Indication of pre-surgical radiochemotherapy enhances psychosocial morbidity among patients with resectable locally advanced rectal cancer.

Patients with cancer experience stress-determined psychosocial comorbidities and behavioural alterations. Patients expectation to be cured by the first line surgery and their emotional status can be negatively influenced by the decision to include neoadjuvant long-course radiotherapy prior to surgical intervention. From the patient's perspective such treatment algorithmindicates incurability of the disease. The aim of this study was to analyse the extent and dynamics of stress and related psychosocial disturbances among patients with resectable rectal cancer to whom the neoadjuvant radiochemotherapy before surgery has been indicated.Three standardised assessment tools evaluating psychosocial morbidity of rectal cancer patients have been implemented: The EORTC QLQ C30-3, the EORTC QLQ CR29 module and the HADS questionnaires previously tested for internal consistency were answered by patients before and after long-course radiotherapy and after surgery and the scores of clinical and psychosocial values were evaluated by means of the EORTC and HADS manuals. The most profound psychosocial distress was experienced by patients after the decision to apply neoadjuvant radiotherapy and concomitant chemotherapy before surgical intervention. The involvement of pre-surgical radiotherapy into the treatment algorithm increased emotional disturbances (anxiety, feelings of hopelessness) and negatively influenced patient's treatment adherence and positive expectations from the healing process. The negative psychosocial consequences appeared to be more enhanced in female patients. Despite provided information about advances of neoadjuvant radiotherapy onto success of surgical intervention, the emotional and cognitive disorders improved only slightly. The results clearly indicate that addressed communication and targeted psychosocial support has to find place before pre-surgical radiochemotherapy and as a standard part through the trajectory of the entire multimodal rectal cancer treatment.

[Anxio-depressive Syndrome -  Biopsychosocial Model of Supportive Care]. / Anxio-depresívny syndróm v onkológii -  biopsychosociálny model suportívnej terapie.

BACKGROUND: Acute stress in patients experiencing cancer diagnosis and the post-traumatic stress disorder in cancer survivors results in impaired overall quality of life mainly due to associated psychological and physical alterations, including anxiety, depression, sleep disturbances, cognitive dysfunctions, fatigue, pain, cachexia and others. Recent studies revealed a new insight into molecular mechanisms contributing to the development of cancer-related co morbidities. It has been shown that adverse psychosomatic reactions including cancer depression to emotional cancer distress result from neuroendocrinne dysfunctions, disruption of the hypothalamus- pituitary-adrenal axis and sympathetic nervous system, serotonin-dopamine interactions and circadian sleep- wake rhythm disruption. AIM: The aim of the present study was to evaluate clinical studies oriented toward elucidation of the hypothesis that cancer-related anxio- depressive syndrome is the major disorder leading to the development of accompanying psychosomatic disruptions. MATERIAL AND METHODS: The data of the biopsychosocial approach in the treatment of cancer presented in the current literature were collecting using appropriate electronic databases and were elaborated in the form of meta-analysis of 24 selected publications. RESULTS: According to relevant clinical studies, psychosocial interventions and psychopharmacological treatment has been shown to reduce cancer symptomatology and to improve the ability of patients to cope with the disease. Thus, one of the key pillars of supportive care in oncology is stress reduction. Cognitive- behavioral interventions and group psychosocial therapies have shown to reduce stress from the diagnosis and treatment, to palliate depression and to help in restoring the circadian rhythm. Psychopharamacological interventions are the most useful approaches in the reduction of stress-induced cancer comorbidities. In the presented study, a plausible role of stress reduction in the protection of cancer patients from posttraumatic and anxio- depressive syndrome, physical and psychical suffering, from decrease of patients quality of life, ability to cope with the disease and cooperate in cancer treatment has been analyzed. CONCLUSION: Implementation of the biopsychosocial model of cancer care needs further cooperation between behavioral scientists and clinical oncologists attempted to elucidate further possibilities of psychosocial and pharmacological interventions leading to the regulation of stress-induced alterations of the neurotransmitter system and neuroendocrinne dysfunctions reduction of cancer-related co morbidities and improvement of patients survival time.

Comparison of iPTH values in serum and plasma samples depending on the time and temperature in patients with chronic kidney disease.

Renal osteodystrophy is a systemic disorder associated with chronic kidney disease (CKD) with abnormal values of biochemical parameters related to bone and mineral metabolism. Assessing renal osteodystrophy subtypes is especially important for diagnostic and therapeutic decision. Management of these disorders includes monitoring of homeostasis of calcium, phosphorus and parathormone (PTH). PTH is a significant regulator of mineral balance and it´s level is used as a surrogate biomarker for the type of underlying renal osteodystrophy. Worldwide, nephrologists rely on KDIGO - Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD) to maintain PTH levels within defined narrow range of optimal values for each stage of CKD and adjust such PTH - lowering treatments as active vitamin D sterols or calcimimetics accordingly. PTH is rapidly degraded in vivo, with half life of 5 minutes and it is also unstable in blood samples. Values can differ significantly when samples are not collected in a standard way and when recommended conditions for transport and sample processing are not followed. It is also important to standardize pre-analytic conditions that may influence the variability in PTH results. The goal of the present study was to compare iPTH stability in serum and plasma samples and evaluate possible pre-analytic errors in sample collection, effect of temperature during transportat and storing prior to analysis (Tab. 1, Fig. 1, Ref. 5).

Psychosocial support needs of Slovak breast cancer survivors one and three years after breast conserving surgery.

OBJECTIVE: To assess psychosocial support needs among Slovak breast cancer survivors treated by breast conserving surgery. METHODS: Patients responded the EORTC QLQ 30.3 questionnaire and the self-elaborated BCPN (Breast Cancer Psychosocial Needs) questionnaire one and three years after breast conserving surgery (BSC) and modified radical mastectomy (MRM). RESULTS: Assessment of psychosocial distress related to breast cancer treatment have shown a remarkable time-related increase in scores of emotional distress symptoms among breast cancer patients treated with breast-conserving surgery. Analysis of psychosocial support needs of these patients has shown, that a substantial part of breast cancer survivors are feeling inadequate beneficial psychosocial support from health care providers (informational support), social oncology workers, and psychologists (emotional support). Insufficient targeted psychosocial support involved individual as well as group intervention (provided by breast cancer patients surviving the disease for long time). CONCLUSION: Unmet psychosocial needs from health care providers has been perceived as a major factor harming patients ability to cope with the disease and to maintain their family, marital and social functioning (Tab. 2, Fig. 1, Ref. 22).

[Communication as a part of the supportive treatment in cancer care]. / Komunikácia ako súcast suportívnej terapie v onkológii.

BACKGROUND: Interpersonal communication skills as part of the supportive care in cancer won new dimensions by demonstrating the association with enhanced ability of patients to cope with the disease, to enhance trust in health care providers, compliance with treatment and to reduce emotional distress and psychosocial burden. Besides empathy the effective patient  centered communication is based upon perceptual and behavioral skills of caregivers. Doctors, nurses, and oncology social workers have to achieve skills to listen to patients complains and to respond to his/ her support needs. The aim of the present paper was to perform a meta analysis of published data dealing with principles and methods of the assertive doctor  patient communication within the supportive care of patients suffering from emotional and social dysfunctions. MATERIAL AND METHODS: The data of interpersonal communication skills in oncology presented in the current literature were collected using electronic databases and were elaborated in form of meta analysis of 24 selected publications. RESULTS: Active behavioral approach involves the understanding of the nonverbal indications of patients needs, preferences, and expectations, the evaluation of patients nonverbal expression of fear, uncertainty, irritability, depression and apathy or even the unwillingness to disclose his/ her concerns. Recognizing these and other concerns (marital and sexual problems, physical and cognitive functioning etc.), caregivers should respond these concerns in verbal form of psychosocial support. Skills in the interpersonal communication can be learned by clinical experience and theoretical preparation. CONCLUSION: Developing the communication skills including the perception and behavioral style is particularly important in clinicians early medical teaching. The implementation of communication skills into undergraduate and postgraduate study programs in medicine, nursing, and other paramedical subjects is still in infancy, although the professional communication with cancer patient and its family members is associated with clear and important outcomes of care approved by clinical research and recognized by cancer professionals.

[The dynamics of psychosocial burden development in breast cancer survivors: clinical success with psychosocial consequences]. / Dynamika vývoja psychosociálnej zát'aze prezívajúcich pacientok s karcinómom prsníka: klinický uspech s psychosociálnymi dôsledkami.

BACKGROUNDS: Modified radical mastectomy (MRM) and breast-conserving surgery (lumpectomy, quadrantectomy - BCS) have shown equivalent clinical outcome in early stage breast cancer. On the other hand, quality of life and, probably, survival time of these patients are negatively influenced by fear of cancer recurrence, leading to episodes of anxiety, depression, and frustration, and, subsequently, physical, marital, sexual, and social functioning disorders. The aim of the present study was to analyze the dynamics and qualitative changes in psychosocial morbidity outcomes in breast cancer survivors one and three years after MRM versus BCS. METHODS: A survey evaluating psychosocial morbidity of patients was performed by distributing Slovak version of the standardised EORTC-QLQ.C30:3 and EORTC-QLQ-BR23 questionnaires provided by the European Organisation for Research and Treatment of Cancer. The survey was performed in both arms of breast cancer patients surviving one and three years after MRM versus BCS. RESULTS: Patients surviving one year post MRM or BCS scored their quality of life rather low (2-4, very bad - acceptable), while 78% patients surviving three years after BSC scored considerably higher (5-6, good - very good). However, 22% of patients in this arm considered their quality of life bad, scoring comparably with patients in the MRM arm. While psychosocial burden and behavioural risk profile remain fully expressed in MRM-treated breast cancer patients three years post surgery, the patients surviving three years after BCS suffer from significant emotional dysfunction. CONCLUSION: The shift in the quality and intensity of psychosocial dysfunction symptoms in breast cancer patients surviving three years after BCS requires greater attention related to the need for appropriate community-based psychosocial interventions and psychosocial prevention due to the negative impact of continuing and even accelerated psychosocial distress on the quality of life of surviving patients and remission period of the malignant disease.

"Real-World" use of cinacalcet for managing SHPT in different European countries: analysis of data from the ECHO observational study.

AIMS: The pan-European ECHO observational study evaluated cinacalcet in adult dialysis patients with secondary hyperparathyroidism (SHPT) in "real-world" clinical practice. A sub-analysis compared data for 7 European countries/country clusters: Austria, CEE (Czech Republic and Slovakia), France, Italy, Netherlands, Nordics (Denmark, Finland, Norway, and Sweden), and the UK/Ireland. METHODS: Data on serum intact parathyroid hormone (iPTH), phosphorous, calcium, as well as the usage of cinacalcet, active vitamin D analogues and phosphate binders were compared. RESULTS: 1,865 patients (mean age 58 years) were enrolled: median baseline iPTH levels ranged from 605 pg/ml in Austria to 954 pg/ml in the UK/Ireland. After ~1 year of cinacalcet, median iPTH reductions from baseline ranged from 38% in the UK/Ireland to 58% in the Netherlands. The proportion of patients achieving NKF/K-DOQITM iPTH targets (150 - 300 pg/ml) at Month 12 ranged from 14% in the UK/Ireland to 40% in CEE. In general, use of sevelamer decreased, while use of calcium-based phosphate binders increased, during cinacalcet treatment. Vitamin D changes were more variable. CONCLUSION: The iPTH level at which cinacalcet is initiated in clinical practice differs considerably among different countries: where cinacalcet was started at a lower iPTH level this resulted in better achievement of serum iPTH targets.