Posttraumatic growth and cancer: a study 5 years after treatment end.

PURPOSE: Cancer survivors often report posttraumatic growth (PTG). The aims of this study were to assess the presence of PTG in Italian long-term disease-free cancer survivors (LCS) and to explore the association between the dimensions of PTG and clinical, demographic variables, various agents of perceived social support and psychological distress. METHODS: Five hundred forty LCS were assessed with Posttraumatic Growth Inventory (PTGI), Multidimensional Scale of Perceived Social Support (MSPSS), Zung Self-Rating Depression Scale, and State-Trait Anxiety Inventory-Y (STAI-Y). RESULTS: Mean age was 57.08 years, mean survival was 11.04 years (range 5-32), and the most common cancer diagnosis was breast cancer (56.9%). The PTGI average total score was higher in more educated LCS, in those employed, in LCS with longer time from diagnosis, and in those with no comorbidities. In this study, PTG was not found correlated with distress, but it correlated with perceived social support, age, education, and employment. CONCLUSIONS: The absence of a correlation between PTG and psychological distress and the low levels of PTG found let us question the importance of talking about PTG when working as psychotherapists with LCS. It may be suggested that the need of finding benefit and PTG in LCS has been overcome by other experiences or worries happened after the cancer, and LCS may not focus anymore on positive changes occurred. The relevance of work and of perceived social support as linked to PTG stresses the need to protect the LCS's relationship with work and to promote and sustain their social network, and this can help them to experience sharing and closeness to others.

Is long-term cancer survivors' quality of life comparable to that of the general population? An italian study.

PURPOSE: Since long-term survivorship is now a reality for an increasingly number of people with a history of cancer, understanding their quality of life (QoL) can inform health care policy as well as help supporting individual patients. This study was aimed to quantify QoL of this specific population in comparison with data provided for both the general population and cancer patients and to assess QoL association with several sociodemographic, clinical, and psychological variables. METHODS: Three hundred fourteen Italian long-term cancer survivors (people who have been free from cancer and cancer treatments for at least 5 years) completed a battery of questionnaires including the SF12 for QoL assessment. RESULTS: Both physical and mental functioning were higher than those among Italian cancer patients but lower than those of the Italian general population (p < .001). Poorer QoL (physical and mental functioning) was associated more often with psychological conditions (as anxiety and depression) than with sociodemographic and cancer-related variables. CONCLUSIONS: These data support an ongoing specific interest in the QoL of long-term cancer survivors and suggest the need for further study of multidimensional functioning in this population.

Beyond treatment - Psychosocial and behavioural issues in cancer survivorship research and practice.

The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.

Dialogues on cancer survivorship: a new model of international cooperation.

The authors describe the rationale and background of the present supplement to Cancer intended to stimulate a dialogue among researchers from Europe and North America regarding important issues faced by cancer survivors. Through jointly written articles addressing various aspects of cancer survivorship, each manuscript reports on the similarities, disparities, and problems viewed from the point of view of each author's respective continent. The supplement is meant to create a springboard for increased collaboration and aid in the development of a shared care model to improve the quality of cancer care, both during and after the completion of primary treatment. We hope that this effort may represent a new model of international cooperation, which is fruitful not only for the field of scientific research but also for identifying and sharing new approaches to the care and management of cancer survivorship issues, ultimately bringing improvements to quality of life of the growing population of cancer survivors.

Cancer survivorship research in Europe and the United States: where have we been, where are we going, and what can we learn from each other?

The growing number of cancer survivors worldwide has led to of the emergence of diverse survivorship movements in the United States and Europe. Understanding the evolution of cancer survivorship within the context of different political and health care systems is important for identifying the future steps that need to be taken and collaborations needed to promote research among and enhance the care of those living after cancer. The authors first review the history of survivorship internationally and important related events in both the United States and Europe. Lessons learned from survivorship research are then broadly discussed, followed by examination of the infrastructure needed to sustain and advance this work, including platforms for research, assessment tools, and vehicles for the dissemination of findings. Future perspectives concern the identification of collaborative opportunities for investigators in Europe and the United States to accelerate the pace of survivorship science going forward.

Unresectable lung malignancy: combination therapy with segmental pulmonary arterial chemoembolization with drug-eluting microspheres and radiofrequency ablation in 17 patients.

PURPOSE: To evaluate the feasibility, safety, and effectiveness of combining segmental pulmonary arterial chemoembolization (SPACE) and percutaneous radiofrequency (RF) ablation in patients with unresectable lung neoplasms or patients with resectable neoplasms who refused surgery and to compare the local tumor progression (LTP) rate with that in previous studies of RF ablation alone. MATERIALS AND METHODS: After institutional review board approval and informed consent, 17 patients with primary and metastatic lung cancer were enrolled in this prospective study. Between January 2008 and February 2011, 20 nodules (median diameter, 3.0 cm; range, 2.0-5.0 cm) were treated during 19 sessions. Antineoplastic agents loaded on 50-100-µm microspheres were selectively infused into specific pulmonary arteries. Percutaneous computed tomography (CT)-guided RF ablation of lung nodules was performed 48 hours after SPACE. Follow-up consisted of enhanced CT 48 hours after combination treatment was completed, after 30 days, and every 3 months thereafter. Fluorine 18 fluorodeoxyglucose positron emission tomography was performed 3 months after combination therapy and then every 6 months. The t test was used to compare groups. RESULTS: Technical success was achieved in 100% of cases. Ventilation-lung single photon emission computed tomography showed a wide area without ventilation in the lung parenchyma treated with SPACE. The LTP rate was 21% (three of 14 nodules) in 3-5-cm-diameter tumors and 0% (zero of six nodules) in tumors of 3 cm or smaller in diameter. Complete response was achieved in 65% (11 of 17) of patients at minimum follow-up of 6 months. Overall, treatment was well tolerated. Major complications were pneumothorax in five of 19 sessions (26%) and one bronchopleural fistula (one of 19, 5%). No treatment-related changes in general lung function were noted. CONCLUSION: Combination therapy with RF ablation after SPACE to treat unresectable lung tumors is technically feasible, safe, and effective and may represent an advantage over RF ablation alone.

Do elderly cancer patients have different care needs compared with younger ones?

AIMS AND BACKGROUND: The increasingly older population confronts oncologists with an imposing challenge: older cancer patients have specific healthcare needs both independent of and associated with the diagnosis of cancer. The aim of the present study is to examine whether elderly versus younger cancer patients have different needs with respect to attendance, treatment and information. METHODS AND STUDY DESIGN: This is an observational and cross-sectional study. Cancer patients aged 35 to 82 years were consecutively interviewed. The group was divided into two subgroups aged ≤65 and ≥66 years old. The Needs Evaluation Questionnaire (NEQ) was used to assess patients' needs and demographic variables were collected. Data analysis was carried out by means of cross-tabulation analyses and the chi-square test. RESULTS: The requests most frequently expressed by the older group concerned financial-insurance information (73.9%), the need to talk to people with the same illness (71.7%), the need to receive more comprehensible information from doctors and nurses (71.7%), and the need for a better dialogue with clinicians (69.6%). Few significant differences between the two age subgroups were found, with the exception of issues such as the need for intimacy and support. CONCLUSIONS: Elderly patients have informational and relational needs similar to those of younger patients. In fact, most of the whole sample flagged up the need for higher levels of satisfaction especially concerning a better dialogue with health staff, along with a new factor: the need to talk to people with the same illness.

Psychological effects of cetuximab-induced cutaneous rash in advanced colorectal cancer patients.

GOALS OF WORK: Advanced colorectal cancer (CRC) has recently been treated with monoclonal antibodies, such as cetuximab. Skin toxicity is a peculiar side effect of cetuximab that may induce patients to interrupt therapy if it becomes serious. This study investigates the psychological and social sequelae of skin rash. MATERIALS AND METHODS: Patients affected by advanced CRC and treated with cetuximab-based therapy entered the trial. The following questionnaires were used: the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) to measure quality of life (QoL) and the Psychological Distress Inventory (PDI). A single item regarding social avoidance was added with a three-point Likert scale. Toxicity was assessed using the National Cancer Institute Criteria (NCI-2). MAIN RESULTS: Eighty patients were recruited; 41% presented psychological distress. As regards social avoidance, 53% of patients answered that they did not avoid going out at all. The rest of the sample answered that they "very much" (22%) or "somewhat" (25%) avoided going out. Psychological distress and social avoidance were not correlated to skin rash, but only to QoL. CONCLUSION: Skin rash was not found to impact patients' psychological status or social life. Two likely explanations for this finding were that (a) patients with advanced cancer consider skin rash as a part of the complex suffering caused by cancer and (b) patients are encouraged by oncologists to continue treatment because skin rash is indicative of response to therapy. This expectation brings hope and helps patients bear the drug-related side effects.

Single-step therapy -- feasibility and safety of simultaneous transarterial chemoembolization and radiofrequency ablation for hepatic malignancies.

BACKGROUND: Radiofrequency thermal ablation (RFA) has been demonstrated to be useful for the treatment of liver neoplasms. The study aimed to evaluate the feasibility and safety of the combination of transarterial chemoembolization (TACE) and RFA, performed simultaneously to treat primary and secondary liver neoplasms. PATIENTS AND METHODS: From July 2006 to October 2007, 34 patients (21 with HCC and 13 with liver metastases) underwent 37 sessions of treatment. The schedule consisted of: induction TACE (with epirubicin, mitomycin C and lipiodol, or with doxorubicin/irinotecan loaded on microspheres), percutaneous RFA and second TACE. Monopolar RFA was used on 52 nodules, whereas the bipolar multiprobe technique was used in 6 cases. RESULTS: The treatment was well tolerated, with moderate hepatic and hematological toxicity. In total 51 nodules were evaluable for response, with technical success in 45/51 cases (88%). CONCLUSION: Combined TACE plus RFA is feasible and safe; the preliminary data make it a promising procedure with regard to efficacy and support further investigation.