Healthcare providers' experiences of continuing care for older adults with cancer during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic has caused great strain on older adults with cancer and their healthcare providers. This study explored healthcare providers' reported changes in cancer care, clinical barriers to care, patient questions, and the overall experiences of caring for older adults with cancer during the COVID-19 crisis.

METHODS

The Advocacy Committee of the Cancer and Aging Research Group and the Association of Community Cancer Centers developed a survey for healthcare providers of adults with cancer, inquiring about their experiences during the pandemic. Responses from the survey's four open-ended items were analyzed by four independent coders for identification of common themes using deductive and inductive methods.

RESULTS

Participants (n = 137) represented a variety of demographic and clinical experiences. Six overall themes emerged, including (1) telehealth use, (2) concerns for patient mental health, (3) patient physical and social isolation, (4) patient fear of contracting COVID-19, (5) continued disruptions to cancer care, and (6) patients seeking guidance, particularly regarding COVID-19 vaccination. Questions fielded by providers focused on the COVID-19 vaccination's safety and efficacy during older adults' cancer treatment.

CONCLUSIONS

Additional resources (e.g., technology support, established care guidelines, and sufficient staffing) are needed to support older adults with cancer and healthcare providers during the pandemic. Future research should explore universally effective in-person and virtual treatment strategies for older adults with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Persistence of telehealth barriers, particularly a lack of infrastructure to support telehealth visits, social isolation, and restrictive visitor policies as a result of COVID-19, negatively impacted the mental health of older adults with cancer.

Occupational Therapy for Poststroke Anxiety and Depressive Symptoms in Inpatient Rehabilitation

Poststroke anxiety and depressive symptoms (P-SADS) affect one in three people and are associated with decreased participation in activities of daily living. This study sought to characterize occupational therapy (OT) P-SADS care practices and identify factors influencing P-SADS care provision in one U.S. inpatient rehabilitation (IRF) facility. An explanatory sequential mixed-methods study design was used by gathering data from electronic health records (from January 1, 2019 to December 31, 2019) as well as semi-structured interviews with OT practitioners in the IRF. No objective P-SADS screens were documented nor were any P-SADS-focused goals written. Minimal evidence-based P-SADS interventions were identified. Practitioners reported multi-level barriers to OT P-SADS care including limited time, pressure to prioritize physical recovery, and inadequate resources to guide practice. OT practitioner P-SADS care was inconsistent with established evidence-based practice. This research identifies gaps in comprehensive stroke recovery and informs implementation efforts to support evidence-based P-SADS care in IRFs.

Older cancer survivors' perspectives and use of telehealth in their cancer survivorship care in the United States: A ResearchMatch® sample

INTRODUCTION

COVID-19 has resulted in reliance on telecommunication technologies for the provision of supportive cancer care. However, research on the use of these resources among older adults, who are the majority of cancer survivors, is limited. The objective of this study was to gather information on older cancer survivors' perspectives and use of telehealth their cancer survivorship care in the United States.

MATERIALS AND METHODS

Potential participants were recruited through ResearchMatch® from December 2020-January 2021. Online semi-structured interviews were conducted. Descriptive statistics were used to analyze the participants' demographic and health characteristics. Content analysis were conducted by two independent coders for identification of common themes. Coding agreement was reached through consensus, and count comparisons of participant responses were made.

RESULTS

The majority of respondents (n = 21; mean age = 73.5 ± 4.9) were female (57%), White (90%), and had a variety of cancer diagnoses. Participants reported using a variety of technology devices and telehealth products. Older cancer survivors (n = 10) endorsed telehealth video use for physical health concerns and basic check-ups, but some (n = 4) preferred in-person visits for major concerns and sensitive issues (e.g., mental health). Half of participants reported mobile health app use; however, ten participants did not use these apps as they felt the technology was not useful. Barriers to health technology use included missing face-to-face connections with providers, lack of familiarity with the technology, and perceived lack of utility and personalized telehealth platforms. Lastly, video-based conferencing and social media site use among seventeen participants was reported for social interaction during the COVID-19 pandemic.

DISCUSSION

These findings suggest that older cancer survivors utilize online platforms for their general health; however, they prefer in-person visits for serious issues and value personalization with telehealth. Despite from a highly educated sample of ResearchMatch® participants, these results can be used to inform clinicians and researchers about the appropriateness and provision of telehealth-based supportive care among older cancer survivors.

Evaluating Implementation Strategies and Outcomes in Postacute Stroke Rehabilitation: A Scoping Review

Date Presented 04/02/2022

This research describes implementation strategies and outcomes commonly leveraged to support evidence implementation in adult stroke rehabilitation. Presenters will share findings from their scoping review that examined the effectiveness of implementation strategies with practitioners in stroke rehabilitation settings. This study addresses the research priority concerning the need to progress beyond implementation barriers to examining implementation strategies to overcome them.

Primary Author and Speaker: James Edward Murrell

Additional Authors and Speakers: Janell Pisegna, Lisa Juckett

Occupational Therapy Interventions to Address Depressive and Anxiety Symptoms in the Physical Disability Inpatient Rehabilitation Setting: A Systematic Review

IMPORTANCE

Depressive and anxiety symptoms across physical disability inpatient rehabilitation (IPR) patient groups are well documented and negatively affect functional recovery. The strategies within the occupational therapy scope of practice to address these symptoms in IPR are unclear.

OBJECTIVE

To determine what interventions within the occupational therapy scope of practice have been used to address depressive and anxiety symptoms in IPR and to determine intervention efficacy.

DATA SOURCES

Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus.

FINDINGS

Five of 8,082 articles met inclusion criteria. Diagnoses included stroke (n = 1), traumatic brain injury (n = 1), spinal cord injury (n = 1), and musculoskeletal conditions (n = 2). Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy.

CONCLUSIONS AND RELEVANCE

Limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning. What This Article Adds: This systematic review provides an evaluation of the evidence within the occupational therapy scope of practice to address depressive and anxiety symptoms within the physical disability IPR setting. This research can support occupational therapy practitioners to comprehensively address physical and mental health for participation in IPR.

OT Interventions for Anxiety and Depressive Symptoms in Physical Inpatient Rehabilitation: A Systematic Review

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This systematic review examined interventions for anxiety and depressive symptoms among inpatient physical rehabilitation patients. Results were framed by intervention type, context, and concentration of current literature among patient groups. Setting specific analyses does not seem to be common, because patient groups are often considered regardless of therapeutic setting and therefore regardless of recovery stage. Setting-specific information can aid resource development and literature navigation.

Primary Author and Speaker: Janell Pisegna

Additional Authors and Speakers: Sarah E. Anderson

Contributing Authors: Jessica L. Krok-Schoen

Lifestyle Challenges Among Older Female Cancer Survivors

The American Cancer Society recommends that survivors maintain a healthy lifestyle including a normal weight, being physically active, and maintaining a healthy diet to improve prognosis and health-related quality of life (HRQoL). Unfortunately, the majority of cancer survivors do not engage in a healthy lifestyle. The largest proportion of cancer survivors are older adults (≥65 years), yet they are often understudied, particularly regarding healthy lifestyles. This study sought to examine the lifestyle behaviors (maintaining healthy weight, dietary intake, physical activity) of older female cancer survivors and to identify associations with HRQoL. Older female cancer survivors (n=170) completed surveys to assess HRQoL (RAND-36), diet quality (HEI-2015), physical activity, malnutrition, and BMI. Descriptive analyses, correlations, and stepwise linear regressions were utilized. The majority of the sample (mean age=74.67±8.43 years) were white (90%), married (54.4%), college-educated (63.9%), and breast cancer survivors (67.4%). Self-reported health was very good (42.6%) and good (39.6%) and general HRQoL was 59.48±15.34 out of 100. Self-reported physical activity was low; 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71±6.24 with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.39±10.00, below the “good” diet quality score of 80. Risk of malnutrition was present in 27.4% of participants. Regressions found that being White (β=-0.528, p=0.001) and lower BMI (β =-0.405, p=0.024) were significant predictors of HRQoL. Results indicate the need for tailored health coaching for older cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.

Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study

The Commission on Cancer’s standard 3.3 represents a paradigm shift in the care of cancer survivors, recommending that survivors receive a treatment summary and survivorship care plan (SCPs). A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population and their experiences and perspectives of SCPs is limited in the literature. This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information on older (≥65 years) breast cancer survivors’ perspectives of their SCPs, cancer survivorship, and communication with their health-care providers. The questionnaire was completed individually by the participants prior to the focus group and contained items on basic demographics and their health status following cancer treatment. The focus groups indicated that only a minority of women actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and within their health-care team, resulting in frustration and confusion. Participants’ suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional long-term care resources, such as health coaches, were important in improving their survivorship. These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.

Prevalence of lifestyle behaviors and associations with health-related quality of life among older female cancer survivors

PURPOSE

Healthy lifestyles including maintaining a normal weight, consuming a healthy diet, and being physically active can improve prognosis and health-related quality of life (HRQoL) among cancer survivors. The largest proportion of cancer survivors are older adults (≥ 65 years), yet their lifestyle behaviors are understudied. This study sought to examine the lifestyle behaviors (maintaining healthy weight, diet quality, physical activity) of older female cancer survivors and identify associations with HRQoL.

METHODS

Older female cancer survivors (n = 171) completed surveys to assess HRQoL (RAND-36), unintentional weight loss, body mass index (BMI), diet quality (HEI-2015), and physical activity. Demographic information and medical record data were also collected. Descriptive analyses, correlations, and stepwise linear regressions were utilized.

RESULTS

Physical and mental HRQoL of the sample (mean age = 74.50 years) were low: 41.94 ± 10.50 and 48.47 ± 7.18, respectively, out of 100. Physical activity was low: 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71 ± 6.24 (overweight) with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.54 ± 10.0. Engagement in moderate physical activity was associated with higher physical HRQoL (β = 0.42, p = 0.004). Being white (β = 0.53, p < 0.001), older (β = 0.27, p = 0.025), and having higher HEI scores (β = 0.30, p = 0.011) were associated with higher mental HRQoL.

CONCLUSIONS

Older cancer survivors report poor diet quality, high rates of being overweight or obese, and low levels of physical activity that impact their HRQoL. Results indicate the need for tailored health coaching for older cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.

Patterns of physical and mental health well-being in older female cancer survivors

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Background: The majority of cancer survivors are older adults (≥65 years), but their lifestyle behaviors are understudied. Factors associated with improved physical and mental well-being in older female cancer survivors are not well understood. The objective of this study was to evaluate the factors associated with physical and mental well-being in older female cancer survivors, including the role of malnutrition, physical activity, and level of emotional support. Methods: Older female cancer survivors (n=171) completed surveys to assess health related quality of life (HRQoL) using SF-36, malnutrition screening tool (MST), and physical activity. Demographics were also collected. The data was analyzed using descriptive analyses, correlations, and ANCOVAs. Survivors were divided into four phenotypes for analysis using the SF-36 physical and mental composite scores (PCS; MCS) stratified based on the sample’s mean scores (table). Factors associated with the four groups were assessed including demographic characteristics, cancer type, level of emotional support, risk for malnutrition, and physical activity. Results: The majority of the cohort (mean age=74.5 years) were white and highly educated. 68.4% were breast cancer survivors, with 10.5% hematologic malignancy survivors, 5.3% gynecologic malignancy survivors, and 15.8% other. Mean PCS and MCS were 41.94 and 48.47, respectively, comparable to general older adult population means. When divided into four groups based on PCS/MCS, there were no significant differences by demographic characteristics or cancer type. Survivors with higher emotional support scores had significantly higher PCS/MCS scores (p<0.001). There was also a significant difference in risk for malnutrition, as those with high PCS/MCS were at lower risk for malnutrition (p≤0.001). Survivors with low PCS/MCS engaged in less moderate exercise as compared to those with high PCS/MCS (p=0.028). Conclusions: This study suggests that lower risk for malnutrition as well as higher levels of emotional support are associated with higher physical and mental well-being in older female cancer survivors. These are two potential modifiable targets for interventional studies to optimize physical and mental well-being among older cancer survivors. [Table: see text]

Healthy lifestyle challenges among older female cancer survivors

156

Background: Healthy lifestyles including consuming a healthy diet, being physically active, and maintaining a normal weight can improve prognosis and health-related quality of life (HRQoL) among cancer survivors. The largest proportion of cancer survivors are older adults (≥65 years), yet their lifestyle behaviors are understudied. This study examined the lifestyle behaviors (diet quality, physical activity, maintaining healthy weight) of older female cancer survivors and associations with HRQoL. Methods: Women aged 65 years or older, with all cancer subtypes and stages, who had completed primary cancer treatment (i.e., chemotherapy, surgery, radiation) within the past five years, were eligible to participate. Older female cancer survivors (n = 171) completed one-time surveys to assess HRQoL (RAND-36), unintentional weight loss, body mass index (BMI), diet quality (Diet History Questionnaire II), and physical activity. Demographic information and medical record data were also collected. Diet History Questionnaire II results were converted to Healthy Eating Index (HEI)-2015 scores. Descriptive analyses, correlations, and stepwise linear regressions were utilized. Results: The majority of the sample (median age = 74.50±8.43 years) were white (90%), married (54.7%), breast cancer survivors (67.7%), and completed at least a bachelor’s degree (54.7%). Physical and mental HRQoL of the sample were low; 41.94±10.50 and 48.47±7.18, respectively, out of 100. Physical activity was low; 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71±6.24 (overweight), with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.54+10.0 out of 100 and below the cutoff score of 80, which represents a “good diet”. Participating in moderate physical activity was associated with higher physical HRQoL (β = 0.42, p = 0.004). Being older (β = 0.27, p = 0.025), white (β = 0.53, p < 0.001), and having higher HEI scores (β = 0.30, p = 0.011) was associated with higher mental HRQoL. Conclusions: Older female cancer survivors reported lifestyle challenges including poor diet quality, low levels of physical activity, and high rates of being overweight or obese, which were associated with HRQoL. Results indicate the need for tailored health interventions for older female cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.

Mental health-related quality of life is associated with diet quality among survivors of breast cancer

OBJECTIVE

This study sought to understand the association of mental health-related quality of life (MHRQoL) and nutritional status (food security status and malnutrition risk), with diet quality among female survivors of breast cancer.

METHOD

This pilot cross-sectional study utilized self-report survey data from the RAND-36, the USDA 2-item food insecurity screen, the Malnutrition Screening Tool (MST), and the Diet History Questionnaire II (DHQII)/Health Eating Index 2015 (HEI). Participants self-selected participation after being identified through an academic medical center cancer registry and contact through mailed recruitment letters and flyers posted in oncology clinics. Emotional well-being and social functioning composite scores of the RAND-36 were used to characterize MHRQoL. Correlational and regression analyses were performed to assess the association of diet quality, nutritional status, and MHRQoL.

RESULTS

The majority of participants (n = 90) were non-Hispanic white (90%), average age of 71.3 ± 8.1 years, and an average body mass index (BMI) of 28.2 ± 6.6. Four of the 90 participants (4.4%) scored at risk for food insecurity. Linear regression indicated that social functioning composite scores were positively associated with HEI scores (β = 0.11, SE = 0.53, p = 0.03). Controlling for demographic characteristics, education level (β = 5.25, SE = 2.25, p = 0.02) was positively associated with HEI scores.

CONCLUSION

Diet quality and MHRQoL were associated among breast cancer survivors, with education level also being associated with diet quality. These results can be used to aid targeted nutrition counseling and mental health interventions to address the nutritional vulnerabilities among female breast cancer survivors, particularly among older cancer survivors.

Would You Want to Be What You Eat? Food Behaviors Associate with Diabetes Status in U.S. Adults

Objectives

Diabetes and prediabetes are a major public health concern in the United States. It is unknown how food-related behaviors are influenced by diabetes status. Therefore this study assessed the association between diabetes status and food behaviors (meal preparation, food procurement, and food spending) among U.S. adults.

Methods

Data from 8799 adults from the 2005–2016 National Health and Nutrition Examination Survey were categorized by glycated hemoglobin levels (A1c%): nondiabetes (&lt;5.7%; n = 5455), prediabetes (5.7–6.4%; n = 2273), and diabetes (&gt;6.5%; n = 1071). A1c levels were compared with meal preparation, food procurement, and spending data. Age-adjusted analyses for total and by sex (n = 4481 females and n = 4318 males) were performed.

Results

All adults (P = 0.002) and males (P = 0.001) with diabetes and prediabetes spent less money dining out than those without diabetes. Those with diabetes had a significantly further distance to grocery stores among the adult (P = 0.018) and male samples (P = 0.032). Females with diabetes spent more on carryout/delivered foods (P = 0.025) and ate fewer meals per week with family (P = 0.039) than those without diabetes. Females with diabetes were less likely to serve as the main food shoppers (P = 0.012) and males with diabetes were less likely to share meal planning/preparation responsibilities (P = 0.034).

Conclusions

Diabetes status associates with meal preparation, food procurement, and spending behaviors, and differs for males and females. These findings support the importance of addressing the behavioral context of food choices to help support a healthier diet and lifestyle for all adults.

Funding Sources

Abbott Nutrition.

POORER DIET QUALITY OBSERVED IN OLDER ADULTS WITH A GREATER NUMBER OF CHRONIC DISEASES

Unhealthy lifestyle behaviors, including poor diet over many years, contribute to the development of chronic diseases, especially overweight/obesity, hyperglycemia, hypercholesterolemia and hypertension. Because poor diet is common to the diseases, it supports the notion of concurrently managing comorbidities through improved diet. Therefore, the purpose of this study was to assess differences in diet quality and nutrient intakes, in adults aged 65 years and older, by the number of chronic conditions. Data from 7,169 adults, aged 65 years and older, from the 2005-2016 National Health and Nutrition Examination Survey were assessed for selected chronic diseases from laboratory data: overweight/obesity (body mass index >25); hyperglycemia (glycated hemoglobin >5.7%); hypercholesterolemia (total cholesterol >200 mg/dL); hypertension (blood pressure >120/80 mmHg). The number of chronic diseases was computed per participant. Dietary intakes and diet quality score were assessed using 24-hour dietary recalls. Few adults had none of the selected chronic disease (n=79;1.4%), with others presenting 1 indicator (n=677;9.8%), 2 indicators (n=1,762;25%), 3 indicators (n=2,741;38.9%) and all 4 indicators (n=1,910;24.9%). Diet quality was significantly lower in those with three or four chronic diseases (P<0.001). Adults without any of the selected chronic diseases consumed significantly more calories, carbohydrates, fiber and added sugars, as well as folate, vitamin C and calcium than those with chronic diseases (P<0.001). Overall, dietary intakes from the day of intake were different for those with or without chronic diseases. These findings strengthen the need to promote healthy eating in older adults with one or more chronic conditions to help improve outcomes.

Functional Brain Stimulation in a Chronic Stroke Survivor With Moderate Impairment

OBJECTIVE

To determine the impact of transcranial direct current stimulation (tDCS) combined with repetitive, task-specific training (RTP) on upper-extremity (UE) impairment in a chronic stroke survivor with moderate impairment.

METHOD

The participant was a 54-yr-old woman with chronic, moderate UE hemiparesis after a single stroke that had occurred 10 yr before study enrollment. She participated in 45-min RTP sessions 3 days/wk for 8 wk. tDCS was administered concurrent to the first 20 min of each RTP session.

RESULTS

Immediately after intervention, the participant demonstrated marked score increases on the UE section of the Fugl-Meyer Scale and the Motor Activity Log (on both the Amount of Use and the Quality of Movement subscales).

CONCLUSION

These data support the use of tDCS combined with RTP to decrease impairment and increase UE use in chronic stroke patients with moderate impairment. This finding is crucial, given the paucity of efficacious treatment approaches in this impairment level.

Review article: oesophageal complications and consequences of persistent gastro-oesophageal reflux disease

The major oesophageal complications associated with persistent gastro-oesophageal reflux disease (GERD) include erosive oesophagitis, ulceration, strictures and gastrointestinal (GI) bleeding. Although the causes of these complications are uncertain, studies indicate that erosive oesophagitis may progress to the development of ulcers, strictures and GI bleeding. Pharmacological treatment with proton pump inhibitors is favoured over that with H(2)-receptor antagonists for the treatment of strictures. The treatment of strictures is accomplished with dilation and many favour the concomitant use of proton pump inhibitors. Most gastroenterologists are seeing far fewer oesophageal strictures these days since the introduction of proton pump inhibitors. In addition, research has shown that oesophageal complications have a greater impact on patients suffering from night-time GERD than on those suffering from daytime GERD. Barrett's oesophagus is a significant complication associated with persistent GERD and those at risk generally experience a longer duration of symptoms, especially those with a high degree of severity. In addition, there is a strong relationship between Barrett's oesophagus and oesophageal adenocarcinoma. This is in part due to the association of obesity and the development of hiatal hernias. Furthermore, endoscopic screening is being used to detect Barrett's oesophagus and oesophageal adenocarcinoma in persons suffering from chronic GERD, even though screening may not have an impact on outcomes (Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett's esophagus: The AGA Chicago Workshop. Gastroenterology 2004; 127: 310-30.).

Hepatic cytoreduction followed by a novel long-acting somatostatin analog: a paradigm for intractable neuroendocrine tumors metastatic to the liver

BACKGROUND

Optimal management of symptomatic neuroendocrine tumors that metastasize to the liver is controversial. We investigated aggressive hepatic cytoreduction and postoperative administration of octreotide long-acting release (LAR), a long-acting somatostatin analog.

METHODS

Between December 1992 and August 2000, 31 patients underwent hepatic surgical cytoreduction (20 carcinoid, 10 islet cell, and 1 medullary). All patients had progressive symptoms refractory to conventional therapy.

RESULTS

Hepatic cytoreduction (resection, cryosurgery, and/or radiofrequency ablation) eliminated symptoms in 27 patients (87%) and decreased secretion of hormones by an overall mean of 59%. When minor symptoms returned and/or hormonal levels increased during follow-up, adjuvant therapy was started. Ten patients received adjuvant octreotide LAR once a month, and 21 received other adjuvants. At a median postoperative follow-up of 26 months, 16 patients had progressive/recurrent disease, 13 had died of their disease, and 2 remained free of disease. Median symptom-free interval was 60 months (95% confidence interval, 48-72) with octreotide LAR and 16 months (95% confidence interval, 10-29) with other adjuvants (P = .0007). Two-year symptom-free survival rate was 100% with octreotide LAR and 33% with other adjuvants.

CONCLUSIONS

Hepatic surgical cytoreduction can palliate progressive symptoms associated with liver metastases from intractable neuroendocrine tumors. Postoperative adjuvant therapy with octreotide LAR can prolong symptom-free survival.

Impaired renal D(1)-like and D(2)-like dopamine receptor interaction in the spontaneously hypertensive rat

D(1)-like (D(1), D(5)) and D(2)-like (D(2), D(3), D(4)) dopamine receptors interact in the kidney to produce a natriuresis and a diuresis. Disruption of D(1) or D(3) receptors in mice results in hypertension that is caused, in part, by a decreased ability to excrete an acute saline load. We studied D(1)-like and D(2)-like receptor interaction in anesthetized spontaneously hypertensive rats (SHR) by the intrarenal infusion of Z-1046 (a novel dopamine receptor agonist with rank order potency of D(3)> or =D(4)>D(2)>D(5)>D(1)). Z-1046 increased glomerular filtration rate (GFR), urine flow, and sodium excretion in normotensive Wistar-Kyoto rats but not in SHRs. The lack of responsiveness to Z-1046 in SHRs was not an epiphenomenon, because intrarenal cholecystokinin infusion increased GFR, urine flow, and sodium excretion to a similar extent in the two rat strains. We conclude that renal D(1)-like and D(2)-like receptor interaction is impaired in SHRs. The impaired D(1)-like and D(2)-like receptor interaction in SHRs is not caused by alterations in the coding sequence of the D(3) receptor, the D(2)-like receptor expressed in rat renal tubules that has been shown to be involved in sodium transport. Because the diuretic and natriuretic effects of D(1)-like receptors are, in part, caused by an interaction with D(2)-like receptors, it is possible that the decreased Z-1046 action in SHRs is secondary to the renal D(1)-like receptor dysfunction in this rat strain.

PACAP(6-38) is a PACAP receptor antagonist for breast cancer cells

The effects of pituitary adenylate cyclase activating polypeptide (PACAP) analogs were investigated using breast cancer cells. 125I-PACAP-27 bound with high affinity (Kd = 5 nM) to T47D cells (Bmax = 29,000 per cell). Specific 125I-PACAP-27 binding was inhibited half maximally by PACAP-27, PACAP-38, PACAP(6-38) and PACAP(28-38) with IC50) values of 8, 17, 750 and >3000 nM, respectively. By RT-PCR, PACAP receptor mRNA was present in MCF-7 and T47D cell lines. Polyclonal antibodies to a PACAP receptor fragment (A-8-C) were elicited. The antibodies were affinity purified, recognized a 60-kDa protein by western blot, and stained malignant cells in breast cancer biopsy specimens by immunohistochemistry. PACAP-27 elevated the cAMP in T47D cells and the increase in cAMP caused by PACAP was inhibited by PACAP(6-38). PACAP-27 stimulated c-fos mRNA in T47D cells and the increase in c-fos gene expression caused by PACAP was reversed by PACAP(6-38). PACAP(6-38) inhibited colony formation using a soft agar assay and inhibited breast cancer xenograft growth in nude mice. These data suggest that PACAP(6-38) functions as a breast cancer PACAP receptor antagonist.

Model demonstrating respiratory mechanics for high school students

We wanted to develop educational materials appropriate for the high school student which would present physiological concepts in an innovative way. The impetus was in response to the lack of physiology educational materials appropriate for the high school level. To this end, we developed an exercise that presents the physiological basis for respiratory mechanics. The materials were designed to engage students in interactive learning and to stimulate interest for future science study. The emphasis of the exercise was the construction of a model that could be built by high school students to demonstrate respiratory mechanics. The use of models to present complex materials has been shown to be an effective medium for science learning. Our exercise contains directions for an inexpensive, easy-to-build model, as well as many supplemental teaching tools. Questions are interspersed throughout the text and at the end of the laboratory experience to facilitate the learning process. Answers are provided to the questions. Students and teachers alike are challenged to build, manipulate, and discuss their experience during the investigation of respiratory mechanics.