Psychological distress and resilience in patients with advanced cancer during the Covid-19 pandemic: the mediating role of spirituality.

BACKGROUND: The purpose of this study was to investigate the sociodemographic factors related to psychological distress, spirituality, and resilience, and to examine the mediating role of spirituality with respect to psychological distress and resilience in patients with advanced, unresectable cancer during the Covid-19 pandemic. METHODS: A prospective, cross-sectional design was adopted. Data were collected from 636 participants with advanced cancer at 15 tertiary hospitals in Spain between February 2019 and December 2021. Participants completed self-report measures: Brief Resilient Coping Scale (BRCS), Brief Symptom Inventory (BSI-18), and Spiritual well-being (FACIT-Sp). Hierarchical linear regression models were used to explore the mediating role of spirituality. RESULTS: Spirituality was significantly different according to the person's age and marital status. Psychological distress accounted for 12% of the variance in resilience (ß = - 0.32, p < 0.001) and spirituality, another 15% (ß =0.48, p < 0.001). Spirituality acted as a partial mediator in the relationship between psychological distress and resilience in individuals with advanced cancer. CONCLUSIONS: Both psychological distress and spirituality played a role in resilience in cases of advanced cancer. Spirituality can help promote subjective well-being and increased resilience in these subjects.

Impact of Obesity on Quality of Life, Psychological Distress, and Coping on Patients with Colon Cancer.

BACKGROUND: Despite the causal relationship between obesity and colon cancer being firmly established, the effect of obesity on the course of cancer calls for further elucidation. The objective of this study was to assess differences in clinical-pathological and psychosocial variables between obese and nonobese individuals with colon cancer. MATERIALS AND METHODS: This was a prospective, multicentric, observational study conducted from 2015-2018. The sample comprised patients with stage II-III, resected colon cancer about to initiate adjuvant chemotherapy with fluoropyrimidine in monotherapy or associated with oxaliplatin and grouped into nonobese (body mass index <30 kg/m2 ) or obese (≥30 kg/m2 ). Subjects completed questionnaires appraising quality of life (European Organization for Research and Treatment of Cancer Quality of Life Core questionnaire), coping (Mini-Mental Adjustment to Cancer), psychological distress (Brief Symptom Inventory 18), perceived social support (Multidimensional Scale of Perceived Social Support), personality (Big Five Inventory 10), and pain (Brief Pain Inventory). Toxicity, chemotherapy compliance, 12-month recurrence, and mortality rate data were recorded. RESULTS: Seventy-nine of the 402 individuals recruited (19.7%) were obese. Obese subjects exhibited more comorbidities (≥2 comorbidities, 46.8% vs. 30.3%, p = .001) and expressed feeling slightly more postoperative pain (small size-effect). There was more depression, greater helplessness, less perceived social support from friends, and greater extraversion among the obese versus nonobese subjects (all p < .04). The nonobese group treated with fluoropyrimidine and oxaliplatin suffered more grade 3-4 hematological toxicity (p = .035), whereas the obese had higher rates of treatment withdrawal (17.7% vs. 7.7%, p = .033) and more recurrences (10.1% vs. 3.7%, p = .025). No differences in sociodemographic, quality of life, or 12-month survival variables were detected. CONCLUSION: Obesity appears to affect how people confront cancer, as well as their tolerance to oncological treatment and relapse. IMPLICATIONS FOR PRACTICE: Obesity is a causal factor and affects prognosis in colorectal cancer. Obese patients displayed more comorbidities, more pain after cancer surgery, worse coping, and more depression and perceived less social support than nonobese patients. Severe hematological toxicity was more frequent among nonobese patients, whereas rates of withdrawal from adjuvant chemotherapy were higher in the obese cohort, and during follow-up, obese patients presented greater 12-month recurrence rates. With the growing and maintained increase of obesity and the cancers associated with it, including colorectal cancer, the approach to these more fragile cases that have a worse prognosis must be adapted to improve outcomes.

Response and survival of breast cancer intrinsic subtypes following multi-agent neoadjuvant chemotherapy.

BACKGROUND: Predicting treatment benefit and/or outcome before any therapeutic intervention has taken place would be clinically very useful. Herein, we evaluate the ability of the intrinsic subtypes and the risk of relapse score at diagnosis to predict survival and response following neoadjuvant chemotherapy. In addition, we evaluated the ability of the Claudin-low and 7-TNBCtype classifications to predict response within triple-negative breast cancer (TNBC). METHODS: Gene expression and clinical-pathological data were evaluated in a combined dataset of 957 breast cancer patients, including 350 with TNBC, treated with sequential anthracycline and anti-microtubule-based neoadjuvant regimens. Intrinsic subtype, risk of relapse score based on subtype and proliferation (ROR-P), the Claudin-low subtype and the 7-TNBCtype subtype classification were evaluated. Logistic regression models for pathological complete response (pCR) and Cox models for distant relapse-free survival (DRFS) were used. RESULTS: Basal-like, Luminal A, Luminal B, and HER2-enriched subtypes represented 32.7%, 30.6%, 18.2%, and 10.3% of cases, respectively. Intrinsic subtype was independently associated with pCR in all patients, in hormone receptor-positive/HER2-negative disease, in HER2-positive disease, and in TNBC. The pCR rate of Basal-like disease was >35% across all clinical cohorts. Neither the Claudin-low nor the 7-TNBCtype subtype classifications predicted pCR within TNBCs after accounting for intrinsic subtype. Finally, intrinsic subtype and ROR-P provided independent prognostic information beyond clinicopathological variables and type of pathological response. A 5-year DRFS of 97.5% (92.8-100.0%) was observed in these neoadjuvant-treated and clinically node-negative patients predicted to be low risk by ROR-P (i.e. 57.4% of Luminal A tumors with clinically node-negative disease). CONCLUSIONS: Intrinsic subtyping at diagnosis provides prognostic and predictive information for patients receiving neoadjuvant chemotherapy. Although we could not exclude a survival benefit of neoadjuvant chemotherapy in patients with early breast cancer with clinically node-negative and ROR-low disease at diagnosis, the absolute benefit of cytotoxic therapy in this group might be rather small (if any).

Pancreatic acinar cell carcinoma with bilateral ovarian metastases, panniculitis and polyarthritis treated with FOLFIRINOX chemotherapy regimen. A case report and review of the literature.

Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic tumor, with an estimated frequency of less than 1% of pancreatic malignancies. There are no prospective studies to guide diagnostic or therapeutic algorithms. We report the case of a 36 year-old woman, diagnosed of a pancreatic tumor with liver and peritoneal metastases that was initially managed as a neuroendocrine tumor with temozolomide and capecitabine. After two cycles a severely painful arthritis developed in her left ankle with panniculitis and extensive fat necrosis, and CT scan demonstrated progressive disease. Pathology of the primary was reassessed establishing the diagnosis of PACC. The patient started treatment with FOLFIRINOX regimen, achieving clinical benefit and disease stabilization. We also briefly reviewed the literature on this rare subtype of pancreatic tumor.

Efficacy and safety of neoadjuvant chemotherapy with concurrent liposomal-encapsulated doxorubicin, paclitaxel and trastuzumab for human epidermal growth factor receptor 2-positive breast cancer in clinical practice.

BACKGROUND: Based on previous results obtained with non-pegylated liposomal-encapsulated doxorubicin (TLC-D99) together with paclitaxel and trastuzumab in patients with human epidermal growth factor receptor 2 (HER2)-positive locally advanced or metastatic breast cancer (BC), a similar regimen was evaluated in the neoadjuvant setting in a prospectively selected series of consecutive patients with clinical stage II-III BC. Primary and secondary objectives included the rate of pathologic complete response (pCR), safety, and predictive factors of pCR. METHODS: Patients received six cycles of TLC-D99 (50 mg/m(2) every 3 weeks), paclitaxel (80 mg/m(2) weekly) and trastuzumab (4 mg/kg initial dose and 2 mg/kg weekly). All patients underwent surgery after treatment. pCR was defined as the absence of invasive cancer cells in the breast and the axilla. RESULTS: Sixty-two patients with a median age of 46.6 years were analyzed. Stage IIIA was diagnosed in 43.5% of patients and 14.5% had inflammatory BC. Conservative surgery was performed in 46.8% of the patients and pCR was achieved in 63% (95% CI 50.5-75.5). Patients with estrogen receptor (ER)-negative tumors presented a significantly higher pCR rate than patients with ER-positive tumors (74.4 vs 43.5%; P = 0.028). Forty-five patients (72.6%) completed study treatment and 80.6% received at least five treatment cycles. No patients developed congestive heart failure and 14.5% of patients showed a ≥ 10 % decrease in the left ventricular ejection fraction. CONCLUSION: The triple combination therapy assessed is effective and safe, offering a high pCR rate in patients with HER2-positive BC.

Prospective study of predictors for anxiety, depression, and somatization in a sample of 1807 cancer patients.

In cancer patients, psychological distress, which encompasses anxiety, depression, and somatization, arises from the complex interplay of emotional and behavioral reactions to the diagnosis and treatment, significantly influencing their functionality and quality of life. The aim was to investigate factors associated with psychological distress in cancer patients. This prospective and multicenter study, conducted by the Spanish Society of Medical Oncology (SEOM), included two cohorts of patients with cancer (localized resected or advanced unresectable). They completed surveys assessing psychological distress (BSI-18) before and after cancer treatment and coping (MINI-MAC) and spirituality (FACIT-sp) prior to therapy. A multivariable logistic regression analysis and a Structural Equation Modeling (SEM) were conducted. Between 2019 and 2022, 1807 patients were evaluated, mostly women (54%), average age 64 years. The most frequent cancers were colorectal (30%), breast (25%) and lung (18%). Men had lower levels of anxiety and depression (OR 0.66, 95% CI 0.52-0.84; OR 0.72, 95% CI 0.56-0.93). Colorectal cancer patients experienced less anxiety (OR 0.63, 95% CI 0.43-0.92), depression (OR 0.55, 95% CI 0.37-0.81), and somatization (OR 0.59, 95% CI 0.42-0.83). Patients with localized cancer and spiritual beliefs had reduced psychological distress, whereas those with anxious preoccupation had higher level. SEM revealed a relationship between psychological distress and coping strategies, emphasizing how baseline anxious preoccupation exacerbates post-treatment distress. This study suggests that age, sex, extension and location of cancer, coping and spirituality influence psychological distress in cancer patients.

Antifouling Mortars for Underwater Restoration.

This research has focused on the assessment of the compositional features and mechanical and antifouling performances of two different mortars formulated for an underwater setting, and which contain Mg(OH)2 as an antifouling agent. Regarding the mechanical characterization, the uniaxial compressive strength and flexural strength were measured. The composition of the materials was explored by differential thermal/thermogravimetric analysis (DTA-TG), X-ray diffraction analysis (XRPD), and scanning electronic microscopy (SEM) coupled with EDS microanalysis. The assessment of the biological colonization was evaluated with colorimetric analysis and image analysis. The results suggest that both mortars have good mechanical resistance once set underwater. Moreover, the adding of Mg(OH)2 improves the resistance toward biofouling; this was observed both in laboratory and sea-exposed specimens.

Multidimensional Scale of Perceived Social Support (MSPSS) in cancer patients: psychometric properties and measurement invariance.

BACKGROUND: The aim of this study was to evaluate the psychometric properties, convergent validity, and factorial invariance of the Multidimensional Scale of Perceived Social Support (MSPSS) in cancer patients. METHOD: Confirmatory factor analysis (CFA) was conducted to explore the scale's dimensionality and test for strong measurement invariance across sex and age in a cross-sectional, multicenter, prospective study. Patients completed the MSPSS and Satisfaction with Life Scale (SWLS). RESULTS: A total of 925 consecutive patients were recruited in 13 hospitals between July 2015 and December 2018. The CFA indicated that the original three-factor model was replicated in patients with cancer. The results of the multi-group CFA revealed a strong invariance according to sex and age. The Spanish version of the MSPSS had high estimated reliability with values exceeding .90. The simple sum of the items of each scale was a good indicator of oncology patients' perceived social support. The three MSPSS subscales correlated significantly with the SWLS. Women scored higher on social support by friends than men. CONCLUSION: The Spanish version of the MSPSS proved to be a valid, reliable instrument to assess perceived social support in cancer patients.

Breast cancer patient experiences through a journey map: A qualitative study.

BACKGROUND: Breast cancer is one of the most prevalent diseases in women. Prevention and treatments have lowered mortality; nevertheless, the impact of the diagnosis and treatment continue to impact all aspects of patients' lives (physical, emotional, cognitive, social, and spiritual). OBJECTIVE: This study seeks to explore the experiences of the different stages women with breast cancer go through by means of a patient journey. METHODS: This is a qualitative study in which 21 women with breast cancer or survivors were interviewed. Participants were recruited at 9 large hospitals in Spain and intentional sampling methods were applied. Data were collected using a semi-structured interview that was elaborated with the help of medical oncologists, nurses, and psycho-oncologists. Data were processed by adopting a thematic analysis approach. RESULTS: The diagnosis and treatment of breast cancer entails a radical change in patients' day-to-day that linger in the mid-term. Seven stages have been defined that correspond to the different medical processes: diagnosis/unmasking stage, surgery/cleaning out, chemotherapy/loss of identity, radiotherapy/transition to normality, follow-up care/the "new" day-to-day, relapse/starting over, and metastatic/time-limited chronic breast cancer. The most relevant aspects of each are highlighted, as are the various cross-sectional aspects that manifest throughout the entire patient journey. CONCLUSIONS: Comprehending patients' experiences in depth facilitates the detection of situations of risk and helps to identify key moments when more precise information should be offered. Similarly, preparing the women for the process they must confront and for the sequelae of medical treatments would contribute to decreasing their uncertainty and concern, and to improving their quality-of-life.

Ascertaining breast cancer patient experiences through a journey map: A qualitative study protocol.

BACKGROUND: The current cancer care system must be improved if we are to have in-depth knowledge about breast cancer patients' experiences throughout all the stages of their disease. AIM: This study seeks to describe breast cancer patients' experience over the course of the various stages of illness by means of a journey model. METHODS: This is a qualitative descriptive study. Individual, semi-structured interviews will be administered to women with breast cancer and breast cancer survivors. Patients will be recruited from nine large hospitals in Spain and intentional sampling will be used. Data will be collected by means of a semi-structured interview that was elaborated with the help of medical oncologists, nurses, and psycho-oncologists. Data will be processed adopting a thematic analysis approach. DISCUSSION: The outcomes of this study will afford new insights into breast cancer patients' experiences, providing guidance to improve the care given to these individuals. This protocol aims to describe the journey of patients with breast cancer through the healthcare system to establish baseline data that will serve as the basis for the development and implementation of a patient-centered, evidence-based clinical pathway.

[Aspirin for the primary prevention of cardiovascular diseases in diabetic patients. A review of currently available tests]. / La prevención primaria con aspirina de enfermedades cardiovasculares en personas diabéticas. Revisión de las pruebas disponibles.

The benefits of aspirin treatment in reducing the risk of myocardial infarction, cerebrovascular accidents and vascular death is well-documented among individuals having prior cardiovascular disease, including the subgroup with diabetes mellitus. The role of aspirin in primary prevention is less clear and debatable: the results of the clinical trials currently available are not consistent, although the meta-analyses are favorable in some aspects. There seems to be a disparity between the type of benefit (when found to exist) and gender, the findings being particularly contradictory for diabetic subjects, totalling a minor percentage of the population sample included in the studies. Despite this fact, in 1997, the American Diabetes Association and more recently other scientific societies (including several Spanish societies) have been recommending the use of aspirin in low doses in primary prevention in all type 1 or type 2 diabetic patients over 40 years of age and in all those within the 21-40 age range having any other cardiovascular risk factor in addition to diabetes (family history of vascular disease, hypertension, smoking, dyslipidemia or albuminuria). This study reviews the findings of the randomized, controlled clinical trials on primary cardiovascular prevention with aspirin, on which the official American Diabetes Association guidelines might be based, the conclusion being reached that there is not currently sufficient scientific evidence to uphold these guidelines.

Clinical implications of the intrinsic molecular subtypes of breast cancer.

Gene-expression profiling has had a considerable impact on our understanding of breast cancer biology. During the last 15 years, 5 intrinsic molecular subtypes of breast cancer (Luminal A, Luminal B, HER2-enriched, Basal-like and Claudin-low) have been identified and intensively studied. In this review, we will focus on the current and future clinical implications of the intrinsic molecular subtypes beyond the current pathological-based classification endorsed by the 2013 St. Gallen Consensus Recommendations. Within hormone receptor-positive and HER2-negative early breast cancer, the Luminal A and B subtypes predict 10-year outcome regardless of systemic treatment administered as well as residual risk of distant recurrence after 5 years of endocrine therapy. Within clinically HER2-positive disease, the 4 main intrinsic subtypes can be identified and dominate the biological and clinical phenotype. From a clinical perspective, patients with HER2+/HER2-enriched disease seem to benefit the most from neoadjuvant trastuzumab, or dual HER2 blockade with trastuzumab/lapatinib, in combination with chemotherapy, and patients with HER2+/Luminal A disease seem to have a relative better outcome compared to the other subtypes. Finally, within triple-negative breast cancer (TNBC), the Basal-like disease predominates (70-80%) and, from a biological perspective, should be considered a cancer-type by itself. Importantly, the distinction between Basal-like versus non-Basal-like within TNBC might predict survival following (neo)adjvuvant multi-agent chemotherapy, bevacizumab benefit in the neoadjuvant setting (CALGB40603), and docetaxel vs. carboplatin benefit in first-line metastatic disease (TNT study). Overall, this data suggests that intrinsic molecular profiling provides clinically relevant information beyond current pathology-based classifications.

[Comprehensive review of type 2 diabetes treatment in primary health care. Hygienic, dietetic, educational and pharmacological aspects]. / Revisión integral del tratamiento de la diabetes tipo 2 en atención primaria. Aspectos higienicodietéticos, educacionales y farmacológicos.

Type 2 diabetes is a highly prevalent disease and its management is performed mainly in primary health care. In the present article, focused on the nursing point of view, we propose a comprehensive and very simple approach to the treatment of patients with diabetes, based on the authors' broad clinical experience. There are 5 pillars of type 2 diabetes treatment: diet, exercise, blood glucose autoanalysis, drugs, and control of vascular risk factors (an important question that is not dealt with in this article). A diabetic diet is always required at all phases of the disease. Regular, moderate-intensity aerobic exercise has demonstrated benefits in the treatment of diabetes. Blood glucose autoanalysis is recommended in certain subgroups of patients. Throughout the natural history of type 2 diabetes, drug therapy is structured in stages, which are analyzed in depth in the present article.

[Unilateral adrenal hemorrhage and hypertensive crisis in a patient with antiplatelet treatment]. / Hemorragia suprarrenal unilateral asociada a crisis hipertensiva en un paciente antiagregado.

OBJECTIVE: We report a case of non-traumatic adrenal hemorrhage in a man with antiplatelet treatment. METHODS: The patient was admitted to the Critical Care Unit because of a non-controlled hypertensive crisis. Pheochromocytoma was analytically excluded. The patient underwent a delayed adrenalectomy. RESULTS: Pathologic study of the specimen showed a wide hemorrhagic necrosis. CONCLUSIONS: Association of high blood pressure and adrenal hemorrhage is not pathognomonic of pheochromocytoma.

[Adrenal incidentaloma associated to elevated urinary normethanephrine in a patient with high blood pressure]. / Incidentaloma suprarrenal asociado a normetanefrina urinaria elevada en un paciente hipertenso.

OBJECTIVES: To report one case of adrenal incidentaloma and to review the sensitivity and specificity of urine methanephrines in the diagnosis of pheochromocytoma. METHODS: We report the case of a patient with high blood pressure and a left adrenal incidentaloma. Surgical excision of the mass was indicated after elevated urine methanephrine. RESULTS: Pathologic study of the nodule established the diagnosis of cortical adenoma. CONCLUSIONS: The elevation of urine normethanephrine is a non-specific parameter for the diagnosis of pheochromocytoma.

Antiagregación, diabetes y prevención cardiovascular primaria. Revisión crítica de las recomendaciones de la Asociación Americana de Diabetes / Antiplatelet treatment, diabetes mellitus and primary cardiovascular prevention. A critical appraisal of the American Diabetes Association statement

La Asociación Americana de Diabetes recomendó por primera vez en 1997 el uso de aspirina en dosis bajas (75-162 mg/día) para la prevención primaria de episodios cardiovasculares en todo paciente con diabetes, tipo1 o tipo 2, mayor de 40 años, y en todos los menores de 40 y mayores de 30 años que presentasen otro factor de riesgo cardiovascular, además de la diabetes (antecedentes familiares de enfermedad vascular, hipertensión arterial, tabaquismo, dislipidemia o microalbuminuria). La alergia a la aspirina, la predisposición a sufrir hemorragias, la terapia anticoagulante, el sangrado digestivo reciente o la enfermedad hepática activa constituyen contraindicaciones para el empleo de aspirina y se sugiere que otros antiagregantes serían una alternativa aceptable para pacientes en esta situación y con riesgo cardiovascular elevado. La terapia combinada con aspirina y clopidogrel se reserva como estrategia para la prevención secundaria. Estas directrices continúan vigentes en 2008. Muchas otras sociedades científicas y autores a título particular han aceptado la conveniencia de la antiagregación generalizada en los pacientes con diabetes para la prevención cardiovascular primaria, aunque reconocen que las pruebas que existen sobre su beneficio son escasas. Este trabajo es una revisión actualizada de tales pruebas, sobre las que, en definitiva, deberían basarse las recomendaciones.

The American Association of Diabetes recommended forthe first time in 1997 the use of low dose of aspirin (75-162 mg/day) for the primary prevention of cardiovascularevents in every type 1 or type 2 diabetic patient over 40years of age, and in everyone less than 40 and over 30years that may have another factor of cardiovascular risk, besides diabetes (family history of cardiovascular disease, hypertension, smoking, dyslipidemia or albuminuria). Other antiplatelet agents may be a reasonable alternativefor high-risk patients with aspirin allergy, with bleedingtendency, who are receiving anticoagulant therapy, withrecent gastrointestinal bleeding, and with clinically active hepatic disease who are not candidates for aspirintherapy. Combination therapy using other antiplateleta agents such as clopidogrel in addition to aspirin is reservedto secondary prevention strategy. These directivescontinue effective in 2008. Many other scientific societiesand individual authors have accepted the convenienceof the generalized antiaggregation for primarycardiovascular prevention in patients with diabetes, although they recognize that available evidence of benefitis scarce. This work is an updated revision of suchevidence, on which the recommendations would haveto be based.