of splenic irradiation as a palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis.

METHODS

Seventeen patients with chronic myelogenous leukemia and 3 with idiopathic polycythaemia presented with splenomegaly, splenic pain and anemia. Due to symptomatic splenomegaly, despite first-line treatment, the patients underwent splenic irradiation. Two patients received two different schedules of external radiotherapy (580 cGy in 5 fractions and 600 cGy in 6 fractions). Eight patients received 980 cGy in 14 fractions. Ten patients received two courses of 360 cGy in 6 fractions, 3 months apart. Median follow-up was 12 months post irradiation.

RESULTS

The patients showed excellent response to treatment one month post-radiotherapy, while treatment was well tolerated without severe toxicity. The dimensions of the spleen decreased significantly. Pain-related Visual Analogue Score (VAS) regressed after completion of irradiation. During 12-month follow-up all patients maintained the benefit of radiotherapy.

CONCLUSION

This study indicates that splenic irradiation could be a safe and effective palliative treatment for symptomatic splenomegaly due to secondary myelofibrosis.

The impact of radiotherapy on symptoms, anxiety and QoL in patients with cancer

AIM

To evaluate prospectively disease- and treatment-related symptoms, anxiety and quality of life (QoL), in patients with different types of cancer undergoing external-beam radiotherapy (RT) and examine the relationship among them, at baseline and at the end of the treatment.

PATIENTS AND METHODS

This study included 90 patients with cancer. Patients' QoL was evaluated using the Linear Analog Scale Assessment (LASAs) questionnaire, anxiety was measured with the Spielberger state and trait inventory (STAI), while symptoms were assessed using the MD Anderson Symptom Inventory (MDASI). The assessments were carried-out at baseline and at the end of RT.

RESULTS

At baseline, the QoL scores were reduced (7.5±6.5) and MDASI elevated (2.35±1.7). Patients' QoL was correlated with symptoms (r=-0.684, p=0.0005). A correlation was found between STAI-trait with MDASI scores (r=0.214, p=0.046). At the second assessment, there were significant correlations between MDASI and QoL (r=-0.68, p=0.0005). The STAI-trait had a moderate correlation with MDASI score (r=0.43, p=0.0005) and with QoL (r=-0.253, p=0.0017).

CONCLUSION

The present study showed a significant impact of symptoms and high levels of anxiety following RT, which correlated with a compromised QoL. The worsening in patients' perception of their QoL did not seem to lead to a significant reduction in daily activities or treatment tolerance.

Samarium-153Sm-EDTMP as an equivalent variant to pharmaceutical analgesic treatment

PURPOSE

Cancer pain is the most serious symptom for patients, especially during their terminal phase, when palliative medicine is needed. Our study tried to verify the usefulness of single-shot intravenous administration of Samarium (Sm)-153EDTMP in patients with bone metastases (group-A, N=53, males=25, females=28, age range: 30-69 years), as well as to compare a series of variables, using as a control group (group-B, N=37, males=17, females=20, age range: 30-69 years) with patients who were under drug treatment given from a physician specialized in palliative medicine.

METHODS

Both groups answered the following questionnaires: Greek Brief Pain Inventory (GBPI), Brief Multidimensional Life Satisfaction Scale (BMLSS), Hospital Anxiety Depression Scale (HADS) and ECOG performance status.

RESULTS

Pain severity and pain interference improvement p=0.0005 for both groups. HADS-anxiety: Samarium group, p= 0.397, drugs group p= 0.031. HADS-depression improvement for both groups p=0.031 and p=0.003, respectively. BMLSS improvement p=0.029 and p=0.265, while EGOG PS improvement was p=0.005 and p=0.014, respectively (numeric values).

CONCLUSION

Intravenous administration of Sm-153EDTMP was equivalent to drug treatment against cancer pain for patients with multiple bone metastasis, an option for those patients who are intolerant or resistant to drug treatment. Samarium-treated patients needed less or not at all pain killers, having a better cost-effective result.

The influence of sense of control and cognitive functioning in older cancer patients' depression

OBJECTIVE

This study aimed to evaluate the associations between depression, sense of control, and cognitive functioning, as well as the predictive power of sense of control and cognitive functioning in older cancer patients' depression.

METHODS

Eighty-six cancer patients were referred to a palliative care unit. They completed the 15-item Geriatric Depression Scale, the Cancer Locus of Control, and the Mini Mental State Examination questionnaires.

RESULTS

Higher perceived control over the 'course of illness' was associated with higher levels of depressive symptoms (p < 0.0005), whereas lower perceived control over the 'cause of illness' was associated with higher depressive symptoms. The same results were found for 'cause of illness' between non-depressed and depressed patients (p = 0.001). Multivariate analysis revealed that whereas an external orientation in 'course of illness' increased the likelihood of depression (p = 0.002), an external orientation in 'cause of illness' decreased the likelihood of depression (p = 0.05).

CONCLUSIONS

Older cancer patients' sense of control orientation over the course of illness and the cause of illness predicted the levels of depressive symptomatology.

Locus of control and distressing symptoms in young cancer patients when assessing depression

PURPOSE

The aim of the current study was to evaluate the correlation between depression, sense of control (internal and external) and cancer-related distressing symptoms in younger patients (<65 years) with locally advanced or metastatic cancer, and to investigate their potential predictive role when screening for depression.

METHODS

70 patients completed the Beck Depression Inventory (BDI), the Cancer Locus of Control Scale, the Linear Analogue System Assessment (LASA) (for Quality of Life/ QoL) and the M.D. Anderson Symptom Inventory (MDASI). Distressing symptoms, QoL, and locus of control (LOC) were correlated with the presence of depression.

RESULTS

The total BDI score was suggestive of depression. In univariate analysis significant correlations were found between the presence of depression and poor QoL, low Eastern Cooperative Oncology Group performance status and 'sense of control over the course of cancer' (p<0.0005). Depression was significantly correlated with pain, distress and poor general activity, overall enjoyment of life and relationships (p=0.004), as well as anxiety, fatigue, anorexia, dyspnoea and sleep disturbances (p=0.001). Multivariate analysis demonstrated that poor QoL and 'sense of control over the course of cancer', as well as anxiety, fatigue, anorexia, dyspnoea and sleep disturbances were significantly correlated with depression (p<0.0005).

CONCLUSIONS

We suggest that younger cancer patients' poor QoL, 'sense of control over the course of cancer', as well as anxiety, fatigue, anorexia, dyspnoea and sleep disturbances are significantly correlated with the presence of depression and can eventually represent potential screening predictors.

Irradiation Toxicity and Inflammatory Bowel Diseases (IBD): Review

BACKGROUND/AIM

The evaluation of radiotherapy toxicity in oncologic IBD patients. Defining the optimal patient and treatment factors that would be able to reduce the risk to organs.

MATERIALS AND METHODS

A review of all published radiotherapy trials was performed to identify the clinical and treatment factors of inflammatory bowel disease's patients treated for different solid tumors.

RESULTS

Overall, acute (Grade ≥ 3) gastrointestinal complications attributable to RT ranged between 20-21% of the treated patients. A late Grade ≥ 3 gastrointestinal toxicity was developed in a range between 8-29%.

CONCLUSION

A special attention should be given to the description of IBD location, activity status, concurrent chemotherapy, irradiation dose and technique, in order to minimize post-irradiation morbidity. It is not easy to distinguish late morbidity attributable to radiotherapy due to the IBD itself.

The key role of bisphosphonates in the supportive care of cancer patients

The present review aims at providing an assessment of the clinical significance of Biphosphonates (BPs) in the treatment of patients with cancer.

MATERIALS AND METHODS

A systematic literature review was performed based on database search in PubMed/Medline and included articles up to August 2013.

RESULTS

BPs can reduce, delay, and prevent complications related to bone metastases. They improve mobility, functionality, pain, and quality of life. They limit survival of any inactive cancer cells in the microenvironment of the bone marrow, contributing to their death from anti-neoplastic treatments. Moreover, they limit and delay bone morbidity due to osteoporosis related to hormonotherapy in breast and prostate cancer. Finally, benefits can be derived from the combination of BPs with radiotherapy in bone density, recalcification, opioid use, and patient's quality of life and performance status.

CONCLUSION

The contribution of BPs in the course of certain neoplasms is preventive and synergistic to other treatments.

Measurement of blood phosphorus: a quick and inexpensive method for detection of the existence of cancer in the body. Too good to be true, or forgotten knowledge of the past?

The possible elevation of phosphorous (P) in cancer patients blood serum has been reported in the past. This however seems to have passed unnoticed. One hundred individuals, divided into two groups of fifty each, i.e. cancer patients (group A) and healthy individuals (group B), were included in this retrospective study. The incidence of cancer by site in group A was 24% head and neck, 50% non-small cell lung cancer (SCLC) and 26% cervical cancer. In all cancer patients in group A the serum P was over the normal values, in contrast with the normal values of P measured in group B. The mean value of serum P in group A and B were 7.80 (± 2.24) and 3.38 (± 0.58), respectively (P<0.001, Mann Whitney test). Increased amount of phosphorus in the blood, when other causes justifying the increase were excluded, should be considered as indicative for the existence of unidentified cancerous lesions.

Breakthrough cancer pain: an observational study of 1000 European oncology patients

CONTEXT

Breakthrough pain is common in patients with cancer and is a significant cause of morbidity in this group of patients.

OBJECTIVES

The aim of this study was to characterize breakthrough pain in a diverse population of cancer patients.

METHODS

The study involved 1000 cancer patients from 13 European countries. Patients were screened for breakthrough pain using a recommended diagnostic algorithm and then questioned about the characteristics and management of their pain.

RESULTS

Of the 1000 patients, 44% reported incident pain, 41.5% spontaneous pain, and 14.5% a combination. The median number of episodes was three a day. The median time to peak intensity was 10 minutes, with the median for patients with incident pain being five minutes (P < 0.001). The median duration of untreated episodes was 60 minutes, with the median for patients with incident pain being 45 minutes (P = 0.001). Eight hundred six patients stated that pain stopped them doing something, 66 that it sometimes stopped them doing something, and only 107 that it did not interfere with their activities. Patients with incident pain reported more interference with walking ability and normal work, whereas patients with spontaneous pain reported more interference with mood and sleep. As well, 65.5% of patients could identify an intervention that improved their pain (29.5%, pharmacological; 23%, nonpharmacological; 12%, combination). Regarding medications, 980 patients were receiving an opioid to treat their pain, although only 191 patients were receiving a transmucosal fentanyl product licensed for the treatment of breakthrough pain.

CONCLUSION

Breakthrough cancer pain is an extremely heterogeneous condition.