Hope and perspective on death in patients with cancer.

This study was conducted to determine the relationship between various attitudes and hope levels of cancer patients. The study was conducted in an observational and cross-sectional design with 106 cancer patients who were followed in the oncology clinic of a hospital. In the study, it was found that women had lower hope levels than men, and as age decreased, hope levels increased and as educational level increased, hope levels increased. It was found that the patients who said "I have fear/worry/anxiety and think about my family as they will be left behind" had lower total scores and subscale scores of hope. The results of the study showed that individuals with cancer had relatively higher hope levels. It was determined that the patients' thoughts about death affected their hope both directly and indirectly.

The combination of weekly trastuzumab plus vinorelbine may be preferable regimen in HER-2 positive breast cancer patients with brain metastasis.

Brain metastasis is one of the most important life-threatening conditions in patients with metastatic HER-2 positive breast cancer. A lot of conventional chemotherapeutic and antibody-based regimens used routinely in treatment of the patients with breast cancer are not effective due to blood-brain barrier. In our cases, we reported on three HER-2 positive breast cancer patients with brain metastasis who were offered a combination of weekly trastuzumab plus vinorelbine after brain metastasis. In our cases, the progression-free survival were 12, 16 and 9 months for Case 1, Case 2 and Case 3, respectively. In Case 1, there was no progression in the brain. In Case 3, we did not detect any progress but the patient died due to cerebrovascular embolic events. After local treatment, the combination of weekly trastuzumab plus vinorelbine may be an effective alternative regimen in HER-2 positive breast cancer patients with brain metastases.

Reversible slurred speech related to capecitabine and lapatinib combination in patients with breast cancer.

Capecitabine plus lapatinib combination is an effective chemotherapy regimen in patients with advanced breast cancer. Neurological adverse effects secondary to this regimen were reported rarely in literature. A woman with breast cancer presented with complaints of slurred speech while using the capecitabine and lapatinib combination. Her major complaint was slurred speech. No other radiologic or laboratory disorders were detected in the patient. Slurred speech improved one week after the capecitabine and lapatinib combination was discontinued without any further intervention.

The Optimal Treatment Modality in Patients with T4N2M0 Non-Small Cell Lung Cancer: The Best Choice May Be Definitive Chemoradiotherapy Followed by Consolidation Chemotherapy.

BACKGROUND: Stage IIIB non-small cell lung cancer (NSCLC) consists of T4N2M0 and TXN3M0 NSCLC. In the present study, we aimed to evaluate the efficacy of different treatment strategies on the survival of patients with radiologically confirmed T4N2M0 NSCLC. METHODS: A total of 145 patients were evaluated in three groups according to the treatment protocol: induction chemotherapy followed by chemoradiotherapy (induction group); chemoradiotherapy (CRT group), and chemoradiotherapy followed by consolidation chemotherapy (consolidation group). The groups were compared regarding survival. RESULTS: The median progression-free survival (PFS) was 10.9, 10.8 and 17.1 months for the induction, CRT and consolidation groups, respectively (p = 0.021). The median overall survival (OS) was 17.6, 13.8 and 25.2 months for the induction, CRT and consolidation groups, respectively (p = 0.001). CONCLUSIONS: The patients with T4N2M0 NSCLC who were treated with chemoradiotherapy followed by consolidation chemotherapy had the best outcome in terms of PFS and OS.

Sunitinib-induced reversible purpuric rash in a patient with gastrointestinal stromal tumor.

Sunitinib which is used in the treatment of kidney cancer, gastrointestinal stromal tumor, and advanced pancreatic neuroendocrine tumor is a multi-targeted tyrosine kinase inhibitor. Although sunitinib is associated with some side effects, it is generally well tolerated. In the present case, the diagnosis of gastrointestinal stromal tumor was four years ago. The patient had multiple liver metastases at the time of diagnosis. Sunitinib was initiated with a dose of 50 mg daily for four weeks and two weeks off, because of resistance of imatinib. The patient was admitted to the hospital with purpuric rash on her arms and body in the eighth week of treatment. No other disorders or drugs which may cause purpuric rash were detected in the patient. Purpuric rash disappeared two weeks after sunitinib discontinuation without any further intervention.

The optimal chemotherapy timing in patients with inoperable locally advanced non small cell lung cancer.

BACKGROUND: Only 20% of patients with stage III NSCLC are cured by surgery. There is a disagreement among the oncologists in terms of whether which regimen (induction chemotherapy followed chemoradiotherapy, concurrent chemoradiation or concurrent chemoradiation followed consolidation chemotherapy) is best choice in inoperable LA NSCLC. OBJECTIVE: To evaluate chemotherapy timing in inoperable LA NSCLC (before, only concomitant or after curative chemotherapy). MATERIALS AND METHODS: Total of 74 consecutive patient with LA NSCLC which was inoperable due to medical condition or stage from Kayseri Research and Training Hospital were analyzed retrospectively. The patients were divided into three groups according to treatment protocols: Induction chemotherapy followed chemoradiotherapy (Ind. CTàCRT), chemoradiotherapy (CRT) and chemoradiotherapy followed consolidation chemotherapy (CRTàCons. CT). RESULTS: When evaluating progression free survival (PFS), PFS did not significantly differed among the groups (p=0,078). We found significant difference among groups (p = 0.047) in terms of overall survival. While CRTàCons. CT arm had highest mean and median survival times, Ind. CTàCRT arm had worst OS. CONCLUSIONS: CRTàCons. CT treatment modality seems preferable regimen for treatment of inoperable LA NSCLC.

Photosensitive rash in association with porphyrin biosynthesis possibly induced by docetaxel and trastuzumab therapy in a patient with metastatic breast carcinoma.

Docetaxel (Taxotere), an anticancer agent, is known to cause various reactions, including hypersensitivity, oedema, skin toxicity with erythrodysesthesia syndrome, infusion site reactions, alopecia, nail onycholysis, nail pigmentation, photosensitivity, scleroderma and stomatitis. However, of all the reported effects, photosensitivity has only rarely been described in the literature. We experienced a case of cutaneous photosensitivity with aberrations in porphyrin biosynthesis that developed 1 month after the patient received combination chemotherapy consisting of docetaxel and trastuzumab. The eruption resolved with sun avoidance and discontinuation of docetaxel therapy. To our knowledge, this is the first case of a photosensitive reaction with enhanced levels of porphyrins during docetaxel therapy.

Divided dose of cisplatin combined with gemcitabine in malignant mesothelioma.

Malignant mesothelioma is a rare but notoriously chemoresistant tumor. An impressive activity of gemcitabine and cisplatin combination in malignant mesothelioma has been shown. However, the hematological toxicity and nephrotoxicity related to this regimen affect the patient's life negatively. The aim of this study is to investigate the efficacy and toxicity of divided dose of cisplatin combined with gemcitabine in chemo-naïve patients with malignant mesothelioma. Twenty-six eligible patients with malignant mesothelioma were enrolled onto the study. Cisplatin 35 mg/m(2) and gemcitabine 800 mg/m(2) were administered on days 1 and 8 as intravenous infusion in a 3-week cycle, up to maximum 6 cycles. Response and toxicity evaluations were performed in 26 patients. Male-female ratio was 11/15 with a mean age of 50.5 years (37-70). Locations of tumor were pleura in 16 patients, and peritoneum in 10 patients. All patients had epitheloid subtype of malignant mesothelioma. The partial response and stable disease were observed in 6 patients (23.1%) and in 13 patients (50%), respectively, with an overall tumor control rate of 73.1%. Seven patients (26.9%) had progressive disease. Median time to disease progression and survival were 4 and 19.5 months, respectively. Grade 3 nausea and vomiting were observed in one patient (3.8%), grade 4 neutropenia developed in one patient (3.8%) and grades 3-4 thrombocytopenia and nephrotoxicity did not develop. There was no treatment related death. Divided dose of cisplatin combined with gemcitabine, at the current dosage and schedule, appears to be an active regimen in chemotherapy-naïve patients with malignant mesothelioma, and well-tolerated.

Alpha fetoprotein producing gastric hepatoid adenocarcinoma.

Gastric carcinoma generally as presents adenocarcinoma and rarely shows a hepatoid pattern, it may or not produce alpha-fetoprotein. The interpretation of the lesion may be difficult in a patient with a hepatic mass and raised alpha-fetoprotein level. A 51 year old man with hepatoid adenocarcinoma in stomach, producing alpha-fetoprotein is presented.

Expression of p53 protein and DNA flow cytometry in gastric adenocarcinoma: implications in patients treated with adjuvant etoposide, adriamycin and cisplatin.

AIMS AND BACKGROUND: We evaluated the prognostic value of p53 protein, DNA content and S-phase fraction in patients with adenocarcinoma of the stomach or the gastroesophageal junction treated with adjuvant etoposide, doxorubicin and cisplatin. METHODS AND STUDY DESIGN: Thirty-five consecutive patients with stage II or III gastric or gastroesophageal junction adenocarcinoma treated with at least two cycles of adjuvant etoposide, doxorubicin and cisplatin after curative gastric resection were included. The expression of p53 protein was determined by immunohistochemistry and DNA content by flow cytometry. The presence of p53 expression and DNA content was compared with clinicopathological features. RESULTS: Median age was 54 years (range, 31-71). P53 expression was detected in 42.9% (15 of 35) of gastric cancer tissues of the patients. Aneuploidy was observed in 31.4% of patients, and S-phase fraction was more than 10% in 22.9%. P53 immunoreactivity (33.3% vs 47.8%) was more common in advanced disease. There was no association among p53 immunoreactivity, DNA content and S-phase fraction. We also found no significant relationship between p53 immunoreactivity, DNA content, S-phase fraction or other clinicopathological parameters. In univariate analysis, the involvement of lymph nodes was a significant predictor of a poor outcome (P = 0.001). Also, p53-positive patients had a poor survival close to the level of significance (P = 0.051). Likewise, p53 immunoreactivity (P = 0.0071), in addition to lymph node involvement (P = 0.0016), were the independent prognostic factors in multivariate analysis. CONCLUSIONS: This trial supports the results of previous reports that p53 immunoreactivity is a prognostic factor for patients with adenocarcinoma of stomach or gastroesophageal junction treated with adjuvant chemotherapy.

Opinions of the Turkish population on cancer and being informed of the diagnosis of cancer.

BACKGROUND/AIM: An opinion survey was conducted to investigate the opinions and attitudes of the Turkish population regarding cancer if they or one of their family members were to receive a diagnosis of cancer. MATERIALS AND METHODS: The opinion survey was completed by 6566 subjects and consisted of questions about the demographics of the participants and their overall opinions about cancer. The other points of the investigation asked whether they would inform relatives who had cancer about the diagnosis and whether they would prefer to be informed if they were the one with the cancer diagnosis. RESULTS: The median age of the participants was 33 years (range: 18-100) and 53.3% were male. It was found that 57.7% of the participants would prefer not to disclose a cancer diagnosis to their first-degree relatives. The diagnosis had been disclosed to relatives with cancer in 69.9% of cases. When asked about their overall opinion of cancer management, 76.5% of participants were optimistic, 16.3% were pessimistic, and 2.9% had mixed opinions. CONCLUSION: This study represents one of the largest surveys done in Turkey to identify the thoughts of healthy people about cancer and their opinion on informing their relatives about the diagnosis if the relatives have cancer. It is comparable with reports from East Europe and Asian countries.

Medication errors in chemotherapy preparation and administration: a survey conducted among oncology nurses in Turkey.

BACKGROUND: Medication errors in oncology may cause severe clinical problems due to low therapeutic indices and high toxicity of chemotherapeutic agents. We aimed to investigate unintentional medication errors and underlying factors during chemotherapy preparation and administration based on a systematic survey conducted to reflect oncology nurses experience. MATERIALS AND METHODS: This study was conducted in 18 adult chemotherapy units with volunteer participation of 206 nurses. A survey developed by primary investigators and medication errors (MAEs) defined preventable errors during prescription of medication, ordering, preparation or administration. The survey consisted of 4 parts: demographic features of nurses; workload of chemotherapy units; errors and their estimated monthly number during chemotherapy preparation and administration; and evaluation of the possible factors responsible from ME. The survey was conducted by face to face interview and data analyses were performed with descriptive statistics. Chi-square or Fisher exact tests were used for a comparative analysis of categorical data. RESULTS: Some 83.4% of the 210 nurses reported one or more than one error during chemotherapy preparation and administration. Prescribing or ordering wrong doses by physicians (65.7%) and noncompliance with administration sequences during chemotherapy administration (50.5%) were the most common errors. The most common estimated average monthly error was not following the administration sequence of the chemotherapeutic agents (4.1 times/month, range 1-20). The most important underlying reasons for medication errors were heavy workload (49.7%) and insufficient number of staff (36.5%). CONCLUSIONS: Our findings suggest that the probability of medication error is very high during chemotherapy preparation and administration, the most common involving prescribing and ordering errors. Further studies must address the strategies to minimize medication error in chemotherapy receiving patients, determine sufficient protective measures and establishing multistep control mechanisms.

Squamous cell carcinoma of the larynx metastasized to the ampulla of Vater. Report of a case.

Metastasis to the ampulla of Vater from squamous cell carcinoma of the larynx has not been reported previously. In a 71-year-old Turkish patient with squamous cell carcinoma of the larynx a polypoid tumor was observed in the ampulla of Vater. Histopathological examination revealed squamous cell carcinoma compatible with metastasis from laryngeal cancer.

Overdose of lomustine: report of two cases.

Two male patients with high-grade gliomas were treated with subtotal or total resection and radiotherapy followed by a lomustine-containing chemotherapy regimen. Both patients took lomustine at an oral dose of 800 mg over five days instead of their regular doses of 200 and 240 mg. Grade 4 neutropenia and thrombocytopenia developed in both patients within two weeks of the last lomustine dose. One of them was admitted to hospital because of febrile neutropenia. Neutropenia and thrombocytopenia were detected in the other patient when he was examined in the emergency room following a generalized convulsion. Both patients recovered from the severe myelosuppression caused by lomustine. No other organ toxicities were observed.

Thromboembolism in Patients with Cancer.

One hundred and forty years ago, Armand Trousseau described phlegmasia alba dolens as a sign of internal malignancy. Nowadays, it is commonly believed that the presence malignant tumaor increases the risk of venous thromboembolism (i.e deep vein thrombosis and pulmonary embolism) However, cancer is usually associated with other factors such as old age, extensive surgery,immobility, etc., which may predispose to thromboembolism. The majority of thrombotic events occur in the venous system; the incidence of arterial thrombosis is much lower.Recurrent thromboembolism in cancer patients frequently and diminishes the quality of life of the patients.Furthermore, if the thromboembolism is massive, destipte of early and aggressive treatment, it may result in death. In this article, we review thromboembolic complications in cancer patients.

Lack of sunlight exposure influence on primary glioblastoma survival.

BACKGROUND: The prognosis of primary glioblastoma (GBM) is poor. Approximately 2/3 of primary brain tumor diagnoses are GBM, of which 95% are primary lesions. In this study, we aimed to evaluate whether more sunlight exposure has an effect on survival of patients with primary GBM. MATERIALS AND METHODS: A total of 111 patients with primary GBM were enrolled from Kayseri in inner Anatolia which has a cold climate (n: 40) and Mersin in Mediterranean region with a warm climate and more sunlight exposure (n: 71). The patients with primary GBM were divided into two groups as Kayseri and Mersin and compared for progression free survival (PFS) and overall survival (OS). RESULTS: The PFS values were 7.0 and 4.7 months for Kayseri and Mersin groups, respectively (p=0.10) and the respective OS values were 13.3 and 9.4 months (p=0.13). We did not found any significant difference regarding age, sex, comorbidity, smoking, surgery, resurgery, adjuvant chemoradiotherapy and palliative chemotherapy between the groups. CONCLUSIONS: We found that more sunlight exposure had no impact on prognosis of patients with primary GBM, adding inconsistency to the literature about the relationship between sunlight and GBM.

Second-line gemcitabine-based chemotherapy regimens improve overall 3-year survival rate in patients with malignant pleural mesothelioma: a multicenter retrospective study.

In the present study, we aimed to evaluate the effectiveness of second-line gemcitabine-based chemotherapy regimens on overall survival (OS) in malignant pleural mesothelioma (MPM) patients receiving first-line pemetrexed-based regimens. A total of 73 patients with MPM from Akdeniz University, Acibadem Kayseri Hospital, Kayseri Training and Research Hospital, and Erciyes University were analyzed and evaluated retrospectively as two groups: second-line gemcitabine-based chemotherapy and no second-line chemotherapy. The median OS of patients who received second-line gemcitabine-based chemotherapy was 11.3 (5.1-17.5) months, while it was 9.9 (2.1-17.7) months in the patients who did not receive chemotherapy in the second-line setting (p = 0.056). When we evaluated the survival rate at the 6th, 12th, 18th, 24th, and 36th month, the OS rate of the 36th month was significantly higher in patients who received gemcitabine-based second-line chemotherapy (p = 0.041). When evaluating the OS from diagnosis to death, the median OS values were 20.8 (17.5-24.1) months for first-line pemetrexed-based regimens then second-line gemcitabine alone and 13.1 (9.0-17.1) months supportive care after first-line pemetrexed-based regimens (p = 0.005). According to our results, we may consider gemcitabine-based regimens as second-line chemotherapy after treatment with pemetrexed plus platinum in patients with MPM.

Survival analysis of biliary tract cancer cases in Turkey.

BACKGROUND: Because of the relative rarity of biliary tract cancers (BTCs), defining long term survival results is difficult. In the present study, we aimed to evaluate the survival of a series of cases in Turkey. MATERIALS AND METHODS: A totally of 47 patients with billiary tract cancer from Mersin Goverment Hospital, Acibadem Kayseri Hospital and Kayseri Training and Research Hospital were analyzed retrospectively using hospital records between 2006-2012. RESULTS: The median overall survival was 19.3±3.9 months for all patients. The median disease free and overall survivals were 24.3±5.3 and 44.1±12.9 months in patients in which radical surgery was performed , but in those with with inoperable disease they were only 5.3±1.5 and 10.7±3.2 months, respectively. CONCLUSIONS: BTCs have a poor prognosis. Surgery with a microscopic negative margin is still the only curative treatment.

The necessity of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma using antiangiogenic targeted therapy after interferon alfa-2b.

BACKGROUND: Targeted therapy has improved the survival of patients with metastatic RCC. In the present study, we evaluated whether there was an effect of cytoreductive surgery on prognosis of patients with metastatic RCC using antiangiogenic tyrosine kinase inhibitor (TKI) agents. PATIENTS AND METHODS: A total of 52 patients with metastatic RCC from Akdeniz University, Afyon Kocatepe University, and Medipol University participated in the study. All the patients had received targeted antiangiogenic therapy after interferon alfa-2b. According to previous CRN, the patients were divided into 2 groups as CRN (+) and CRN (-). RESULTS: The CRN (+) group was younger than the CRN (-) group (P < .001) and the hemoglobin levels were significantly higher in the CRN (+) group (P = .023). The median progression-free survival time from the date of starting TKIs were 8.5 and 3.0 months for the CRN (+) and CRN (-) groups, respectively (P = .104). The median overall survival was 15.1 and 5.4 months for the CRN (+) and CRN (-) groups, respectively (P = .034). CONCLUSION: We speculate that CRN is still an important part of treatment modalities in patients with metastatic RCC in modern era targeted therapy, which is currently the best systemic therapy. However, the indications of CRN might be limited to good-risk patients with metastatic RCC. Further randomized studies are warranted to clarify the necessity of CRN in patients with metastatic RCC.