The incidence of over-the-counter medication use in patients with midgut neuroendocrine tumors.

Recent increases in the use of over-the-counter (OTC) medicines and the underreporting of the use of these medications to physicians have sparked interest in the number and types of "supportive" therapies used by patients with neuroendocrine tumors (NETS). Patients with NETS are of special interest as a result of the potential interactions/interferences between tumor-associated peptide and amine production and OTC supplements. A prospective analysis of patients with primary small bowel NETS between 1998 and 2012 was conducted to define and catalog each patient's prescription and OTC medication use at each clinic visit. The most recently recorded patient medications were used for this analysis. Three hundred sixty-two patients with small bowel primary NETS were studied. One hundred eighty-seven patients (51.6%) were taking nutritional supplements. Of these taking supplements, the per cent of patients taking one, two, three, or more than three supplements was 28.3, 24.1, 22.5, and 25.1 per cent, respectively. Females (n = 109) were more likely to take supplements in comparison to males (n = 78; P = 0.037). Fifty one patients (14.1%) took proton pump inhibitors and 31 patients (8.6%) took loperamide. OTC supplements were used by 50 per cent of patients with primary small bowel NETS in this study. Over one-third of our patients reported using three or more OTC medicines daily. These medicines have the potential to interact with the metabolism of prescribed medicines, modify ability to clot during surgery, exacerbate NET symptoms, and alter NET markers. Given the prevalence of OTC medications and their potential actions, it is important to carefully catalog their use.

Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial.

BACKGROUND: Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival. METHODS: From 485 women with advanced breast cancer recruited between 1996-2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat. RESULTS: SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69-1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74-1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless-helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03). CONCLUSIONS: SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression.

[Quality of life of patients with metastatic breast or intestinal cancer, treated with anthroposophic medicine or with mainstream medicine, the latter with or without psycho-oncologic or supplementary anthroposophic therapy]. / Untersuchungen der Lebensqualität von Patienten mit metastasierendem Brust- oder Darmkrebs, behandelt in der anthroposophischen Medizin oder in der Schulmedizin, letztere mit oder ohne psychoonkologische oder anthroposophische Zusatztherapie.

This project dealt with two subjects. On the one hand, the measurement of the quality of life of cancer patients which needed to be further refined in order to assess the usefulness and efficacy of a treatment by complementary medicine. On the other hand, it was important to know whether severely ill cancer patients treated in an anthroposophical clinic would differ from equally ill patients in a university hospital in terms of attitude towards their illness and in terms of clinical diagnosis. Finally, an attempt was made to demonstrate an improvement of quality of life in conventionally treated patients of the university hospital, who were offered an additional treatment either with a supportive-expressive group therapy or with an anthroposophical therapy. More than 500 patients participated in the study. There were marked sociodemographic and medical differences between the patients of the anthroposophical clinic and those of the university hospital. In addition, it seems that spiritually oriented and active, problem-oriented coping contribute a lot to the quality of life. It was not possible to truly compare the value of the two additional therapies offered to the patients at the university hospital because patient accrual was much slower than anticipated and many patients left the study too early for health reasons or death.