Clinicopathological factors associated with novel prognostic markers for patients with triple negative breast cancer.

INTRODUCTION: Triple negative breast cancer (TNBC) is characterized by a worse prognosis than other breast cancer subtypes. TNBC is defined by lack of expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2. The aim of this analysis was to evaluate the relationship between immunohistochemical expression of novel prognostic markers (erythropoietin (EPO) and erythropoietin receptor (EPO-R)) and clinicopathological features of TNBC and non-TNBC patients. MATERIAL AND METHODS: Our analysis was conducted on a group of 162 patients with breast carcinoma with lymph node metastasis (111 TNBC and 51 non-TNBC). All statistical analyses were performed with SPSS software v 12.0. RESULTS: Histopathologic subtyping of the 111 triple negative breast cancers identified 89.1% invasive ductal carcinomas of no special type and 10.9% other special types of cancers. TNBC more often presented EPO-R and EPO expression (36%; 37.8%) than non-TNBC (23.5%; 29.4%). Non-TNBC subgroup showed statistically significant correlation only between Ki-67 expression and histological grade (G1-G3) (p < 0.001), while TNBC subgroup demonstrated significant correlation between Ki-67 expression and histological grade (G1-G3) and tumor size (pT1-pT4) as well (p = 0.002; p = 0.042), between the EPO-R expression and histological grade (G1-G3) (p < 0.001). CONCLUSIONS: The relationship between the expression of EPO-R and histological malignancy grade in triple negative breast cancer, suggests that the present EPO-R expression in TNBC may constitute an additional prognostic factor.

Immunoexpression of DNA fragmentation factor 40, DNA fragmentation factor 45, and B-cell lymphoma 2 protein in normal human endometrium and uterine myometrium depends on menstrual cycle phase and menopausal status.

INTRODUCTION: DNA fragmentation factors 40 and 45 (DFF40 and DFF45) are final executors of apoptosis, and B-cell lymphoma 2 (Bcl-2) is a well-recognized apoptosis inhibitor. We aimed to evaluate DFF40, DFF45 and Bcl-2 immunoexpression in the normal human endometrium with respect to the glandular and stromal layer and in uterine myometrium. MATERIAL AND METHODS: DFF40, DFF45, and Bcl-2 expression was assessed via immunohistochemistry in the endometrium and myometrium collected postmenopausally and premenopausally during the proliferative and secretory phases of the menstrual cycle. RESULTS: Compared to the myometrium and stroma, endometrial glands showed the highest DFF40 and DFF45 expression in pre- and postmenopausal specimens. DFF45, but not DFF40, glandular expression dependent on menstrual cycle phase and DFF40 and DFF45 scoring was significantly lower in postmenopausal specimens. Significantly higher Bcl-2 expression was observed in proliferative glandular endometrium compared to secretory and postmenopausal specimens. No cycle- or menopause-dependent changes were reported for stromal or myometrial DFF40, DFF45 or Bcl-2 expression. DFF40, DFF45 and Bcl-2 expression was independent of age, age at menarche and menopause, BMI, menstrual cycle and menses lengths, parity and gravidity. CONCLUSIONS: The study provides important evidence regarding menstrual cycle-dependent changes in the expression of DFF40, DFF45 and Bcl-2 in the normal human endometrium, especially in the glandular layer, and shows that their levels are stable in the normal uterine myometrium.

Health needs as a priority of local authorities in Poland based on the example of implementation of health policy cancer programmes.

INTRODUCTION: In developed countries, malignant tumours are the second most common cause of death after cardiovascular diseases. The estimates made by epidemiologists indicate that the incidence and death rate for malignant tumours all over the world, Poland included, will probably grow in the decades to come, specifically among patients who are over 65. The aim of the study was to evaluate how local government units address the health needs of citizens on the basis of an analysis of health policy programmes concerning malignant tumours completed in Poland in 2009-2014. MATERIAL AND METHODS: The study was based on desk research. The data included in the annual reports submitted to the Minister of Health concerning completed health policy programmes were used. RESULTS: The most programmes were completed in the Wielkopolskie and the Mazowieckie voivodeships, whereas the fewest were completed in the Kujawsko-Pomorskie and the Podlaskie voivodeships (χ2(15) = 2121.81, p < 0.001). The most programmes were completed by municipalities, followed by counties and, finally, self-governed voivodeships (Q(2) = 1967.90, p < 0.061). The majority of programmes concerned breast cancer and cervical cancer. There was no increase in the activity of local government units in terms of the number of implemented programmes, and a decreasing size of the population covered by the programmes. CONCLUSIONS: There is a very high degree of differentiation in the involvement of particular voivodeships in fighting cancer regarding the number of implemented health programmes. There are various degrees of involvement of particular types of local government units in the implementation of programmes in the field of cancer. The repeatability of actions undertaken at the local and national level may indicate limited effectiveness of the policy to fight cancer. It is necessary to implement more programmes in the field of oncological diseases and to increase the population covered by these programmes.

Health needs in local government policies in Poland in the context of anti-smoking health policy programs.

BACKGROUND: According to the World Health Organization (WHO), every year tobacco smoking kills around 5.4 million people worldwide. Tobacco smoking is a major risk factor for cardiovascular diseases, respiratory diseases and cancer. In Poland, an average of 67,000 people die every year on account of smoking. OBJECTIVES: The aim of the study was to evaluate the health security guaranteed by local governments based on an analysis of health policy programs associated with tobacco consumption, which were conducted in Poland from 2009 to 2014 by local governments. MATERIAL AND METHODS: The study was based on desk research. The data was sourced from the annual reports submitted to the Minister of Health, concerning the health policy programs which were carried out. The analysis covered programs which name, objective or description of tasks indicated that they concerned tobacco smoking. RESULTS: The largest number of programs was completed in the West Pomeranian, Warmian-Masurian and Masovian voivodeships. The smallest number of programs were completed in Kuyavian-Pomeranian, Lódz and Opole voivodeships. The greatest number of programs were carried out by municipalities, followed by counties and county towns, and finally by self-governments of the voivodeships. The number of preventive programs was significantly greater than the number of other types of programs. The majority of programs were aimed at children; there were fewer programs dedicated to adults. The expenditure on the programs was the highest in self-governments of the voivodeships, while the lowest was in municipalities. CONCLUSIONS: The steady growth in the number of anti-smoking programs completed 2009-2014 was one of the factors that reduced tobacco smoking. In view of the mortality rates due to cardiovascular diseases, the inhabitants of Lublin and Warmian-Masurian voivodeships had their health needs addressed most efficiently. In the case of mortality rates due to tracheal, bronchial and lung cancer, the health needs of the inhabitants of Warmian-Masurian and West Pomeranian voivodeships were addressed most efficiently.

Pain, acceptance of illness, adjustment to life with cancer and coping strategies in prostate cancer patients.

INTRODUCTION: Prostate cancer is the second most common type of carcinoma in men. The rate of prostate cancer has increased approximately fivefold lover the last 30 years. The purpose of the study was to evaluate coping strategies, pain management, illness acceptance, and adjustment to cancer in patients diagnosed with prostate carcinoma and the effect of socioeconomic variables on the above-mentioned issues. MATERIAL AND METHODS: The study included 228 patients diagnosed with prostate cancer. The questionnaire interview consisted of demographic questions and four psychometric tests: BPCQ, measuring the influence of factors affecting pain management, CSQ, designed to evaluate pain coping strategies, the AIS questionnaire, measuring disease acceptance, and the Mini-Mac. RESULTS: Pain locus of control scores in prostate cancer patients are distributed evenly across all three BPCQ subscales. The top mean score was observed in the area of beliefs that powerful others (doctors) control pain. Increased behavioral activity was the most frequently selected coping strategy (mean score = 18.27). The average level of disease acceptance in study patients was 30.39, with a standard deviation of 8.07. The results were differentiated by education (p = 0.08) and income (p = 0.012). The most frequently indicated coping strategies were fighting spirit (mean score = 22.46) and positive re-evaluation (mean score = 22.04). CONCLUSIONS: The main belief about pain control in prostate cancer patients is that powerful others (doctors) control pain. The study patients cope with disease constructively. The main socioeconomic variables which differentiate the scores obtained across all tests are income and education.

Adjustment to Life with Lung Cancer.

BACKGROUND: In Poland, lung cancer is the most common type of cancer in males (20% of all cases) and third most common type of cancer in females (9% of all cases), right behind breast and colorectal cancers. Recently, 28,000 new cases of lung cancer per year were reported in both genders. OBJECTIVES: The objective of the study was to asses coping strategies, pain management, acceptance of illness and adjustment to cancer in patients diagnosed with pulmonary carcinoma and the effect of socioeconomic variables on the abovementioned issues. MATERIAL AND METHODS: The study included 243 patients diagnosed with lung cancer during outpatient chemotherapy (classical chemotherapy and molecularly targeted therapies) at the Center of Oncology, Maria Sklodowska-Curie Institute in Warszawa. We applied the Paper and Pencil Interview (PAPI) technique. The questionnaire interview was composed of demographic questions and the following four psychometric tests: BPCQ measuring the influence of factors affecting pain management in patients, CSQ designed to evaluate pain coping strategies, AIS questionnaire, measuring disease acceptance, and the mini-Mac scale, assessing psychological adjustment to disease. RESULTS: The highest mean score recorded in the BPCQ was recorded in the powerful doctors subscale (16.79) and the lowest in the internal factors section (15.64). Education, professional status and income were the variables which differentiated the scores. We recorded the top average score in CSQ in the coping self statements subscale (mean = 19.64), and the lowest score in the reinterpreting pain sensations subscale (mean score = 10.32). The results of the test were differentiated by education and income. Patients had the highest Mini-MAC scale scores in the fighting spirit section (21.91). CONCLUSIONS: In the case of patients affected with lung cancer, education and professional status affect the way patients treat doctors in the disease process. These variables are also critical in patients' approach to disease and methods of coping with it.

The assessment of the impact of socio-economic factors in accepting cancer using the Acceptance of Illness Scale (AIS).

AIM OF THE STUDY: The paper presents the results of examining the level of acceptance of the illness in cancer patients using the Acceptance of Illness Scale (AIS). MATERIAL AND METHODS: The study involved cancer patients treated at the Central Clinical Hospital of the Ministry the Interior in Warsaw in 2014. The questionnaire comprised basic demographic questions (socio-economic factors) and the AIS test estimating the level of illness acceptance in patients. RESULTS: For the group of patients in the research group, the arithmetic mean amounted to 27.56 points. The period of time that elapsed between the first cancer diagnosis and the start of the study did not influence the score of accepting illness. The acceptance of illness in patients diagnosed with metastases differed from the acceptance of illness by patients diagnosed with metastatic cancer. Females obtained the average of 29.59 in the AIS test, whereas the average in male patients was 26.17. The patients' age did not impact the AIS test. There were no differences in the AIS test results between a group of people with secondary education and a group of people with higher education. There were no differences in the AIS test results between employed individuals versus pensioners. The inhabitants of cities were characterized by the highest degree of acceptance of their health condition. The lowest degree of acceptance of illness was observed in the group with the lowest average incomes. In the group of married individuals the average degree of acceptance of illness amounted to 27.37 points. The average degree of acceptance of illness in patients that declared themselves as single amounted to 25.75. CONCLUSIONS: The average degree of acceptance of illness in the study group was 27.56 points, which is a relatively high level of acceptance of cancer. The main socio-economic factor, which influenced the AIS test results was whether metastases were diagnosed or not. There were no differences between patients in groups where the time that elapsed from the first diagnosis of cancer varied. There were no statistical differences between female and male patients as well as patients of different age. Additionally, the level of education and patients' professional status did not impact in the AIS test results.

Assessment of pain, acceptance of illness, adjustment to life with cancer, and coping strategies in colorectal cancer patients.

INTRODUCTION: Every year more than 15,000 newly diagnosed cases of colorectal carcinoma are recorded in Poland. AIM: The objective of the study was an assessment of coping strategies and pain management, acceptance of illness, and adjustment to cancer in patients diagnosed with colorectal carcinoma. The analysis was extended to include the effect of socioeconomic variables on the above-mentioned issues. MATERIAL AND METHODS: The study included 238 colorectal cancer patients treated on an outpatient basis at the Centre of Oncology, the Maria Sklodowska-Curie Institute in Warsaw in the year 2013. The questionnaire interview comprised demographic questions (socioeconomic variables) and the following four psychometric tests: BPCQ (Beliefs about Pain Control Questionnaire), CSQ (Coping Strategies Questionnaire), AIS questionnaire (Acceptance of Illness Scale), and the Mini-Mac scale (Mental Adjustment to Cancer). RESULTS: The source of pain control depends on the respondent's level of education. An increase in patient income was associated with a lower mean result in the "power of doctors" subscale. The coping self-statements and increased behavioural activity are the two most frequently selected strategies of coping with pain. The most commonly followed ways of mental adjustment to cancer in the study group were a fighting spirit (23.42) and positive re-evaluation (22.31). CONCLUSIONS: Colorectal cancer patients believe that the greatest role in pain management is played by internal factors. The locus of pain control depends on the level of education. The study patients feature a constructive way of struggling with disease differentiated by the place of residence, professional status, and income.