Quality of life in Mexican colorectal cancer patients: analysis with sociodemographic, medical, and psychological variables.

In this study, we evaluated the influence of sex, age, clinical stage, and colostomy/ileostomy variables on the quality of life of Mexican patients with colorectal cancer. Using a descriptive cross-sectional design, 192 colorectal cancer patients were included in the study. Significant differences were observed in emotional functioning between patients with rectal cancer and those with colon cancer. Presence of colostomy/ileostomy was associated with significantly impaired social functioning. Body image was significantly different based on gender and diagnosis. Likewise, significant differences were observed with respect to symptoms of the general and specific quality of life modules for colorectal cancer: these included significant difference between male and female patients with respect to taste; significant difference between rectal and colon cancer with respect to presence of blood and mucous in stool, urinary incontinence, and buttock pain; and significant difference between patients with and without colostomy/ileostomy with respect to constipation, stool frequency, sore skin, and embarrassment. We observed significant correlation of dimensions of the quality of life with distress, post-traumatic stress, and optimism. Interventions for improving the quality of life of patients with colorectal cancer should be individualized based on the specific diagnosis and the presence/absence of colostomy/ileostomy.

Cognitive Behavioral Stress Management intervention in Mexican colorectal cancer patients: Pilot study.

OBJECTIVE: Determine the feasibility and the preliminary effects of brief cognitive behavioral stress management (CBSM) intervention, compared with psychoeducation (PE) group in posttraumatic stress, distress, optimism, and quality of life in patients with colorectal cancer. METHODS: Ninety-four patients were randomized: 40 in CBSM intervention and 54 in PE. They answered psychological questionnaires before and after the intervention and 3 months later for follow-up. RESULTS: Of the included participants, 23.40% (22) completed the sessions (11 in each group). A significant effect was obtained in the variable of optimism F2,28  = 4.0, P = 0.03, ƞ2p  = 0.22 and a significant interaction effect between the groups in the avoidance behavior F2,28  = 6.0, P = 0.01, ƞ2p  = 0.30 and hyperactivation F2,30  = 3.91, P = 0.03, ƞ2p  = 0.20, with a large effect size in both. A significant interaction effect was found in the quality of life symptoms subscale for patients with colorectal cancer with a stoma F3,20  = 21.8, P = 0.00, ƞ2p  = 0.68. CONCLUSIONS: The CBSM intervention and PE are feasible therapies, albeit with some modifications. Preliminary effects are observed in the dimensions of posttraumatic stress and symptoms of quality of life.

TCF1-positive and TCF1-negative TRM CD8 T cell subsets and cDC1s orchestrate melanoma protection and immunotherapy response.

BACKGROUND: Melanoma, the most lethal form of skin cancer, has undergone a transformative treatment shift with the advent of checkpoint blockade immunotherapy (CBI). Understanding the intricate network of immune cells infiltrating the tumor and orchestrating the control of melanoma cells and the response to CBI is currently of utmost importance. There is evidence underscoring the significance of tissue-resident memory (TRM) CD8 T cells and classic dendritic cell type 1 (cDC1) in cancer protection. Transcriptomic studies also support the existence of a TCF7+ (encoding TCF1) T cell as the most important for immunotherapy response, although uncertainty exists about whether there is a TCF1+TRM T cell due to evidence indicating TCF1 downregulation for tissue residency activation. METHODS: We used multiplexed immunofluorescence and spectral flow cytometry to evaluate TRM CD8 T cells and cDC1 in two melanoma patient cohorts: one immunotherapy-naive and the other receiving immunotherapy. The first cohort was divided between patients free of disease or with metastasis 2 years postdiagnosis while the second between CBI responders and non-responders. RESULTS: Our study identifies two CD8+TRM subsets, TCF1+ and TCF1-, correlating with melanoma protection. TCF1+TRM cells show heightened expression of IFN-γ and Ki67 while TCF1- TRM cells exhibit increased expression of cytotoxic molecules. In metastatic patients, TRM subsets undergo a shift in marker expression, with the TCF1- subset displaying increased expression of exhaustion markers. We observed a close spatial correlation between cDC1s and TRMs, with TCF1+TRM/cDC1 pairs enriched in the stroma and TCF1- TRM/cDC1 pairs in tumor areas. Notably, these TCF1- TRMs express cytotoxic molecules and are associated with apoptotic melanoma cells. Both TCF1+ and TCF1- TRM subsets, alongside cDC1, prove relevant to CBI response. CONCLUSIONS: Our study supports the importance of TRM CD8 T cells and cDC1 in melanoma protection while also highlighting the existence of functionally distinctive TCF1+ and TCF1- TRM subsets, both crucial for melanoma control and CBI response.

Post-traumatic Stress Symptoms, Distress, and Optimism in Mexican Colorectal Cancer Patients.

Background: The diagnosis and treatment of colorectal cancer are considered highly stressful and potentially traumatic events that can generate post-traumatic stress symptoms and distress among patients. Objective: This study assessed levels of post-traumatic stress symptoms, distress, and optimism, as well as differences between these conditions relative to sociodemographic and medical variables, in Mexican patients with colorectal cancer. Design: A cross-sectional descriptive study design was employed, in which 192 colorectal cancer patients over the age of 18 years participated. They filled out the following questionnaires in person: a sociodemographic and medical data questionnaire; the Event Impact Scale-Revised (EIE-R); the Hospital Anxiety and Depression Scale (HADS); and the Life Orientation Test (LOT-R). Results: The results showed that 32.3% of the patients reported post-traumatic stress symptomatology, and 21.4% reported distress. Post-traumatic stress symptoms and distress varied according to age and monthly income. Significant differences between the sexes were also observed in the levels of post-traumatic stress symptoms and distress. Post-traumatic stress was positively and significantly related to distress, and negatively and significantly to optimism. Conclusion: Based on these data, we concluded that a significant percentage of colorectal cancer patients present high levels of post-traumatic stress symptoms as well as distress, and that these levels may vary according to sociodemographic and medical characteristics.

Thymidylate synthase gene variants as predictors of clinical response and toxicity to fluoropyrimidine-based chemotherapy for colorectal cancer.

BACKGROUND: Fluoropyrimidines form the chemotherapy backbone of advanced and metastatic colorectal cancer (CRC). These drugs are frequently associated with toxicity events that result in dose adjustments and even suspension of the treatment. The thymidylate synthase (TYMS) gene is a potential marker of response and toxicity to fluoropyirimidines as this enzyme is the molecular target of these drugs. Our aim was to assess the association between variants of TYMS with response and toxicity to fluoropyrimidines in patients with CRC in independent retrospective and prospective studies. METHODS: Variants namely rs45445694, rs183205964, rs2853542 and rs151264360 of TYMS were genotyped in 105 CRC patients and were evaluated to define their association with clinical response and toxicity to fluoropyrimidines. Additionally, the relationship between genotypes and tumor gene expression was analyzed by quantitative polymerase chain reaction. RESULTS: The 2R/2R (rs45445694) was associated with clinical response (p=0.05, odds ratio (OR)=3.45) and severe toxicity (p=0.0014, OR=5.21, from pooled data). Expression analysis in tumor tissues suggested a correlation between the 2R/2R genotype and low TYMS expression. CONCLUSIONS: The allele 2R (rs45445694) predicts severe toxicity and objective response in advanced CRC patients. In addition, the alleles G(rs2853542) and 6bp-(rs151264360) are independent predictors of response failure to chemotherapy. This is the first study made on a Latin American population that points out TYMS gene variants have predictive values for response and toxicity in patients with CRC treated with fluoropyrimidine-based chemotherapy.