The sinister significance of dysphagia

The lived experiences of oropharyngeal dysphagia in adults living with fibromyalgia

BACKGROUND

Fibromyalgia is a chronic pain condition which has recently been linked with eating, drinking and swallowing difficulties (dysphagia). However, to date, sample sizes within completed research are small and study designs heterogeneous, and therefore, little is known about the lived experiences of dysphagia among people with fibromyalgia. To go some way towards addressing this gap in the literature, this study collected and analysed the first-hand experiences of the physical symptoms, the psychosocial impacts and environmental factors that influenced the lived experience of a sample of people living with fibromyalgia-associated dysphagia.

METHODS

Qualitative semi-structured interviews were conducted with adults with dysphagia and fibromyalgia. Reflexive thematic analysis was employed and themes were identified regarding the reported experience and impact of swallowing problems. The same researcher conducted the interviews and extracted all data, and a second researcher analysed a random sample of 5% of the data for accuracy, with no disagreements arising between the two researchers.

RESULTS

All participants (n = 8) reported the negative psychosocial impact of their dysphagia. Participants reported managing their dysphagia independently, primarily using compensatory strategies. Participants discussed feeling unsupported in healthcare interactions due to clinicians not understanding the occurrence, nature or impact of eating, drinking and swallowing difficulties. Participants also reported that they did not have access to evidence-based management strategies that adequately addressed their fibromyalgia-related swallowing problems.

CONCLUSIONS

Despite minimal previous research in this area, findings here highlight the impact that dysphagia has on people with fibromyalgia. A broad range of physical symptoms were reported to have negative consequences across both social and emotional domains. The reported symptoms often required complex coping strategies and sometimes impeded participants from seeking suitable medical intervention from healthcare providers. There are both broad-ranging implications of fibromyalgia-associated dysphagia and reported poor perceptions of medical interactions for this cohort of patients. Therefore, there is evidently a need for clinical research into the management of this condition to develop patient-centred care delivery options and to equip healthcare professionals with the knowledge and skills necessary to provide efficacious management to this group.

PATIENT OR PUBLIC CONTRIBUTION

Before initiation of the qualitative interviews, the interview schedule was piloted with an individual living with fibromyalgia and dysphagia, with feedback provided on the appropriate wording and format of semi-structured questioning.

A survey of public awareness of dysphagia

OBJECTIVES

Purpose: Dysphagia affects a wide cross-section of society. Reports of stigma and missed diagnoses suggest limited public awareness of this prevalent condition, exacerbating the hidden disability stemming from this impairment. This study explored the public awareness of dysphagia among people both with and without occupational ties to healthcare to assess the level of awareness and identify topics where public knowledge may be deficient.

METHODS

Method: An online purpose-built survey was administered to determine self-assessed awareness of dysphagia, and researcher-assessed understanding of the causes, symptoms, assessment and treatment of swallowing disorders. Survey answers (n = 374) were grouped by healthcare (n = 105) and non-healthcare (n = 269) respondents. Responses were analysed using both qualitative and quantitative methods.

RESULTS

Result: Self-assessed respondent awareness was low among 71% of non-healthcare and 29% of healthcare respondents, corroborating the limited demonstrated knowledge of the causes, symptoms, assessment and treatment of dysphagia. Self-assessed and researcher-assessed awareness was more limited among non-healthcare respondents.

CONCLUSIONS

Conclusion: Survey results confirm limited public knowledge of dysphagia and demonstrate the need for greater public awareness of this largely invisible disorder.

Socioeconomic and administrative factors associated with treatment delay of esophageal and gastric carcinoma: Prospective study from a tertiary care centre in a developing country

This study was aimed to analyze the spectrum of time intervals, from the onset of symptoms to the commencement of treatment in esophagogastric cancers. Factors influencing these time delays and correlation between these time points with variables including socioeconomic strata, educational level, histopathology, location of tumor and the initial modality of treatment were assessed.

STUDY SETTING AND METHODS

A prospective analysis of patients with esophagogastric cancer presenting to a single tertiary care unit over a period of 12 months was performed. Histopathology other than adenocarcinoma and squamous cell were excluded.

RESULTS

202 patients were enrolled in the study. Most patients presented with advanced disease, i.e. 91.5 % of esophageal and 90 % of gastric malignancies belonged to either stage 3 or stage 4 as per American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The median delay from the appearance of the first symptoms to initiation of treatment was 15 weeks (range 4-64). Patient related factors contributed to a significant delay [median of 5 weeks (range 1-24)]. Administrative factors were responsible for median delay of 3 weeks (range 0.5-20). Curative multimodality treatment was administered in 62.5 % of patients. Significant longer delay was influenced by socioeconomic strata, educational level, evaluation by non-specialist (p < 0.05). No relationship was noted between histopathology, location of tumor or initial modality of treatment.

CONCLUSIONS

Delays in our setting is much more than that is seen in Western and even some Asian countries. An important component of delay is administrative related factors. These may be intervened at the hospital level compared to other factors which may need long term community oriented approaches.

Evidence for a novel mechanism of the PAK1 interaction with the Rho-GTPases Cdc42 and Rac

P21-activated kinase 1 (PAK1) is activated by binding to GTP-bound Rho GTPases Cdc42 and Rac via its CRIB domain. Here, we provide evidence that S79 in the CRIB domain of PAK1 is not directly involved in this binding but is crucial for PAK1 activation. S79A mutation reduces the binding affinity of PAK1 for the GTPases and inhibits autophosphorylation and kinase activity of PAK1. Thus, this mutation abrogates the ability of PAK1 to induce changes in cell morphology and motility and to promote malignant transformation of prostate epithelial cells. We also show that growth of the prostate cancer cell line PC3 is inhibited by the treatment of a PAK1-inhibiting peptide comprising 19 amino acids centered on S79, but not by the PAK1 peptide containing the S79A mutation, and that this growth inhibition is correlated with reduced autophosphorylation activity of PAK1. Together, these findings demonstrate a significant role of S79 in PAK1 activation and provide evidence for a novel mechanism of the CRIB-mediated interaction of PAK1 with Cdc42 and Rac.

Lack of awareness of oesophageal carcinoma among the public in Ireland

BACKGROUND

Oesophageal cancer is advanced in the majority at presentation and its symptoms are usually present for many months suggesting poor awareness of its symptoms. Few studies have examined awareness of oesophageal cancer amongst the public.

AIMS

This study aimed to identify the level of awareness among the general public of oesophageal cancer, of its symptoms, of its awareness campaigns and to compare it with other common cancers.

METHODS

Face-to-face interviews were conducted with 279 members of the public. People were asked about their awareness of a range of cancers, and their knowledge of cancer symptoms and cancer awareness campaigns.

RESULTS

Awareness of oesophageal cancer was low and knowledge of its symptoms was even lower. Despite the efforts of awareness campaigns, knowledge of these campaigns was poor amongst the public.

CONCLUSION

Awareness of oesophageal cancer and its symptoms is low amongst the public. This needs to be addressed if disease is to be detected at an earlier and curable stage.

Systematic review of factors influencing patient and practitioner delay in diagnosis of upper gastrointestinal cancer

As knowledge on the causation of cancers advances and new treatments are developed, early recognition and accurate diagnosis becomes increasingly important. This review focused on identifying factors influencing patient and primary care practitioner delay for upper gastrointestinal cancer. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Included studies were those evaluating factors associated with the time interval between a patient first noticing a cancer symptom and presenting to primary care, between a patient first presenting to primary care and being referred to secondary care, or describing an intervention designed to reduce those intervals. Twenty-five studies were included in the review. Studies reporting delay intervals demonstrated that the patient phase of delay was greater than the practitioner phase, whilst patient-related research suggests that recognition of symptom seriousness is more important than recognition of the presence of the symptom. The main factors related to practitioner delay were misdiagnosis, application and interpretation of tests, and the confounding effect of existing disease. Greater understanding of patient factors is required, along with evaluation of interventions to ensure appropriate diagnosis, examination and investigation.

5-Aminolaevulinic acid-induced photodynamic therapy and photodetection in Barrett's esophagus

Barrett's esophagus is a precursor of adenocarcinoma of the esophagus. This cancer has the fastest growing incidence of any solid tumor in the Western world. Surveillance of Barrett's esophagus is routinely undertaken to detect early malignant transformation. However, ablative endoscopic treatments are available and these can obliterate the abnormal epithelium, allowing neosquamous regrowth. Photodynamic therapy using 5-aminolaevulinic acid (ALA) is such a technique. In this non-thermal method of ablation, ALA is metabolized to produce the photosensitizer protoprophyrin IX. This, together with light and oxygen, produces local tissue destruction. Fluorescence detection using ALA has also been used to identify areas of dysplasia and thus enhance positive biopsy yield. The use of ALA in photodynamic therapy and photodetection is reviewed.