Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients

BACKGROUND

The aim of this longitudinal study was to determine age- and sex-standardised prevalence rates of cancer-related fatigue in different groups of patients.

METHODS

This was a prospective study in a cohort of N=1494 cancer patients investigating fatigue at three time points t1-t3 (t1: admission to hospital, t2: discharge, t3: half a year after t1). Fatigue was measured with the Multidimensional Fatigue Inventory. Age- and sex-adjusted norms were derived from a representative community sample of N=2037, using a cutoff at the 75th percentile.

RESULTS

At admission to the hospital, 32% of the patients were classified as fatigued. At discharge, the overall prevalence rate was 40%, and at half a year after t1, prevalence was 34%. Fatigue prevalence rates differed according to tumour stage, site, age, and sex of the patients.

CONCLUSION

The prevalence rates provided by this study can be used for the planning of research and clinical routine.

Response shift in the assessment of anxiety, depression and perceived health in urologic cancer patients: an individual perspective

The assessment of quality of life in cancer patients is hampered because patients may change their frames of reference during the course of the disease. The aim of this study was to test individual differences in these response shift effects. Urologic cancer patients (n= 275) were examined during the stay in the hospital (T1), 2 weeks later (T2) and 3 months later (T3). Furthermore, at T3 they were asked to retrospectively assess their situation at T1 (then-test). The difference between this retrospective assessment and the original assessment at T1 was used to determine the response shift effect (recalibration). Anxiety (Generalized Anxiety Disorder Questionnaire-2), depression (Patient Health Questionnaire-2) and health dissatisfaction (Questionnaire on Life Satisfaction) were obtained at all points in time. The effect sizes of the mean response shift effects (recalibration) ranged between 0.26 and 0.48. Nevertheless, a large proportion of the sample showed no response shift (22-38%) or even negative response shift effects (20-30%). There were significant correlations among the response shift measures of the domains (anxiety, depression and health dissatisfaction) with coefficients between 0.29 and 0.51. The results indicate that response shift should not only be assessed on the mean score level, since it is also a dimension of individual difference.

Abstract 4972: High-throughput functional profiling of dedifferentiated liposarcoma cell lines

We previously profiled several adult soft-tissue sarcoma subtypes using sequencing, copy number analysis, and gene expression arrays. This high-throughput genetic profiling revealed dozens of candidate genes deserving of further functional validation.

To prioritize genes, we performed a pooled shRNA screen to identify essential genes in liposarcoma. Dedifferentiated liposarcoma (DDLS) served as a model for this approach as multiple robust cell lines are available. Five DDLS cell lines (DDLS8817, LPS141, FU-DDLS-1, RDD8107, and LP6) were infected with a pool of 54,020 lentiviral shRNAs targeting ∼11,000 genes (median 5 shRNAs per gene) and passaged for 16 doublings. DNA was extracted and hairpin sequences were PCR amplified and hybridized to a custom microarray that interrogates all shRNAs in the pool. shRNAs were ranked according to their differential abundance between early and late passages. Genes corresponding to the most significantly depleted shRNAs are presumed to affect cell proliferation and are candidate oncogenes.

We compared the pattern of hairpin depletion in the DDLS cell lines to a panel of over 60 cell lines representing other common cancers screened with the same pooled shRNA library. The 5 DDLS cell lines clustered into 3 distinct groups. Only one gene appeared to be essential in all 3 groups: WWTR1 (TAZ1), a master-regulator of adipocyte differentiation. Twenty-eight genes appeared essential in at least two DDLS groups including MDM2 and ZBTB2, both reported to negatively regulate the tumor suppressor gene TP53. Low-throughput in vitro experiments have confirmed that WWTR1 knockdown using two shRNA clones inhibits LPS141 proliferation by 78 and 75% after 4 days as compared to scramble (p=0.004 and 0.06 respectively).

Our complementary genome-scaled functional screen has confirmed a known oncogene in DDLS and revealed additional candidate genes that appear to have a role in proliferation. Further integration of existing datasets may nominate additional genes essential for liposarcoma pathogenesis.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4972. doi:10.1158/1538-7445.AM2011-4972

Randomized trial of Cervene, a kappa receptor-selective opioid antagonist, in acute ischemic stroke

The purpose of this randomized trial was to confirm drug safety and to obtain preliminary efficacy data on Cervene (nalmefene), an opioid antagonist with relative kappa receptor selectivity, for the treatment of acute ischemic stroke. Patients were treated for 24 hours with either intravenous Cervene (0.05 mg/kg as an initial infusion over 15 minutes and 0.01 mg/kg/h maintenance) or placebo within 6 hours of an ischemic stroke. Efficacy was assessed by comparing the change from baseline to day 7 in the National Institutes of Health stroke scale score (NIHSSS) and the Glasgow Outcome Scale and Barthel Index at 3 months. Forty-four evaluable patients were randomized (3:1) to Cervene (n = 34; treated at 5.0 +/- 0.9 hours after onset) and placebo (n = 10; treated at 4.6 +/- 1.5 hours). No deaths or serious adverse events reasonably attributable to Cervene have been reported. A "major improvement" (NHSSS > 4) was seen at day 7: placebo, 33% (three of nine patients) and Cervene, 66% (19 of 29 patients). Only patients with initial NIHSSS >/= 4 were considered evaluable for this primary endpoint. "Good recovery" at 3 months (Glasgow = 5) was as follows: placebo, 50% (5 of 10 patients) and Cervene, 73% (24 of 33 patients). The death rate at 3 months was placebo, 20% (2 of 10 patients) and Cervene, 9.1% (3 of 33 patients). One patient was lost to follow-up. In conclusion, results from this randomized trial suggest that Cervene is safe, tolerable, and may be beneficial in the treatment of acute stroke patients.

[Measuring quality of life in head and neck cancer. Current status and future needs]

This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.

[Smoking behaviour after laryngectomy]

BACKGROUND

Tobacco smoking is an important risk factor for laryngeal cancer. Aim of this study was to investigate the prevalence of smoking and to identify factors that can promote tobacco abstinence.

PATIENTS AND METHODS

In a multi-centre cross-sectional study, 187 patients after laryngectomy were surveyed regarding their smoking behaviour. Instruments used were the questionnaire "Quality of Life after Laryngectomy" (Ackerstaff & Hilgers) and the "Questionnaire of Health Behaviour" ("Fragebogen zur Erfassung des Gesundheitsverhaltens", Dlugosch & Krieger).

RESULTS

Life time prevalence of tobacco smoking was 89%, whereas current prevalence was only 6%. None of the laryngectomies believed tobacco consumption to be safe. 24% thought that their tumour was caused mainly by smoking, although the current prevalence of smoking was not related to that number. 74% of all ex-smokers had stopped smoking at the time of the laryngectomy.

CONCLUSIONS

Only a small fraction of laryngectomized patients do smoke several years after the operation. Anti-tobacco interventions should therefore be focused on high risk persons, not on the entire patient population.

Mosaic trisomy 21/monosomy 21 in a living female infant

Many autosomal monosomies are presumed to end in arrested growth in the first few mitoses, prior even to the time of implantation, with possibly some proceeding to the stage of occult abortion. The single exception may be monosomy 21, although this has been questioned, with most earlier reports of monosomy 21 recently re-interpreted as being due to an unbalanced translocation involving chromosome 21. Here we report a female infant with a mosaic trisomy 21/monosomy 21 karyotype. While the karyotype 46,XX,i(21)(q10) is detected in all metaphases investigated in lymphocytes, mosaicism with the karyotype 46,XX,i(21)(q10)[31]/45,XX, -21[12] is seen in fibroblasts from a skin biopsy. Dysmorphic facial features and multiple malformations remarkably resemble cases of monosomy 21 that have been described in the literature. This suggests a dominant phenotypic effect of loss of one chromosome 21. Detailed clinical description, results of gene dosage studies, and cytogenetic analysis will be presented.

Association of Notch signaling pathway expression in liposarcomas with outcome, and targeting with gamma-secretase inhibitors

10526

Background: The Notch pathway directs normal fat cell development, but its aberrant activation may promote the development of sarcomas. The expression of the Notch pathway in liposarcoma (LPS), however, is unknown. We examined Notch signaling components in LPS's and suppressed Notch activation with drug targeting in LPS cell lines. Methods: RNA was isolated from 18 normal fat and 140 LPS tissue samples from five LPS subtypes: well-differentiated (33%), de-differentiated DD (25%), myxoid (12%), round cell (6%), and pleomorphic (13%), and were hybridized to Affymetrix U133A arrays. Microarray data were normalized with the RMA method. Correlation analysis identified genes expressed between sample classes, using Empirical Bayes t-test, and genes associated with survival, using Cox regression. The Notch pathway in two LPS lines, DDLS and LS141, was suppressed with a novel gamma-secretase inhibitor (GSI) or with siRNA to Notch receptors. Viability was assessed by colony formation, apoptosis by DAPI staining, and Notch expression by immunoblotting. Results: Expression of Notch-3 and its targets, Hes-1, Hey-1, and survivin, was increased in LPS subtypes, compared to fat tissue (p<0.001). Inhibition of Notch signaling with GSI's or siRNA to Notch-1 suppressed the viability of both DD LPS lines (p<0.05), inducing a G1/S arrest followed by apoptosis. Transfection of siRNA to each Notch receptor, especially Notch-3, also suppressed the viability of DD LPS's (p<0.05). Expression of Notch-3 (p=0.027, HR=2.64), Notch-4 (p=0.026, HR=2.70), the ligand JAG-2 (p=0.049, HR=2.32), and Hey-1 (p=0.001, HR=4.25) was associated with reduced distant recurrence free survival in patients with DD LPS's. Expression of the negative Notch regulator Fbxw7 was associated with improved overall survival in patients with LPS (p=0.008, HR=-1.42). Conclusions: Elements of the Notch pathway (receptors, ligands, targets, and modifiers) are overexpressed in LPS's compared to normal fat tissue and associate with outcome. Suppression of Notch signaling decreased DD LPS cell line viability and induced apoptosis. Notch inhibition may represent a new therapeutic strategy for patients with LPS's and deserves further validation in a clinical trial.

No significant financial relationships to disclose.

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of ⩾13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of ⩾6 (specificity 0.21). With scores of ⩾16 and ⩾22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

[Quality of life in elderly cancer patients--need for and benefit of inpatient rehabilitation]

BACKGROUND AND AIMS

Elderly cancer patients are often excluded from research studies and in turn do not end up receiving treatment according to standard guidelines. While frequent co-morbidity or non-compliance of the patients provides a partial explanation for this the chronological age of the patients also plays a significant role. This presents the question of whether elderly patients have either less or no need for comprehensive treatment such as, for instance, oncological inpatient rehabilitation, and/or whether or not they are able to benefit from it.

PATIENTS AND METHODS

In a rehabilitation centre in Germany, 339 tumour patients (> or = 70 years) were assessed at the beginning of inpatient rehabilitation regarding quality of life via the EORTC QLQ-C30. Need for rehabilitation was defined as being a clinically relevant difference on the EORTC scales (> or = 10 points) as compared with an age-matched sample of the German general population (n = 276). Four months after completing inpatient rehabilitation patients were asked to fill in the questionnaire again.

RESULTS

On 13 out of 15 EORTC scales, patients reported having more problems than the general population (adjusted for age and sex), whereby 8 domains were also clinically relevant (physical, emotional, social and role functioning, global quality of life, fatigue, appetite loss, constipation and diarrhoea). Low quality of life was associated with higher age (> or = 80 years), as well as gastro-intestinal and urological tumours (not prostate cancer). Significant improvements were achieved in 13 domains and clinically relevant improvements in 8 (physical, emotional, social and role functioning, global quality of life, fatigue, appetite loss, and pain), adjusted for age, sex, and tumour site.

CONCLUSIONS

Tumour patients should not be excluded from rehabilitation only because of their chronological age.

[Use of adaptive devices by laryngectomees]

AIMS

This study is directed at the following questions: How many laryngectomees are using which adaptive devices how often? Which devices are they lacking? Which alaryngeal voice has the best results in terms of intelligibility?

METHODS

218 patients operated on in 6 ENT-clinics in Eastern Germany over the last 25 years were interviewed in person. Items from a German questionnaire for psychosocial adjustment after laryngectomy (FPAL) and from the quality of life questionnaire EORTC QLQ-H&N35 were used. Voice intelligibility was measured by an objective test, the Postlaryngectomy-Telephone-Intelligibility-Test (PLTT).

RESULTS

The most common communication method in this group is the esophageal voice, only 20% use voice prostheses regularly, and 15% of the patients use electronic devices. 87% of the laryngectomees wear scarves to protect their stoma, and 82% use inhalers. Several patients lack tools for communication, some for protection of the tracheostoma and others devices for showering and swimming. The best speech results are gained with voice prostheses. Health related Quality of Life shows only poor correlation with the use of adaptive devices.

CONCLUSION

In general the health care for laryngectomees in terms of device use can be seen as relatively good but not as optimal. Problematic is the fact that 15.5% of the patients could not acquire an adequate voice, that some devices are missed by patients despite the fact that they are available for purchase, and that some patients do not care for their tracheostoma. It could be useful to consider these findings within medical consultations.