Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study.

BACKGROUND: Sacral neuromodulation (SNM) is a minimally invasive fully reversible therapy that was approved in 1997 for overactive bladder syndrome (OAB) refractory to behavior modification and pharmacotherapy. Despite being in use for over two decades, the data on medium to long-term safety and efficacy of SNM in OAB is limited. We investigated the medium-term efficacy and safety of SNM along with the predictive factors for its success in patients with refractory OAB. METHODS: A retrospective consecutive case series of 66 patients undergoing SNM for refractory OAB between July 2009 and July 2018. All patients underwent a test period followed by permanent implantation, if there was > = 50% improvement in any symptom. The primary outcome was "success" defined as > = 50% improvement in any clinical parameter based on the subjective assessment of patient's response. The secondary outcomes were number of pads used in 24 hours, post-operative complications and re-operation rates. RESULTS: 66 females with an average age of 62.7 years were included. 55/66 patients (83.3%) had a successful test phase and underwent permanent implantation. After a median follow-up of 32 months, SNM was successful in 41/55 (74.5%) patients. Mean number of pads used in 24 hours decreased significantly from 3.5 preoperatively to 1.2 at last follow-up (p<0.001). 8/55 (14.5%) patients reported complications of pain, lead migration, wound dehiscence and device malfunction. 10/55 (18.2%) patients underwent revision surgeries after a median duration of 21.9 months. Device was explanted in 15/55 (27.3%) patients after a median duration of 24 months. No significant predictor for success was identified. CONCLUSIONS: The success rate of SNM is 75% with a complication rate of 14.5% after a median follow-up of ~3 years. This study suggests medium-term efficacy and safety but a high re-operation rate of SNM in patients with refractory OAB.

Disease burden of Crigler-Najjar syndrome: Systematic review and future perspectives.

BACKGROUND AND AIM: Crigler-Najjar syndrome (CNS) results from biallelic mutations of UGT1A1 causing partial or total loss of uridine 5'-diphosphate glucuronyltransferase activity leading to unconjugated hyperbilirubinemia and its attendant risk for irreversible neurological injury (kernicterus). CNS is exceedingly rare and has been only partially characterized through relatively small studies, each comprising between two and 57 patients. METHODS: A systematic literature review was conducted to consolidate data on the patient, caregiver, and societal burden of CNS. RESULTS: Twenty-eight articles on clinical aspects of CNS were identified, but no published data on its humanistic or economic burden were found. In patients with complete UGT1A1 deficiency (type 1 CNS [CNS-I]), unconjugated bilirubin levels increase 3-6 mg/dL/day during the newborn period and reach neurologically dangerous levels between 5 and 14 days of age. Phototherapy is the mainstay of treatment but poses significant challenges to patients and their families. Despite consistent phototherapy, patients with CNS-I have worsening hyperbilirubinemia with advancing age. Liver transplantation is the only definitive therapy for CNS-I and is increasingly associated with excellent long-term survival but also incurs high costs, medical and surgical morbidities, and risks of immunosuppression. CONCLUSIONS: Crigler-Najjar syndrome is associated with a substantial burden, even with existing standards of care. The development of novel disease-modifying therapies has the potential to reduce disease burden and improve the lives of CNS patients and their families.

Outcomes of systematic nutritional assessment and medical nutrition therapy in pancreatic cancer.

OBJECTIVES: We investigated the nutritional and survival outcomes of medical nutrition therapy by a registered dietitian, along with support from a dedicated nutrition and metabolic support team in pancreatic cancer patients requiring enteral or parenteral nutrition. METHODS: Subjective global assessment (SGA) was used to assess nutritional status in 304 pancreatic cancer patients. Using baseline and last SGA, patients were categorized into 3 groups: improved SGA, deteriorated SGA, and unchanged SGA. Kaplan-Meier and Cox regression were used to calculate survival after controlling for relevant confounders. RESULTS: One-hundred twenty-five (41.1%) patients had their SGA unchanged, 87 (28.6%) patients had "improved SGA," whereas 92 (30.3%) patients had "deteriorated SGA." On univariate survival analysis, the median survival was 7.8, 11.2, and 12.6 months for deteriorated, unchanged, and improved SGA groups, respectively. On multivariate analysis, change in SGA was independently predictive of survival. Patients with deteriorated SGA had 1.5 times (95% confidence interval, 1.1-2.1) greater risk of mortality compared to those with improved SGA. CONCLUSIONS: The majority of pancreatic cancer patients (70%) in our study either maintained or improved their nutritional status during cancer treatment. Improvement in SGA correlated with a significantly decreased risk of mortality independent of sex, previous treatment history, and evidence of biological anticancer activity.

Effect of naturopathic and nutritional supplement treatment on tumor response, control, and recurrence in patients with prostate cancer treated with radiation therapy.

OBJECTIVES: Use of naturopathic and nutritional supplements (NNS) with antioxidant activity is controversial in patients receiving radiation therapy. The effects of concomitant use of NNS with antioxidant activity during radiation therapy for prostate cancer were investigated in terms of clinical tumor responsiveness, kinetics, and durability. MATERIALS AND METHODS: A retrospective investigation was done of 134 patients treated with curative intent for limited-stage prostate cancer by radiation therapy. Patients self-selected to receive NNS as part of their treatment and maintenance during an extended post-treatment interval of at least 2 years. The outcome measures were the following: prostate-specific antigen (PSA) nadir; ≥24 months post-treatment PSA; time to reach nadir; and time to last follow-up were compared across +NNS and -NNS. RESULTS: Sixty-nine (69) patients elected to receive NNS while 65 did not. Seventy-seven (77) (+NNS 39, -NNS 38) patients received hormone therapy while 57 (+NNS 30, -NNS 27) did not. In the nonhormone cohort, median pretreatment PSA, nadir, post-treatment PSA, time to reach nadir, and time to follow-up were 5.5 ng/mL, 0.56 ng/mL, 0.61 ng/mL, 25 months, and 39.7 months for the -NNS group and 5.1 ng/mL, 0.32 ng/mL, 0.44 ng/mL, 27 months, and 50.1 months for the +NNS group, respectively (p>0.05 for all). Similarly, no significant differences were observed between +NNS and -NNS in the hormone-receiving cohort. CONCLUSIONS: The clinical tumor response to radiation therapy in patients with limited-stage prostate cancer is not inhibited by concomitant NNS based on the magnitude of the PSA response, the velocity of the PSA nadir, and the duration of PSA normalization.

Serum 25-hydroxyvitamin D is inversely associated with body mass index in cancer.

BACKGROUND: The association between vitamin D deficiency and obesity in healthy populations and different disease states remains unsettled with studies reporting conflicting findings. Moreover, current dietary recommendations for vitamin D do not take into account a person's body mass index (BMI). We investigated the relationship between serum 25-hydroxy-vitamin D [25(OH)D] and BMI in cancer. METHODS: A consecutive case series of 738 cancer patients. Serum 25(OH)D was measured at presentation to the hospital. The cohort was divided into 4 BMI groups (underweight: <18.5, normal weight: 18.5-24.9, overweight: 25-29.9, and obese: >30.0 kg/m²). Mean 25(OH)D was compared across the 4 BMI groups using ANOVA. Linear regression was used to quantify the relationship between BMI and 25(OH)D. RESULTS: 303 were males and 435 females. Mean age at diagnosis was 55.6 years. The mean BMI was 27.9 kg/m² and mean serum 25(OH)D was 21.9 ng/ml. Most common cancers were lung (134), breast (131), colorectal (97), pancreas (86) and prostate (45). Obese patients had significantly lower serum 25(OH)D levels (17.9 ng/ml) as compared to normal weight (24.6 ng/ml) and overweight (22.8 ng/ml) patients; p < 0.001. After adjusting for age, every 1 kg/m² increase in BMI was significantly associated with 0.42 ng/ml decline in serum 25(OH)D levels. CONCLUSIONS: Obese cancer patients (BMI ≥ 30 kg/m²) had significantly lower levels of serum 25(OH)D as compared to non-obese patients (BMI <30 kg/m²). BMI should be taken into account when assessing a patient's vitamin D status and more aggressive vitamin D supplementation should be considered in obese cancer patients.

Impact of oral vitamin D supplementation on serum 25-hydroxyvitamin D levels in oncology.

BACKGROUND: Serum 25-hydroxyvitamin D [25(OH)D] is the major circulating form of vitamin D and a standard indicator of vitamin D status. Emerging evidence in the literature suggests a high prevalence of suboptimal vitamin D (as defined by serum 25(OH)D levels of <32 ng/ml) as well as an association between lower serum levels and higher mortality in cancer. We investigated the effect of oral vitamin D supplementation as a means for restoring suboptimal levels to optimal levels in cancer. METHODS: This is a retrospective observational study of 2198 cancer patients who had a baseline test prior to initiation of cancer therapy at our hospital to evaluate serum 25(OH)D levels between Jan 08 and Dec 09 as part of their initial nutritional evaluation. Patients with baseline levels of < = 32 ng/ml (n = 1651) were considered to have suboptimal serum 25(OH)D levels and were supplemented with 8000 IU of Vitamin D3 (four 2000 IU D3 capsules) daily as part of their nutritional care plan. The patients were retested at their first follow-up visit. Of 1651 patients, 799 were available for follow up assessment. The mean serum 25(OH)D levels were compared in these 799 patients across the 2 time points (baseline and first follow-up) using paired sample t-test. We also investigated the factors associated with response to vitamin D supplementation. RESULTS: Of 2198 patients, 814 were males and 1384 females. 1051 were newly diagnosed and treated at our hospital while 1147 were diagnosed and treated elsewhere. The mean age at presentation was 55.4 years. The most common cancer types were breast (500, 22.7%), lung (328, 14.9%), pancreas (214, 9.7%), colorectal (204, 9.3%) and prostate (185, 8.4%). The mean time duration between baseline and first follow-up assessment was 14.7 weeks (median 10.9 weeks and range 4 weeks to 97.1 weeks). The mean serum 25(OH)D levels were 19.1 ng/ml (SD = 7.5) and 36.2 ng/ml (SD = 17.1) at baseline and first follow-up respectively; p < 0.001. Patients with prostate and lung cancer had the highest percentage of responders (70% and 69.2% respectively) while those with colorectal and pancreas had the lowest (46.7% each). Similarly, patients with serum levels 20-32 ng/ml at baseline were most likely to attain levels > 32 ng/ml compared to patients with baseline levels < 20 ng/ml. CONCLUSIONS: The response to supplementation from suboptimal to optimal levels was greatest in patients with prostate and lung cancer as well as those with baseline levels between 20-32 ng/ml. Characteristics of non-responders as well as those who take longer to respond to supplementation need to be further studied and defined. Additionally, the impact of improved serum 25(OH)D levels on patient survival and quality of life needs to be investigated.

Can anorexia predict patient satisfaction with quality of life in advanced cancer?

GOALS: Anorexia is the second most common symptom after fatigue in patients with advanced cancer. We quantified the relationship between anorexia and patient satisfaction with quality of life (QoL) in advanced cancer. MATERIALS AND METHODS: A case series of 954 cancer patients treated at the Cancer Treatment Centers of America. Anorexia was measured using the QLQ-C30 loss of appetite/anorexia subscale. Patient satisfaction with QoL was measured using the Ferrans and Powers Quality of Life Index (QLI). The relationship between anorexia and QLI was evaluated using multivariate analysis of variance and multiple regression analysis. MAIN RESULTS: Of 954 patients, 579 were females and 375 males with the median age at presentation of 56 years. Of these patients, 66% had failed prior treatment. Most common cancers were breast (26%), colorectal (19%), and lung (16%). After controlling for the effects of age, treatment history, and other QLQ-C30 symptom subscales, every 10 unit increase in anorexia was statistically significantly associated with 0.18 unit decline in QLI health and physical function score. CONCLUSION: We found that anorexia is significantly correlated with patient satisfaction with health and physical function in advanced cancer. Future studies should evaluate the impact of integrative cancer care services on patient satisfaction with QoL.

Patient satisfaction with quality of life as a prognostic indicator in ovarian cancer patients treated in an integrative treatment setting.

Extensive data show that quality of life (QoL) tools measuring the activities of daily life provide prognostic information in cancer. Ferrans and Powers Quality of Life Index (QLI) is an instrument measuring patients' satisfaction with their life. This study evaluated the association between QLI and survival in ovarian cancer. We examined a consecutive case series of 90 patients with histologically confirmed stage I-IV ovarian cancer treated at Cancer Treatment Centers of America. QLI measures overall QoL and QoL in four major subscales: Health and Physical, Social and Economic, Psychological and Spiritual, and Family. The Kaplan-Meier method was used to calculate survival. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of QoL and clinical factors. The Health and Physical subscale was marginally statistically significant (p = .08) after controlling for stage at diagnosis, prior treatment history, and other QLI subscales. Our study has demonstrated no statistically significant prognostic association of patient satisfaction with QoL, as measured by the QLI, with survival in ovarian cancer.

Can subjective global assessment of nutritional status predict survival in ovarian cancer?

BACKGROUND: Malnutrition is a significant problem in patients with ovarian cancer. The goal of this study was to investigate the prognostic role of Subjective Global Assessment (SGA) in patients with ovarian cancer treated in an integrative cancer treatment setting. METHODS: We evaluated a case series of 132 ovarian cancer patients treated at Cancer Treatment Centers of America(R) from Jan 2001 to May 2006. SGA was used to assess nutritional status at baseline. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of SGA independent of other factors. RESULTS: Of 132 patients, 24 were newly diagnosed while 108 had received prior treatment. 15 had stage I disease at diagnosis, 8 stage II, 85 stage III and 17 stage IV. The median age at presentation was 54.4 years (range 25.5 - 82.5 years). 66 patients were well-nourished (SGA A), 35 moderately malnourished (SGA B) and 31 severely malnourished (SGA C). Well nourished patients had a median survival of 19.3 months (95% CI: 14.1 to 24.5), moderately malnourished 15.5 months (95% CI: 5.8 to 25.1), and severely malnourished 6.7 months (95% CI: 4.1 to 9.3); the difference being statistically significant (p = 0.0003). Multivariate Cox modeling, after adjusting for stage at diagnosis and prior treatment history found that moderately malnourished and severely malnourished status were associated with a relative risk of 2.1 (95% CI: 1.2 to 3.6, p = 0.008) and 3.4 (95% CI: 1.9 to 5.8, p < 0.001) respectively as compared to well nourished status. CONCLUSION: Univariate and multivariate survival analyses found that low SGA scores (i.e. well-nourished status) are associated with better survival outcomes. This study lends support to the role of aggressive nutritional intervention in improving patient outcomes in cancer care.

Patient satisfaction with health-related quality of life: implications for prognosis in prostate cancer.

PURPOSE: The goal of this study was to evaluate the association between patient satisfaction with health-related quality of life (HRQOL), as measured by the Ferrans and Powers Quality of Life Index (QLI), and survival in patients with prostate cancer treated in an integrative cancer treatment setting. MATERIALS AND METHODS: This is a case series of 230 histologically confirmed stage I-IV prostate cancers treated at Cancer Treatment Centers of America. Quality of Life Index measures overall HRQOL and HRQOL in 4 major subscales: health and physical, social and economic, psychological and spiritual, and family. Study patients were dichotomized into 2 groups based on the median scores for all QLI subscales. Kaplan- Meier and log-rank tests were used to evaluate survival. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of HRQOL and clinical factors. RESULTS: Patient satisfaction with health and physical (P = .0001), psychological and spiritual (P = .03), family (P = .02), and overall HRQOL (P = .0001) were statistically significantly associated with survival upon univariate analysis. Upon multivariate analysis, patient satisfaction with the health and physical subscale was found to be predictive of survival (P = .04), independent of the effects of previous treatment history and Gleason score. CONCLUSION: This study suggests that baseline patient satisfaction with health and physical function, as measured by the QLI, provides useful prognostic information in patients with prostate cancer, independent of previous treatment history and Gleason score. The QLI Index can be used as a stratification variable in the oncology clinic to aid in medical decision-making.

Comparison of two quality of life instruments for cancer patients: the Ferrans and Powers Quality of Life Index and the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire C30.

Health-related quality of life (QoL) in cancer patients cannot be adequately captured with a single instrument. We compared the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and the Ferrans and Powers Quality of Life Index (QLI). We hypothesized that there would be little overlap among their subscales. Baseline QoL data were collected from a consecutive series of 954 cancer patients treated at our center. Data from the two questionnaires were analyzed on a subscale basis using correlation analysis and the Bland-Altman method. The mean and standard deviations of the difference in QoL subscale scores were used to construct 95% limits of agreement among the subscales. Five hundred seventy-nine were females and 375 were males, with a median age of 52 years. There were poor to modest correlations and poor agreement among the subscales of the two instruments. For QLQ-C30 physical and QLI health, the correlation and limits of agreement were 0.6 and -22.2 to 59.8. For QLQ-C30 role and QLI health, the correlation and limits of agreement were 0.6 and -47.3 to 61.5. For QLQ-C30 social and QLI social, the correlation and limits of agreement were 0.2 and -78.2 to 50.2. Consequently, these instruments measure unrelated aspects of QoL and can give different conclusions.

The relationship between insomnia and patient satisfaction with quality of life in cancer.

GOALS OF WORK: Insomnia is the most common sleep disorder in patients with advanced cancer. The goal of this study was to investigate the relationship between insomnia and patient satisfaction with quality of life (QoL) in cancer. MATERIALS AND METHODS: A case series of 954 cancer patients treated at Cancer Treatment Centers of America was investigated. Insomnia was measured using the EORTC QLQ-C30 insomnia subscale. Patient satisfaction with QoL was measured using the Ferrans and Powers Quality of Life Index (QLI). The relationship between insomnia and QLI was evaluated using multivariate analysis of variance and multiple regression analysis. RESULTS: Of 954 patients, 579 were females and 375 males, with the median age at presentation of 56 years (range, 20-90 years). Most common cancers were breast (26%), colorectal (19%), and lung (16%). After controlling for the effects of age and treatment history, every 10-unit increase in insomnia was statistically significantly associated with 0.67-, 0.17-, 0.42-, 0.20-, and 0.42-unit decline in QLI health/physical, social/economic, psychological/spiritual, family, and overall QoL functioning, respectively. CONCLUSIONS: We found that insomnia is strongly correlated with patient satisfaction with QoL in cancer. Future studies should evaluate the impact of integrative cancer care services on patient satisfaction with QoL.

The relationship between dyspnea and patient satisfaction with quality of life in advanced cancer.

GOALS OF THE WORK: Dyspnea is a common symptom in patients with advanced cancer. The goal of this study was to investigate the relationship between dyspnea and patient satisfaction with quality of life (QoL) in advanced cancer. MATERIALS AND METHODS: A case series of 954 cancer patients treated at the Cancer Treatment Centers of America was investigated. Dyspnea was measured using the EORTC dyspnea subscale. Patient satisfaction with QoL was measured using the Ferrans and Powers Quality of Life Index (QLI). The relationship between dyspnea and QLI was evaluated using multivariate analysis of variance and multiple regression analysis. RESULTS: Of 954 patients, 579 were females and 375 males with the median age at presentation of 56 years (range: 20-90 years). Of these patients, 66% did not respond to prior treatment. Most common cancers were breast (26%), colorectal (19%) and lung (16%). After controlling for the effects of age and treatment history, every ten unit increase in dyspnea was statistically significantly associated with 0.81, 0.16, 0.47, and 0.47 unit decline in QLI health/physical, social/economic, psychological/spiritual and global function score, respectively. CONCLUSIONS: We found that dyspnea is strongly correlated with patient satisfaction with QoL in advanced cancer. Future studies should evaluate the impact of integrative cancer care services on patient satisfaction with QoL.

Can patient satisfaction with quality of life predict survival in advanced colorectal cancer?

GOALS OF WORK: The goal of this study was to evaluate the association between patient satisfaction with quality of life (QoL) and survival in colorectal cancer patients undergoing care in a community hospital comprehensive cancer center. MATERIALS AND METHODS: A consecutive case series of 177 cases of histologically confirmed colorectal cancer treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between April 2001 and November 2004. The quality of life index (QLI) was utilized to assess patient satisfaction with QoL. QLI measures global QoL and the QoL in four major subscales: health and physical functioning, social and economic, psychological/spiritual, and family. All scores range from 0 to 30 with higher scores indicating a better QoL. Kaplan-Meier method was used to calculate survival. Log-rank test was used to study the equality of survival distributions. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of those QoL and clinical factors that were shown to be prognostic in univariate analyses. RESULTS: Of the 177 patients, 46 were newly diagnosed and 131 have treatment history. The median age was 53 years (range 25-85 years). Eight patients had stage I disease, 16 had stage II, 51 had stage III, and 77 had stage IV. Health and physical subscale was significantly associated with survival (p=0.0003), with the median survival for low scores being 8.3 and 20.6 months for high scores. Health and physical subscale was found to be predictive of survival independent of the effects of tumor stage at diagnosis and treatment history. CONCLUSIONS: We found that baseline patient satisfaction with QoL, as measured by the QLI, provides useful prognostic information in patients with colorectal cancer independent of tumor stage at diagnosis and treatment history. While these findings require further investigation in large patient cohorts, they may have important implications for patient stratification in clinical trials and aid in clinical decision-making.

Self-reported quality of life in users and nonusers of dietary supplements in cancer.

GOALS OF WORK: To describe the Quality of Life (QoL) characteristics of users of dietary supplements vs nonusers. PATIENTS AND METHODS: A survey of 225 cancer patients presenting for treatment at Cancer Treatment Centers of America was completed between November 2001 and October 2003. A validated instrument assessed the use of 56 dietary supplements in the past month. Two validated questionnaires assessed QoL. Mean QoL scores were compared between the users and nonusers using univariate and multivariate linear regression. RESULTS: Of 225 patients, 91 (40%) were males and 134 (60%) females. Sixty seven (30%) had breast cancer, 40 (18%) colorectal cancer, and 32 (14%) lung cancer. One hundred sixty four (73%) had used dietary supplements in the past month, while 61 (27%) had not. Mean European Organization for Research Treatment of Cancer QoL scores were significantly better among the users for physical and emotional function scales and fatigue, nausea, appetite loss, and constipation symptom scales adjusting for tumor site. In the stratified analysis, lung cancer patients did not show any statistically significant differences in QoL scores between the users and nonusers. Colorectal cancer patients demonstrated statistically significant differences in constipation symptom, with dietary supplement users having better QoL. Breast cancer patients demonstrated statistically significant differences in several QoL scale scores between users and nonusers. CONCLUSIONS: Contrary to some of the previously published research, this study, conducted at a community hospital comprehensive cancer center that combines alternative treatment approaches with conventional cancer care, found better self-reported QoL among the users of dietary supplements, as compared to nonusers. The next step in this research is to prospectively evaluate the patterns of changing QoL in relation to dietary supplement use across the entire duration of cancer diagnosis and treatment.

The European organization for research and treatment of cancer quality of life questionnaire: implications for prognosis in pancreatic cancer.

BACKGROUND: The goal of this study was to evaluate the association between patient quality of life (QoL) and survival in pancreatic cancer patients undergoing care in a community hospital comprehensive cancer center. PATIENTS AND METHODS: A consecutive case series of 55 histologically confirmed pancreatic cancer treated at Cancer Treatment Centers of America® at Midwestern Regional Medical Center was studied between 04/01 and 11/04. The EORTC QLQ-C30 was utilized to assess patient QoL. Kaplan-Meier method was used to calculate survival. Log-rank test was used to study the equality of survival distributions. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of those QoL and clinical factors that were shown to be prognostic upon univariate analyses. RESULTS: Of the 55 patients, 28 were newly diagnosed and 27 had prior treatment history. The median age was 55 years (range 33-74 years). Majority (34) had stage IV disease at diagnosis. The QLQ-C30 parameters to show statistically significant associations with survival were physical, role, and emotional functioning scales and fatigue, appetite loss, constipation, and diarrhea symptom scales. CONCLUSIONS: We found that patient QoL, as measured by the QLQ-C30 physical functioning scale, provides useful prognostic information, independent of multiple cancer symptoms, in patients with pancreatic cancer. While these findings require further investigation in large patient cohorts, they may have important implications for patient stratification in clinical trials, as well as aid in clinical decision making.

Patient satisfaction with quality of life as a predictor of survival in pancreatic cancer.

BACKGROUND: The goal of this study was to evaluate the association between patient satisfaction with quality of life (QoL) and survival in pancreatic cancer patients undergoing care in a community hospital comprehensive cancer center. PATIENTS AND METHODS: A consecutive case series of 55 cases of histologically confirmed pancreatic cancer treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center was studied between 04/01 and 11/04. The Quality of Life Index (QLI) was utilized to assess patient satisfaction with QoL. QLI measures global QoL as well as the QoL in four major subscales: health and physical, social and economic, psychological and spiritual, and family. All scores range from 0 to 30 with higher scores indicating a better QoL. The Kaplan-Meier method was used to calculate survival. Log-rank test was used to study the equality of survival distributions. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of those QoL and clinical factors that were shown to be prognostic in univariate analyses. RESULTS: Of the 55 patients, 28 were newly diagnosed and 27 had prior treatment history. The median age was 55 yr (range 33-74 yr). Amajority (34) had stage IV disease at diagnosis. Health and physical subscale, family subscale, and global QoL were significantly associated with survival upon univariate analysis. Health and physical subscale was marginally significant upon multivariate analysis after controlling for the effects of stage at diagnosis. CONCLUSIONS: We found that baseline patient satisfaction with QoL, as measured by the QLI, provides useful prognostic information in patients with pancreatic cancer. While these findings require further investigation in large patient cohorts, they may have important implications for patient stratification in clinical trials, as well as aid in clinical decision-making.

The use of dietary supplements in a community hospital comprehensive cancer center: implications for conventional cancer care.

GOALS OF WORK: There is little data on the prevalence of use of dietary supplements in cancer, especially in light of the growing evidence that some dietary supplements can have adverse interactions with conventional cancer treatment. The purpose of this study was to investigate the use of dietary supplements among adult cancer patients in a community hospital comprehensive cancer center. PATIENTS AND METHODS: A survey of 227 new adult cancer patients presenting for treatment for the first time at Cancer Treatment Centers of America at Midwestern Regional Medical Center, between November 2001 and October 2003. Patients completed the McCune Questionnaire, a validated instrument that captures information on the use of 56 dietary supplements in cancer, at admission to the hospital. RESULTS: Of the 227 patients, 73% used some form of dietary supplements during the 30 day period before the survey was conducted. Dietary supplement use was significantly higher (p = 0.04) in patients with colorectal (80%) and breast (75%) cancer as compared to patients with lung cancer (53%). Patients with stage II (86%) and III (76%) disease at diagnosis were more likely (p = 0.02) to use dietary supplements as compared to those with stage I (71%) disease at diagnosis, while those with stage IV (61%) disease at diagnosis were least likely to use them. Of the 80 patients who had received chemotherapy within the last 30 days, 71% had also used dietary supplements in that timeframe and 25% had consumed one or more herbal therapies that are suspected to have adverse interactions with chemotherapy. Of the 57 patients combining chemotherapy with dietary supplements, 52.6% did not consult a healthcare professional. CONCLUSIONS: In our study, twenty-five percent of patients receiving chemotherapy were concurrently using dietary supplements suspected to have adverse interactions with chemotherapy, usually relying on information sources other than healthcare professionals. Given the prevalence rates of these agents, healthcare providers should systematically inquire about them, and consider the potential for drug-dietary supplement interactions in treatment planning.