Breaking bad news to cancer patients: survey and analysis.

PURPOSE: To find out how patients perceived the disclosure of news about their cancer as regards the physician counselling and how they perceived the flow of information between hospital-based and family physicians. METHODS: 272 cancer patients were polled with a 16-item questionnaire. RESULTS: 252 cancer patients, 92.6% of those asked, completed the questionnaire. 37.7% (f:35.4%, m:41.8%) stated that the fact that they had cancer was presented to them 'very empathically' or 'empathically'. 62.3% (f:64.7%, m:58.3%) stated that it was presented to them 'not so empathically' or ' not at all empathically'. When patients had been counselled by family physicians they were more likely to state that it had been done 'very empathically' or 'empathically', in contrast to when they had been counselled by hospital-oncologists or self-employed specialists (81.8% vs. 41.2% vs. 41.2%; p=0.001). Significantly more patients thought that they had been given adequate opportunity to ask the questions they considered important when counselled by a family physician (81.8%) as compared to counselling by a hospital-oncologist (43.5%; p=0.002) or a self-employed specialist (44.3%; p=0.001). 56.8% preferred to discuss the suggested cancer therapies with an oncologist. 87.5% of patients considered the exchange of information between the hospital-based specialists and their family physician 'very important' or 'important'; more than half of all patients stated that this exchange of information was 'rather poor' or 'poor'. CONCLUSIONS: Oncologists should involve family physicians in disclosing bad news to patients. There are considerable deficiencies regarding information-exchange in cancer care in Austria.

Multidrug resistance markers P-glycoprotein, multidrug resistance protein 1, and lung resistance protein in non-small cell lung cancer: prognostic implications.

PURPOSE: The aim of this retrospective study was to comparatively investigate the expression of the three drug-resistance genes P-glycoprotein (P-gp), multidrug-resistance protein 1 (MRP1), and lung resistance protein (LRP), in non-small cell lung cancer (NSCLC) tissues, and to assess possible associations with clinicopathologic features. METHODS: Tumor specimens from 126 patients were analyzed by immunohistochemistry and, in selected cases, by reverse transcriptase polymerase chain reaction (RT-PCR), and data were statistically analyzed by SPSS. RESULTS: The mean expression levels of tumor tissues in the case of P-gp and LRP did not exceed the one of normal epithelia, while MRP1 was significantly enhanced in NSCLC. A weak association was observed between higher grading and P-glycoprotein expression (p <0.08) as well as lower grading and MRP1 expression in the case of adenocarcinoma (p <0.05). MRP1 levels were highest in TNM stage I and declined with advanced stage (p <0.03). A significant association was found between high MRP1 levels and longer overall survival (N =115, p <0.04), which was highly significant in the patient group never treated with chemotherapy (N =77; p <0.007). P-gp expression was enhanced in those patients who had received chemotherapy before surgery (p <0.05). CONCLUSIONS: Our data point towards a major role of MRP1 in the intrinsic treatment resistance of NSCLC and suggest, in addition, a significant activation of P-gp expression during chemotherapy.

Morphological and functional results of AcrySof intraocular lens implantation in children: prospective randomized study of age-related surgical management.

PURPOSE: To evaluate the prevalence and severity of posterior capsule opacification (PCO) in pediatric eyes with a foldable acrylic AcrySof (Alcon) intraocular lens (IOL) and age-related surgical methods. SETTING: Department of Ophthalmology, University of Vienna, Medical School, Vienna, Austria. METHODS: This prospective randomized study comprised 50 eyes of 34 children aged between 2 and 16 years. Eyes of children between 2 and 5.9 years were consecutively randomized to Group 1a (primary posterior capsulotomy and anterior vitrectomy) or Group 1b (optic capture in addition). Eyes of children between 6 and 16 years were consecutively randomized to Group 2a (primary posterior capsulotomy without anterior vitrectomy), Group 2b (optic capture in addition), or Group 2c (in-the-bag IOL implantation without opening the posterior capsule). Main outcome parameters were the incidence and severity of PCO formation, early postoperative complications, pigmented cell deposits on the IOL surface, and cataract morphology. RESULTS: The visual axis was clear at the last follow-up in all eyes in Groups 1a, 1b, 2a, and 2b except in 1 eye in Group 1a. Sixty-percent of eyes in Group 2c had PCO. The incidence of early postoperative complications was significantly higher in eyes that developed PCO than in those that maintained a clear visual axis. There was no evidence that cataract morphology influenced PCO rates. CONCLUSIONS: The AcrySof IOL was well tolerated in pediatric eyes. Optic capture was not necessary to ensure a clear visual axis. Primary posterior capsulotomy should be performed in preschool and uncooperative children and in eyes expected to have relatively high postoperative inflammation. Implanting the AcrySof in the bag and leaving the posterior capsule intact is acceptable for school children and juveniles with isolated developmental cataract.

Complementary therapies in cancer patients: prevalence and patients' motives.

BACKGROUND: Data relating to the use of complementary/alternative medicine (CAM) in cancer patients have been published for a number of European countries. No recent data are available for Austria. AIM: To ascertain the extent of CAM use by cancer patients, what patients' motives are, what methods are used and who the CAM providers are. DESIGN: Self-administered questionnaire; cross-sectional study. PATIENTS AND METHODS: A sample of 231 cancer patients who had consulted the Viennese Cancer League. Chi-square and Mantel-Haenszel tests were used for the statistical evaluation. RESULTS: 27.3% of the cancer patients had received CAM therapy: 33.1% of the female and 20.5% of the male participants (p = 0.045). Those who were below the median of the age categories (53.8 years) had used CAM to a statistically higher degree (35.5% vs. 21.1%; p = 0.023). The most important motives were the enhancement of "nature" and the GPs' recommendation. CAM was administered in 44.4% of cases by the family doctor, in 39.7% by patients themselves, in 6.3% by a hospital doctor, in 6.3% by a lay-practitioner or "non-medical practitioner against payment" and in 4.8% of cases by a practising oncologist. CONCLUSION: From the high percentage of patients who use CAM without consulting a physician or who follow the advice of others, it would seem highly probable that conventional and complementary methods are rarely effectively coordinated. To rectify this we conclude that oncologists and GPs should have a basic knowledge of CAM and address the issue when counselling their cancer patients.

Stigma resistance in patients with schizophrenia.

BACKGROUND: An individual's capacity to counteract the stigma of mental illness, stigma resistance (SR), is considered as playing a crucial role in fighting stigma. However, little is known about SR and its correlates in patients with schizophrenia or schizoaffective disorder. AIM: Exploring SR in patients with schizophrenia or schizoaffective disorder. METHOD: One hundred fifty-seven participants completed the "Internalized Stigma of Mental Illness" (ISMI) Scale including its subscale on SR. Measures of perceived devaluation and discrimination, depression, self-esteem, empowerment, quality of life, and demographic and clinical variables were obtained. RESULTS: Two-thirds of all patients showed high SR. SR correlated positively with self-esteem, empowerment, and quality of life and negatively with stigma measures and depression. A social network with a sufficient number of friends, being single or married, in contrast to being separated, as well as receiving outpatient treatment, was associated with higher SR. CONCLUSIONS: SR is a new and promising concept. The development of stigma-resisting beliefs might help individuals in their hope of finding a fulfilling life and in their recovery from mental illness.

Cancer patients' perception of information exchange between hospital-based doctors and their general practitioners.

RATIONALE, AIMS AND OBJECTIVES: The quality of communication between health care professionals is a key issue determining health outcomes in cancer care. This study aims to find out what importance cancer patients in Austria attach to information exchange between hospital-based doctors and their general practitioners (GPs) and how patients perceive this flow of information. METHODS: In this cross-sectional study, cancer patients seeking help at a community-based organization in the voluntary sector (Viennese Cancer League) were polled with a 16-item questionnaire. Contingency tables were evaluated by means of the chi-squared and Mantel-Haenszel test. RESULTS: The mean age of the 252 respondents - 92.6% of those polled (272) - was 51.9 years (SD ± 13.6). 87.5% [female (f): 92.1%, male (m): 80.2%] considered the exchange of information between the hospital-based specialists and their GP 'very important' or 'important'; 12.5% (f: 8.0%, m: 19.8%) 'not so important' or 'not at all important'; 28.1% (f: 26.0%, m: 31.2%) of patients considered the flow of information as 'very good' or 'fairly good', but 50.9% (f: 58.7, m: 40.0%) as 'rather poor' or 'poor'. Some 34.8% of patients thought that their cancer disease was first suspected by a hospital-based specialist; 42.1% thought that it was first suspected by a doctor outside the hospital. Even when patients were counselled elsewhere they gave high importance to the provision of appropriate information to their GP. CONCLUSIONS: Cancer patients in Austria attach high importance to the provision of appropriate information to their GP by hospitals and perceive this exchange of information as insufficient, a finding that could well be prevalent in other European health systems.

Polymorphism in ARE-I region of prostate-specific antigen gene associated with low serum testosterone level and high-grade prostate cancer.

OBJECTIVES: To examine the impact of polymorphism in the androgen-responsive element I region of the prostate-specific antigen (PSA) gene on the serum testosterone level and Gleason score in patients with newly diagnosed, untreated prostate cancer (PCa). High-grade PCa is associated with a low serum testosterone level, and the testosterone level has been negatively correlated with the expression of PSA. METHODS: Endocrine factors (including testosterone, follicle-stimulating hormone, and luteotropic hormone), PSA level, prostate volume, and Gleason score were measured in 134 patients with untreated, biopsy-verified PCa. PSA polymorphism was determined by polymerase chain reaction-based methods using DNA from peripheral blood samples. RESULTS: Patients with the PSA G/G genotype had lower serum testosterone levels (3.5 +/- 1.2 ng/mL) than those with the A/A genotype (4.3 +/- 1.6 ng/mL) or the A/G genotype (4.4 +/- 1.5 ng/mL). The PSA level in the A/A and A/G genotype groups were significantly lower than that in the G/G genotype group (18.2 +/- 55.0 ng/mL versus 20.5 +/- 27.6 ng/mL, P = 0.013). In a multiple logistic regression model, the odds ratio for the G/G polymorphism was significantly increased for Gleason score (odds ratio 2.4, 95% confidence interval 1.6 to 10.4; P = 0.02) and serum testosterone level (odds ratio 0.44, 95% confidence interval 0.36 to 0.94; P = 0.01) relative to genotypes A/A and A/G. CONCLUSIONS: Our results showed that the PSA G/G genotype is associated with a greater Gleason score and serum PSA level but lower serum testosterone level and could be considered a risk factor for a poor outcome of PCa.

[Empowerment, quality of life and participation in neurological rehabilitation. Empirical study with stroke patients and their relatives]. / Empowerment, Lebensqualität und Partizipation in der neurologischen Rehabilitation. Eine empirische Studie an Schlaganfallpatienten und Angehörigen.

The active role (participation) that patients with chronic conditions are able to achieve has increasingly been recognised as a measure for the effectiveness of prevention- and rehabilitation strategies. An empowerment scale is an especially effective instrument for measuring social participation, and was applied to stroke patients in neurological rehabilitation for the first time. 26 stroke survivors and 26 informal carers, who participated in self-help groups in Lower Austria, were surveyed. The mean age was 63.9 (+/- 10.4) (stroke survivors) and 61.9 (+/- 9.6) years (informal carers). The mean duration of disease was 7.3 (+/- 3.2) years and the mean length of self-help group participation approximately 4 years. Every other stroke survivor and every fifth informal carer had to give up their professional life because of the stroke. Financial burden, reduction of vacations and social activities was found for both groups. Informal carers more frequently reported an increased fear of a relapse and generally of the future. One third of the stroke survivors had insomnia, depression, and nervousness. Reduced mobility, memory impairment, and increased sensitivity to temperature-changes were seen as the largest burdens. In spite of the large overlap in many domains of empowerment- and quality-of-life measures, empowerment measures also seem to reflect aspects of social participation. Therefore, measures of empowerment should be included in long-term outcome measurements following stroke.

Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadal hormone axis.

OBJECTIVES: To assess the impact of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) on the hypothalamic-pituitary hormone axis, we determined the endocrine changes after radical prostatectomy (RP) and transurethral resection of the prostate (TURP) for BPH and in a group of men with BPH followed up conservatively. METHODS: Patients with PCa before RP (n = 49), those who underwent TURP for BPH (n = 51), and men with lower urinary tract symptoms for whom a wait-and-see strategy was chosen (n = 46) were included. Serum levels of total testosterone, luteinizing hormone, and follicle-stimulating hormone were determined at baseline and 6 and 12 months later in all patients. RESULTS: No significant endocrine changes were observed in the wait-and-see and TURP groups 6 and 12 months after baseline. In contrast, luteinizing hormone increased from 5.2 to 8.9 mIU/mL (P = 0.0004) and follicle-stimulating hormone from 5.7 to 9.3 mIU/mL (P = 0.0003) 12 months after RP. The rise of total testosterone from 3.9 to 4.4 ng/mL failed to reach statistical significance (P = 0.18). Patients with Gleason score 2 to 6 PCa had higher testosterone values (4.2 ng/mL) at baseline than did those with Gleason score 7 to 10 PCa (2.2 ng/mL, P < 0.05). Although 12 months after RP no changes in testosterone were observed in the low Gleason score group, the testosterone levels more than doubled in those with high-grade tumors. The increases in luteinizing hormone and follicle-stimulating hormone at 12 months, however, were comparable in both groups. CONCLUSIONS: Our findings suggest a significant impact of PCa on the hypothalamic-pituitary axis that is more profound in high-grade cancer. Such an effect was not demonstrable for the transition zone in BPH.

Polymorphic CAG repeats in the androgen receptor gene, prostate-specific antigen polymorphism and prostate cancer risk.

As the development of prostate cancer is androgen-dependent, it has been hypothesized that variation in transcriptional activity by the androgen receptor (AR) related to polymorphic CAG repeats in exon 1, influences prostate cancer risk. The AR regulates gene transcription by binding to androgen-response elements (AREs) in target genes, such as the prostate-specific antigen (PSA). In the ARE-I sequence of the PSA gene an adenine to guanine polymorphism is described. It has been hypothesized that the AR binds the two PSA alleles (A and G) with differing affinities and may, thereby, differentially influence prostate cancer risk. To examine the role of the polymorphisms in the AR and PSA genes in prostate cancer susceptibility, we conducted a case-control study of Austrian Caucasians with 190 newly diagnosed prostate cancer patients and 190 age-matched control men with benign prostatic hyperplasia (BPH). The polymorphisms were determined by polymerase chain reaction (PCR)-based methods using DNA from peripheral white blood cells. Logistic regressions were performed to calculate odds ratios (OR) and confidence limits (CL) and to control for possible confounders. Our data provide no evidence for an association between prostate cancer and CAG repeat length. However, we found a significant influence of the ARE-I PSA polymorphism on prostate cancer risk, when calculating the combination of the A/G and G/G genotypes relative to subjects with the A/A genotype (OR = 0.63; 95% CL 0.39-0.99; P = 0.048), suggesting that the G allele has a protective effect. In a case analysis according to Gleason score, the PSA G/G genotype was significantly more frequent in patients with Gleason score >7 (35.1%) than in patients with Gleason score <7 (21.5%), providing evidence that the PSA G/G genotype is associated with more advanced disease at time of diagnosis. However, the ambivalent role of the PSA during prostate carcinogenesis needs further investigation.

Growth data in large series of 587 children and adolescents with type 1 diabetes mellitus.

OBJECTIVE: Discordant data were found in recent growth studies in children with type-1 diabetes mellitus. This study focuses on growth data and final height in the largest cohort of diabetic children studied so far. METHODS: 7598 growth data collected in a longitudinal/cross sectional way between 1971 and 1996 in 587 diabetic subjects (317 males, 270 females) were available for analysis of height and BMI, together with 3889 HbA1c measurements. Final height data were correlated with target height in 123 subjects. The individual growth and BMI linear regression curve of each patient was compared to growth standards and correlated with HbA1c. RESULTS: Children of both sexes were taller at the first observation (males, SDS 0.15 +/- 1.10, mean +/- SD, P=0.02, females, SDS 0.74 +/- 1.46, P<0.001) and tended to lose height afterwards (males, P<0.001, females, n.s.). Males reached a final height of 176.5 cm (n=62, target height 176.8, n.s.) and females 167.0 cm (n=61, target height 165.6, n.s.). Children of both sexes had a higher than normal BMI at first observation (males, SDS 0.32 +/- 1.31, P<0.001, females, SDS 0.10 +/- 0.52, P=0.02). Females but not males gained weight over-proportionally afterwards. HbA1c did not predict any of the variables. CONCLUSION: Diabetic children are taller close to the diabetes onset, which may be due to the synchronization of onset of diabetic symptoms with the mid-childhood growth spurt or the pubertal growth spurt accompanied by elevated growth hormone and/or androgen levels and increased insulin resistance. The subsequent growth deceleration may represent a physiological lag-down growth. This concept is supported by normal adult heights following growth deceleration.

Patterns of joint involvement at onset differentiate oligoarticular juvenile psoriatic arthritis from pauciarticular juvenile rheumatoid arthritis.

OBJECTIVE: To compare the patterns of joint involvement of patients with oligoarticular onset juvenile psoriatic arthritis (Oligo-JPsA) and pauciarticular onset juvenile rheumatoid arthritis (Pauci-JRA) in order to estimate the predictive performance of specific patterns for the diagnosis of Oligo-JPsA. METHODS: Twenty-three children who fulfilled the diagnostic criteria for JPsA (Vancouver criteria) and who had fewer than 5 joints involved in the first 6 months of disease (Oligo-JPsA), and 64 children with Pauci-JRA (ACR criteria) were enrolled. Patients were also classified with respect to the ILAR criteria for juvenile idiopathic arthritis (JIA). Patient characteristics and clinical features at onset and during followup were determined. Patterns of joint involvement at onset of disease and their ability to differentiate between Oligo-JPsA and Pauci-JRA/Oligo-JIA were evaluated. RESULTS: Small joint disease (defined as involvement of any of the metatarsophalangeal or proximal or distal interphalangeal joints of the foot, or metacarpophalangeal or proximal or distal interphalangeal joints of the hand) was significantly more frequent in Oligo-JPsA than in Pauci-JRA at disease onset. The odds of patients with Oligo-JPsA having small joint disease or wrist disease within 6 months of disease onset were much higher than those with Pauci-JRA or Oligo-JIA (p < 0.05 or 0.001). CONCLUSION: Small joint disease and wrist disease are suggestive of Oligo-JPsA. The use of a criterion consisting of small joint disease and/or wrist disease and/or dactylitis instead of dactylitis alone may increase the ability to differentiate Oligo-JPsA from Pauci-JRA or Oligo-JIA.