High-speed spectral nanocytology for early cancer screening.

High-throughput partial wave spectroscopy (HTPWS) is introduced as a high-speed spectral nanocytology technique that utilizes the field effect of carcinogenesis to perform minimally invasive cancer screening on at-risk populations. HTPWS uses fully automated hardware and an acousto-optic tunable filter to scan slides at low magnification, to select cells, and to rapidly acquire spectra at each spatial pixel in a cell between 450 and 700 nm, completing measurements of 30 cells in 40 min. Statistical quantitative analysis on the size and density of intracellular nanostructures extracted from the spectra at each pixel in a cell yields the diagnostic biomarker, disorder strength (Ld). Linear correlation between Ld and the length scale of nanostructures was measured in phantoms with R2=0.93. Diagnostic sensitivity was demonstrated by measuring significantly higher Ld from a human colon cancer cell line (HT29 control vector) than a less aggressive variant (epidermal growth factor receptor knockdown). Clinical diagnostic performance for lung cancer screening was tested on 23 patients, yielding a significant difference in Ld between smokers and cancer patients, p=0.02 and effect size=1.00. The high-throughput performance, nanoscale sensitivity, and diagnostic sensitivity make HTPWS a potentially clinically relevant modality for risk stratification of the large populations at risk of developing cancer.

Helping the clinician help me: towards listening in cancer care.

Despite global support for the ideal of shared decision making, its enactment remains difficult in practice. The UK charity, Macmillan Cancer Support, attempted to incorporate the principles of shared decision making within a programme of distress management in Scotland. Distress management begins by completing the Distress Thermometer (DT). Although the DT is a screening tool, its function in this programme was extended to facilitate collaborative communication within a consultation. The aim of this grounded theory was to analyse the patient experience of the process. Nineteen people underwent semi-structured interviews focused on their experience of distress management. Participants were a mixed-cancer cohort aged 40-79 years. Findings were discussed in a structured manner with a further 14 service users and carers, and 19 clinical specialists in cancer. Constant comparison of all data revealed that the process of positive distress management could best be explained by reference to the core category: 'helping the clinician help me'. The emergence of this core category is detailed by situating its development within the iterative nature of the grounded theory method.

The clinical utility of the distress thermometer: a review.

The Distress Thermometer (DT) is a well validated screening tool, demonstrably sensitive and reasonably specific to the construct of distress in cancer. Its brevity makes it ideal to incorporate into a system of distress management. To ascertain how far this idea has been developed in practice, and to support future research, a literature review was undertaken. Medline, CINAHL, PsycINFO, Embase, ASSIA, British Nursing Index, AMED, CCTR, and HMIC were systematically searched. Forty studies were reviewed that examined the function of the DT alone, together with the problem list (PL), and/or other validated measures. The majority of studies validated the DT against other robust measures of distress in order to establish 'caseness' in these populations, and establish factors associated with distress. Many of the studies recommended that further research should test their findings in clinical practice. A small section of the literature focused on the clinical utility of the DT as a facilitator of consultations, and found it to have potential in this regard. It is concluded that there is enough validation research, and in line with the majority of these studies' recommendations, future research should focus on the utility of DT as part of a structured distress management programme.

The outcomes of palliative care day services: a systematic review.

This systematic review evaluates the evidence underpinning the provision of palliative day care services (PDS) to determine whether such services have a measurable effect on attendees' wellbeing. The majority of studies reviewed were qualitative and elicited individual perceptions of the benefits PDS. Although it was difficult to determine the quality of many studies, it would appear that attendance at PDS had a positive impact on attendees' quality of life. Fewer studies utilized validated outcome measures to determine the effect of PDS on attendees' wellbeing and small sample sizes combined with high attrition rates influenced the significance of some the results. However little quantitative evidence was offered to prove that PDS had an impact on attendees' quality of life or wellbeing. The review concludes that dying people find attending PDS a valuable experience that allows them to engage with others and to be supported in a restorative environment. However, further well-powered empirical studies are required to provide quality evidence to determine whether or not attendance at PDS does indeed have a positive impact on the wellbeing of attendees.

Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer.

PURPOSE: Persistent insomnia is a common complaint in cancer survivors, but is seldom satisfactorily addressed. The adaptation to cancer care of a validated, cost-effective intervention may offer a practicable solution. The aim of this study was to investigate the clinical effectiveness of protocol-driven cognitive behavior therapy (CBT) for insomnia, delivered by oncology nurses. PATIENTS AND METHODS: Randomized, controlled, pragmatic, two-center trial of CBT versus treatment as usual (TAU) in 150 patients (103 females; mean age, 61 years.) who had completed active therapy for breast, prostate, colorectal, or gynecological cancer. The study conformed to CONSORT guidelines. Primary outcomes were sleep diary measures at baseline, post-treatment, and 6-month follow-up. Actigraphic sleep, health-related quality of life (QOL), psychopathology, and fatigue were secondary measures. CBT comprised five, small group sessions across consecutive weeks, after a manualized protocol. TAU represented normal clinical practice; the appropriate control for a clinical effectiveness study. RESULTS: CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in TAU. These outcomes were sustained 6 months after treatment. Standardized relative effect sizes were large for complaints of difficulty initiating sleep, waking from sleep during the night, and for sleep efficiency (percentage of time in bed spent asleep). CBT was associated with moderate to large effect sizes for five of seven QOL outcomes, including significant reduction in daytime fatigue. There was no significant interaction effect between any of these outcomes and baseline demographic, clinical, or sleep characteristics. CONCLUSION: CBT for insomnia may be both clinically effective and feasible to deliver in real world practice.

Warfarin-induced skin necrosis and heparin-induced thrombocytopenia following mitral valve replacement for marantic endocarditis.

Hemostatic physiology involves a complex interlinking of blood and endothelial factors. Its pharmacological manipulation invariably impacts at multiple molecular sites. Herein is reported an unusual case of coexistent warfarin-induced skin necrosis and heparin-induced thrombocytopenia following mitral valve replacement for thromboembolic phenomena associated with marantic endocarditis and bronchial adenocarcinoma. Thrombophilia in the face of endocarditis should be treated with a suspicion of underlying cancer.

The prevalence and moderators of fatigue in people who have been successfully treated for cancer.

OBJECTIVE: The aims of this study were to estimate the prevalence of severe fatigue in disease-free breast cancer patients according to draft International Classification of Disease, Tenth Edition (ICD-10) criteria for cancer-related fatigue (CRF) and to obtain further information on the validity of these criteria. Furthermore, hypotheses derived from psychosocial theories of fatigue regarding the association of fatigue with activity level, psychological distress, and cognitive constructs were also tested. METHODS: Sixty-nine disease-free breast cancer patients were assessed at least 6 months posttreatment, using self-report questionnaires and a structured interview. RESULTS: Nineteen percent of the sample met criteria for CRF. This subgroup differed significantly from the rest of the sample on multiple measures of fatigue and interference. Self-reported activity level bore no relationship to fatigue. Fear of recurrence (FOR) contributed to fatigue indirectly, whilst psychological distress and beliefs about activity appeared to predict fatigue directly. CONCLUSION: The validity of the draft ICD-10 criteria for CRF was supported. Further research is required into the relationship between fatigue, emotional distress, and cognitive-behavioural factors.

Fear of recurrence, sense of coherence and posttraumatic stress disorder in haematological cancer survivors.

The diagnosis and treatment of cancer has been shown to precipitate posttraumatic stress disorder (PTSD) in some cancer survivors. However few studies have considered the links between cancer-related PTSD and theoretical models of PTSD. This study considers a cognitive model of PTSD by examining the relationship between sense of coherence, and fear of recurrence to posttraumatic stress symptomatology (PTSS) in haematological cancer survivors. Thirty-six participants completed the PTSD Checklist-Civilian Version (PCL-C), the Impact of Events Scale-Revised (IES-R), the sense of coherence scale and two measures of fear of recurrence. Two measures of fear of recurrence were included as no fear of recurrence measures had previously been assessed for reliability and validity on British populations. Seventeen percent of the sample met DSM-IV diagnostic criteria for PTSD. Statistically significant relationships were found between sense of coherence and fear of recurrence and PTSS, raising questions about the possibility of using this construct as a screening measure for vulnerability to PTSD. A relationship was also found between fear of recurrence and PTSS suggesting that cancer-related PTSS may fit within the theoretical model of PTSD considered. Further examination of factors affecting the onset, maintenance and treatment of PTSD in this population is required.

Meaning and its measurement in psychosocial oncology.

Although 'meaning' is a construct that has been referred to for many years within psychological research, particularly in work to examine the ways in which individuals respond to crises or illness, it is only relatively recently that this has started to appear within the psychosocial oncology literature. Where the term has been used, there has been much variation in the way in which this has been operationalised and measured (a problem that has been evident within other areas of psychosocial oncology). This article will review some of the self-report measures that have been developed to assess levels of meaning, outlining their background and status regarding psychometric performance. This will be followed by some recommendations on measures that are particularly suited for use in further work. It is suggested that their application to examine conceptual issues of will be more productive if researchers aim to develop existing measures and not to create new measures. Use of those measures with better psychometric properties could in time facilitate larger data sets and allow for cross cultural comparisons of the impact of cancer on global and situational meaning. Specific recommendations are made for measures to be used in the assessment of global and situational meaning in cancer.

Austin Bowel Cancer Consortium: changing culture in bowel cancer care.

The Austin Bowel Cancer Consortium aimed to identify drivers of clinical decision-making so as to inform a continuous practice improvement approach to the use of evidence. Strategies for engaging clinicians included a direct clinician-clinician approach, gaining the support of opinion leaders and using the clinicians' desire for patient outcome data. Interviews with clinicians identified barriers to using evidence in practice. These included poor integration of medical and surgical disciplines, different learning styles, negative attitudes to guidelines and pathways, and no consensus as to what is an effective multidisciplinary team. A clinical implementation group provided a forum for interaction between disciplines. The group agreed on management pathways covering the continuum of care and developed decision-support software for use in the clinic. Interviews with patients and carers highlighted psychosocial and communication difficulties and prompted greater clinician awareness. Consumers developed patient information resources with minimal assistance from project staff. The clinical encounter is the prime site for change for putting evidence into practice, rather than trying to change individual clinicians.

Attentional bias in people with acute versus persistent insomnia secondary to cancer.

This study investigated the role of attentional bias in the development of persistent insomnia. Two groups of people with cancer who developed sleep-onset problems 0-3 months and 12-18 months after diagnosis completed a computerized emotional Stroop task comprising cancer-related and sleep-related word cues and self-complete measures. Both groups demonstrated attentional bias for cancer-related words, but only the persistent insomnia group demonstrated attentional bias for sleep-related words. High levels of presleep cognitive arousal were evident in both groups despite lower levels of psychological distress in the persistent insomnia group. Results suggest that secondary, sleep-related mental preoccupation may inhibit recovery to normal sleep after stress-related acute sleep disturbance. Findings are discussed in relation to current models of insomnia.