Febrile neutropenia and its associated hospitalization in breast cancer patients on docetaxel-containing regimen: A retrospective cohort study on duration of prophylactic GCSF administration.

PURPOSE: To compare febrile neutropenia (FN) incidence and hospitalization among breast cancer patients on docetaxel with no granulocyte colony-stimulating factors (GCSF) primary prophylaxis (PP), 4/5-day PP, or 7-day PP. METHODS: We identified 3916 breast cancer patients using docetaxel-cyclophosphamide (TC), doxorubicin-cyclophosphamide then docetaxel (AC-T), fluorouracil-epirubicin-cyclophosphamide then docetaxel (FEC-T), docetaxel-carboplatin-trastuzumab (TJH), or docetaxel-doxorubicin-cyclophosphamide (TAC) from a hospital pharmacy dispensing database in Hong Kong between 2014 and 2016. Patients were offered GCSF within 5 days since administering docetaxel. Outcomes included FN incidence, time to first hospitalization, hospitalization rate, and duration. RESULTS: In TC regimen, FN incidence (with odds ratio, OR) of patients with no PP, 4/5-day PP, and 7-day PP was 21.69%, 7.95% (OR 0.31, p < 0.001), and 5.33% (OR 0.20, p < 0.001), respectively. In TJH regimen, FN incidence of patients with no PP, 4/5-day PP, and 7-day PP was 38.26%, 8.33% (OR 0.15, p < 0.001), and 8.57% (OR 0.15, p < 0.001), respectively. FN incidence of patients on AC-T regimen with no PP and 4/5-day PP was 20.93% and 6.84%, respectively (OR 0.28, p = 0.005); with FEC-T regimen, the incidence was 9.91% and 4.77%, respectively (OR 0.46, p = 0.035). Only 3.27% FN cases were not hospitalized. Mean (±standard deviation, SD) time to first hospitalization was 8.21 ± 2.44 days. Mean (±SD) duration of hospitalization for patients with no PP, 4/5-day PP, and 7-day PP was 4.66 ± 2.60, 4.37 ± 2.85, and 5.12 ± 2.97 days, respectively. CONCLUSION: GCSF prophylaxis in breast cancer patients on docetaxel could reduce FN incidence and hospitalization. 4/5-day PP demonstrated similar efficacy to 7-day PP with superior saving benefits on healthcare expenditure.

Effects of backpack and double pack loads on postural stability.

Measurement of postural stability is crucial for identifying predictors of performance, determining the efficacy of physical training and rehabilitation techniques and evaluating and preventing injuries, particularly for heavy load carriage in hikers, mountain search and rescue personnel and soldiers. This study investigated the effect of load distribution on postural stability in an upright stance using backpack and double pack loads under conflicting or impaired somatosensory, visual and vestibular conditions. The sensory organisation tests were conducted on 20 young adults before and after a 10-min level walking exercise. Young adults' ability to use inputs from somatosensory and visual systems to maintain postural stability was significantly reduced following a 10-min walking exercise with a heavy backpack (30% of body weight), whereas no significant changes were observed for double pack carriage. Thus, the distribution of heavy loads to the front and back provides superior balance control compared with back-only loading. Practitioner summary: This study investigated the effects of heavy (30% of body weight) load distribution on postural stability after a 10-min walking exercise. Backpack carriage significantly reduced postural stability, whereas there was no significant effect under double pack loads. Distribution of heavy loads on the front-and-back is desirable for superior balance control.

The Use of Post-ablation Stimulated Thyroglobulin in Predicting Clinical Outcomes in Differentiated Thyroid Carcinoma - What Cut-off Values Should We Use?

AIMS: Recently published international guidelines recommended using the stimulated thyroglobulin (sTg) post-radioactive iodine (RAI) ablation, in conjunction with tumour stage, as a risk stratification factor. The choice of cut-off values for sTg, namely 1 and 10 ng/ml, was, however, largely based on the functional sensitivities of the assays used, with relatively few published data addressing the prognostic impact of alternative cut-off values. Our study aims to provide data on the prognostic value of sTg at different levels of sensitivities and specificities. MATERIALS AND METHODS: We conducted a retrospective review of all adult cases of differentiated thyroid carcinoma receiving RAI ablation at our centre from 2008 to 2010. All patients had sTg measured at around 6 months post-ablation. The functional sensitivity of our assay was 0.5 ng/ml. The outcome was adverse clinical event, defined as cancer-related death, persistent macroscopic disease demonstrable on imaging (including radioisotope scan) and/or receiving further treatment for persistent or recurrent disease. A receiver operating characteristic (ROC) analysis was carried out. RESULTS: We identified 140 patients treated in the review period, with 106 of them suitable for further analysis. The reasons for exclusion included the presence of anti-thyroglobulin antibodies and medullary or anaplastic histological subtypes. Most (54.7%) had intermediate-risk disease as per the American Thyroid Association classification (2009). The median follow-up duration was 6.4 years; the minimum, excluding deaths, was 5.0 years. ROC analysis showed that the optimal cut-off value of sTg for predicting adverse clinical events was >1.0 ng/ml, associated with a sensitivity of 90.9%, a specificity of 81.0%, a positive predictive value of 55.6% and a negative predictive value of 97.1%. CONCLUSION: Based on ROC analysis of sensitivities and specificities, our data showed that a post-ablation sTg value of 1 ng/ml is the optimal cut-off in prognostication of adverse clinical events.

Gender Differences in Energy Expenditure During Walking With Backpack and Double-Pack Loads.

OBJECTIVE: To investigate gender differences in energy expenditure during walking with backpack and double-pack loads. BACKGROUND: Studies have reported that energy expenditure during walking with double-pack loads is lower compared with backpack carriage. However, the effect of gender on energy expenditure while walking with these two load distribution systems has not been investigated. METHOD: Thirty healthy young adults (15 female and 15 male participants) walked on a treadmill with backpack and double-pack loads weighing 30% of their body weight at a speed of 0.89 m/s for 10 min. The energy expenditure in terms of oxygen consumption (VO2) and respiratory exchange ratio (RER) were continuously monitored using a portable gas analyzer throughout each walking exercise. A mixed-design analysis of variance model was adopted to test the effects of gender, pack, and time on VO2 and RER. RESULTS: No time effect was observed on VO2. However, significant gender, pack, and interaction effects were observed. The lowest VO2 was found in female participants under double-pack carriage. No significant gender or pack differences existed in RER. However, RER significantly and incrementally increased in time from the 4th through 6th, 8th, and 10th min. CONCLUSION: This study revealed that heavy double-pack load carriage for healthy young female participants had significantly lower energy expenditure (normalized by the entire system weight, i.e., the participant's weight plus the weight of the pack) than that of the male participants in a 10-min walking exercise. APPLICATION: The findings of this study indicated that healthy young female participants carried a heavy double-pack with less energy cost (normalized by the entire system weight, i.e., the participant's weight plus the weight of the pack) compared with their male counterparts during a 10-min walking exercise.

A new method for the accurate measurement of higher-order frequency response functions of nonlinear structural systems.

Higher-order frequency response functions (FRFs) are important to the analysis and identification of structural nonlinearities. Though much research effort has been devoted recently to their potential applications, practical issues concerning the difficulty and accuracy of higher-order FRF measurement have not been rigorously assessed to date. This paper presents a new method for the accurate measurement of higher-order FRFs. The method is developed based on sinusoidal input, which is ideal for exciting a nonlinear structure into desired regimes with flexible control, and the correlation technique, which is a novel signal processing method capable of extracting accurate frequency components present in general nonlinear responses. The correlation technique adopted is a major improvement over Fourier transform based existing methods since it eliminates leakage and aliasing errors altogether and proves to be extremely robust in the presence of measurement noise. Extensive numerical case studies have been carried out to critically assess the capability and accuracy of the proposed method and the results achieved are indeed very promising. Interesting nonlinear behavior such as frequency shift and jump have been observed in first-, second- and third-order FRFs, as well as solitary islands which have been identified over which higher-order FRFs virtually do not change as input force amplitude varies. Higher-order FRFs over such solitary islands are essentially their theoretical counterparts of Volterra transfer functions which can be measured with very low input force and can be profitably employed for the identification of physical parameters of structural nonlinearities. Subsequently, a nonlinear parameter identification method has also been developed using measured higher-order FRFs and results are presented and discussed.

Efficacy and tolerability of trastuzumab emtansine in advanced human epidermal growth factor receptor 2-positive breast cancer.

INTRODUCTION: The management of human epidermal growth factor receptor 2 (HER2)-positive breast cancer has changed dramatically with the introduction and widespread use of HER2-targeted therapies. There is, however, relatively limited real-world information about the effectiveness and safety of trastuzumab emtansine (T-DM1) in Hong Kong Chinese patients. We assessed the efficacy and toxicity profiles among local patients with HER2-positive advanced breast cancer who had received T-DM1 therapy in the second-line setting and beyond. METHODS: This retrospective study involved five local centres that provide service for over 80% of the breast cancer population in Hong Kong. The study period was from December 2013 to December 2015. Patients were included if they had recurrent or metastatic histologically confirmed HER2+ breast cancer who had progressed after at least one line of anti-HER2 therapy including trastuzumab. Patients were excluded if they received T-DM1 as first-line treatment for recurrent or metastatic HER2+ breast cancer. Patient charts including biochemical and haematological profiles were reviewed for background information, T-DM1 response, and toxicity data. Adverse events were documented during chemotherapy and 28 days after the last dose of medication. RESULTS: Among 37 patients being included in this study, 28 (75.7%) had two or more lines of anti-HER2 agents and 26 (70.3%) had received two or more lines of palliative chemotherapy. Response assessment revealed that three (8.1%) patients had a complete response, eight (21.6%) a partial response, 11 (29.7%) a stable disease, and 12 (32.4%) a progressive disease; three patients could not be assessed. The median duration of response was 17.3 (95% confidence interval, 8.4-24.8) months. The clinical benefit rate (complete response + partial response + stable disease, ≥12 weeks) was 37.8% (95% confidence interval, 22.2%-53.5%). The median progression-free survival was 6.0 (95% confidence interval, 3.3- 9.8) months and the median overall survival had not been reached by the data cut-off date. Grade 3 or 4 toxicities included thrombocytopaenia (13.5%), raised alanine transaminase (8.1%), anaemia (5.4%), and hypokalaemia (2.7%). No patient died as a result of toxicities. CONCLUSIONS: In patients with HER2-positive advanced breast cancer who have been heavily pretreated with anti-HER2 agents and cytotoxic chemotherapy, T-DM1 is well tolerated and provided a meaningful progression-free survival of 6 months and an overall survival that has not been reached. Further studies to identify appropriate patient subgroups are warranted.

Occurrence, Distribution, and Fate of Organic UV Filters in Coral Communities.

Organic ultraviolet (UV) filters are widely used in personal care products and occur ubiquitously in the aquatic environment. In this study, concentrations of seven commonly used organic UV filters were determined in seawater, sediment and five coral species collected from the eastern Pearl River Estuary of South China Sea. Five compounds, benzophenone-1, -3, and -8 (BP-1, -3, and -8), octocrylene (OC) and octyl dimethyl-p-aminobenzoic acid (ODPABA), were detected in the coral tissues with the highest detection frequencies (>65%) and concentrations (31.8 ± 8.6 and 24.7 ± 10.6 ng/g ww, respectively) found for BP-3 and BP-8. Significantly higher concentrations of BP-3 were observed in coral tissues in the wet season, indicating that higher inputs of sunscreen agents could be attributed to the increased coastal recreational activities. Accumulation of UV filters was only observed in soft coral tissues with bioaccumulation factors (log10-values) ranging from 2.21 to 3.01. The results of a preliminary risk assessment indicated that over 20% of coral samples from the study sites contained BP-3 concentrations exceeding the threshold values for causing larval deformities and mortality in the worst-case scenario. Higher probabilities of negative impacts of BP-3 on coral communities are predicted to occur in wet season.

A new REBO potential based atomistic structural model for graphene sheets.

A new atomistic structural model is developed here for graphene sheets based on the stiffnesses from the REBO potential. Using this model, the flexural vibration natural frequencies and buckling loads of rectangular single-layer graphene sheets of different sizes, chiralities and boundary conditions are calculated. The newly developed atomistic structural model is verified by comparing the calculated fundamental natural frequencies for small-sized graphene sheets with those obtained from ab initio density functional theory (DFT) frequency analysis. The vibration and buckling analysis results are also compared with those of an earlier atomistic structural model based on the AMBER potential as well as the equivalent continuum model for graphene sheets. Through this study, it is observed that graphene sheets display very slight anisotropic characteristics in flexural vibration and buckling. Also, it is shown that the atomistic structural model cannot be replaced by a classical equivalent continuum model such as a plate model. Most significantly, we verify that the new atomistic structural model based on the REBO potential predicts more accurate natural frequencies and buckling loads for graphene sheets, which are considerably lower than those predicted by the earlier atomistic structural model based on the AMBER potential.

Pleomorphic adenoma of nasal septum: a case report.

Pleomorphic adenoma of the nasal septum presents a clinical diagnostic challenge. We report a rare case of pleomorphic adenoma of the nasal septum in a 39-year-old woman with a 1-month history of nasal obstruction. Wide surgical excision is the recommended treatment for this tumour.

The implementation of an end-of-life integrated care pathway in a Chinese population.

The integrated care pathway is used in end-of-life care to improve quality of care; the Liverpool Care Pathway (LCP) has been used in Europe and North America. Tuen Mun Hospital is a regional hospital in Hong Kong, China. The End-of-life Care Pathway (ECP) based on the concepts used in the Liverpool Care Pathway, was developed, with modification to suit the local condition. Criteria for entry onto the ECP were that the multidisciplinary team agreed the patient was dying, and was at least two of the following: bedbound; semi-comatose; only able to take sips of fluid; no longer able to take tablets. The ECP template replaced all other inpatient documents. The ECP was implemented in the palliative care unit for terminal cancer patients. An audit was performed to review the result. Fifty-one Chinese patients were included in the audit with mean age 64. The median duration of ECP use was 24 hours. All patients had current medication assessed and non-essential drugs were discontinued. The audit result suggested integrated care pathway in end-of-life care could be implemented successfully in an Oriental culture. The acceptance of using the ECP as a standard clinical practice takes time and education. Appropriate template design and supervision are the keys to success.

Coupling of ab initio density functional theory and molecular dynamics for the multiscale modeling of carbon nanotubes.

A multiscale technique is developed that couples empirical molecular dynamics (MD) and ab initio density functional theory (DFT). An overlap handshaking region between the empirical MD and ab initio DFT regions is formulated and the interaction forces between the carbon atoms are calculated based on the second-generation reactive empirical bond order potential, the long-range Lennard-Jones potential as well as the quantum-mechanical DFT derived forces. A density of point algorithm is also developed to track all interatomic distances in the system, and to activate and establish the DFT and handshaking regions. Through parallel computing, this multiscale method is used here to study the dynamic behavior of single-walled carbon nanotubes (SWCNTs) under asymmetrical axial compression. The detection of sideways buckling due to the asymmetrical axial compression is reported and discussed. It is noted from this study on SWCNTs that the MD results may be stiffer compared to those with electron density considerations, i.e. first-principle ab initio methods.

Activities of daily living performance in dementia.

OBJECTIVE: To explore the activities of daily living ADL performance profile of community-living people with dementia and to investigate its relationship with dementia severity. MATERIALS & METHODS: ADL performance of 86 subjects were evaluated using Barthel Index (BI), Lawton and Brody's Instrumental Activities Daily Living (IADL) and Assessment of Motor and Process Skills (AMPS). Dementia severity was measured by Clinical Dementia Rating (CDR). RESULTS: Subjects were able to perform most basic ADL (BI mean = 16.4) and some IADL (Lawton and Brody's IADL mean = 4.3). The AMPS process ability measure and the Lawton and Brody's IADL were significantly correlated with CDR (P < 0.01). CONCLUSIONS: Subjects with mild dementia were able to perform mostly all basic ADL and some IADL. The AMPS process ability measure and the Lawton and Brody's IADL could provide useful information on their ability to live independently in the community.

Metallothionein turnover, cytosolic distribution and the uptake of Cd by the green mussel Perna viridis.

We examined the relationship between Cd kinetics (uptake from solution and diet, and efflux), metallothionein turnover, and changes in the cytosolic distribution of accumulated Cd between protein fractions in the green mussel Perna viridis. We pre-exposed the mussels to 5, 20, 50 and 200 microg l(-1) of Cd for 1 week and determined the biokinetics of Cd uptake and efflux in the mussels. The dietary assimilation efficiency of Cd increased by 2 times following exposure to 20-200 microg l(-1) Cd, but the dissolved uptake rate was unchanged by pre-exposure to any Cd concentrations. The efflux rate of Cd was also similar among control and Cd pre-exposed mussels. The cytosolic distribution of Cd in the mussels that had been exposed to dissolved Cd, showed that besides metallothionein (7000 - 20,000 Da), high molecular weight proteins (>20,000 Da) were important for Cd binding and depuration. In general, the Cd pre-exposed mussels had higher metallothionein turnover with a higher metallothionein synthesis rate, but similar metallothionein breakdown rates as the control mussels. Metallothionein synthesis rate was correlated to the dietary assimilation of Cd, whereas metallothionein breakdown and Cd efflux rate were independent of each other. This study provides important new information for the role of metallothionein turnover on Cd kinetics in an aquatic invertebrate.

Analysis of pH and electrically controlled swelling of hydrogel-based micro-sensors/actuators.

In this paper, we carry out the theoretical electro-chemo-mechanical investigation into water swollen ionic polymer gels under the simultaneous influence of electrical and chemical stimuli. In addition to these hydrogels being deployed as active sensing/actuating elements in MEMS/BioMEMS devices, this work can also serve as the basis of illustrating synthetic analogs of physiological muscles with possible applications in orthotics, prosthetics, and as artificial muscles. An electro-chemo-mechanical model or Multi-Effect-Coupling of pH Stimulus (MECpH) model, which was developed earlier by the present authors, is significantly extended to handle nonlinear deformation and implemented numerically to simulate the deformation characteristics of the pH-stimulus responsive hydrogel under the application of an externally applied voltage in different buffered pH solutions. The nonlinear deformation theory provides more accurate results especially when the deformations are large. The hydrogel is observed to experience swelling and bending when pH and external electric field stimuli coexist. The mode and degree of deformation are found to be highly dependent on changes of environmental pH, external electrical potential and bathing ionic strength. As an anionic hydrogel is considered in the simulation, it shows larger changes in deformation characteristic in basic than in acidic solutions. More importantly, the average curvatures of the swollen hydrogel are found to be a linear function with the applied electric potential, making the hydrogel an ideal actuator. However, we also note a significant decrease in the swelling equilibrium degree as the ionic strength becomes concentrated.

Effects of initial-fixed charge density on pH-sensitive hydrogels subjected to coupled pH and electric field stimuli: a meshless analysis.

In this paper, we study the effects of initial fixed-charge density on the response behavior of pH-sensitive hydrogels subjected to coupled stimuli, namely, solution pH and externally applied electric field. This is the first instance in which a coupled stimuli numerical analysis has been carried out for these polymer gels, which are used as active sensing/actuating elements in advanced biomicroelectromechanical systems devices. In this work, a chemo-electro-mechanical formulation, termed the multi-effect-coupling pH-stimulus (MECpH) model, is first presented. This mathematical model takes into account the ionic species diffusion, electric potential coupling, and large mechanical deformation. In addition, a correlation between the diffusive hydrogen ions and fixed-charge groups on the hydrogel polymeric chains is established based on the Langmuir absorption isotherm, and incorporated accordingly into the MECpH model. To solve the resulting highly nonlinear and highly coupled partial differential equations of this mathematical model, the Hermite-Cloud method, a novel true meshless technique, is employed. To demonstrate the accuracy and robustness the MECpH model, computed numerical results are compared with experimental data available from literature. Following this validation, several numerical studies are carried out to investigate the effects of initial fixed-charge density on the volumetric variations of these pH-stimulus-responsive hydrogels when immersed in buffered solutions.

Differential effects of isoflavones, from Astragalus membranaceus and Pueraria thomsonii, on the activation of PPARalpha, PPARgamma, and adipocyte differentiation in vitro.

Compounds that target the peroxisome proliferator-activated receptors PPARalpha and PPARgamma are used to correct dyslipidemia and to restore glycemic balance, respectively. Because the majority of diabetic patients suffer from atherogenic lipid abnormalities, in addition to insulin resistance, ligands are required that can activate both PPARalpha and PPARgamma. In this study, we used chimeric PPARalpha/gamma reporter-gene bioassays to screen herbal extracts with purported antidiabetic properties. Extracts of Astragalus membranaceus and Pueraria thomsonii significantly activated PPARalpha and PPARgamma. Bioassay-guided fractionation resulted in the isolation of the isoflavones, formononetin, and calycosin from Astragalus membranaceus, and daidzein from Pueraria thomsonii as the PPAR-activating compounds. We investigated the effects of these and 2 common isoflavones, genistein and biochanin A, using chimeric and full-length PPAR constructs in vitro. Biochanin A and formononectin were potent activators of both PPAR receptors (EC50 = 1-4 micromol/L) with PPARalpha/PPARgamma activity ratios of 1:3 in the chimeric and almost 1:1 in the full-length assay, comparable to those observed for synthetic dual PPAR-activating compounds under pharmaceutical development. There was a subtle hierarchy of PPARalpha/gamma activities, indicating that biochanin A, formononetin, and genistein were more potent than calycosin and daidzein in chimeric as well as full-length receptor assays. At low doses, only biochanin A and formononetin, but not genistein, calycosin, or daidzein, activated PPARgamma-driven reporter-gene activity and induced differentiation of 3T3-L1 preadipocytes. Our data suggest the potential value of isoflavones, especially biochanin A and their parent botanicals, as antidiabetic agents and for use in regulating lipid metabolism.

Ethnicity is a factor to be considered before dose planning in ovarian cancer patients to be treated with topotecan.

The objective of this study was to determine the efficacy and toxicity of topotecan in Chinese patients with ovarian cancer. A retrospective analysis on recurrent ovarian cancer patients receiving topotecan 1.25 mg/m(2) daily for 5 consecutive days on a 21-day cycle from 1997 to 2002 was conducted. The patients included were all treated with at least two cycles of topotecan. The patient characteristics were compared in relation to their toxicity profile and their response to treatment. Response was evaluated by physical findings, imaging techniques, and serum CA125 level. A total of 60 patients were included in the study. All patients were evaluable for response and toxicities. A total of 361 cycles were given (median, 5 per patient; range 2-15). The major toxicity was neutropenia, which was grade 4 in 45.0% of the patients and 10.2% of the cycles. Age was the only covariate predicting the occurrence of grade 4 neutropenia (logistic regression P= 0.046, CI 1.01-1.12). Neutropenic fever occurred in 8.3% of the patients. Eighteen (30%) patients were required to delay their chemotherapy and 11 (18.3%) required dose reduction. Nonhematologic toxicities were mild. The overall response rate was 21.6%, with eight (13.3%) complete responses and five (8.3%) partial responses. The median duration of response and median time to progression were 11 and 5 months, respectively. The median survival was 14 months. Topotecan 1.25 mg/m(2) in a five-times-daily schedule was well tolerated in a cohort of Chinese patients. Myelotoxicity was the most important side effect in our study, but the incidence is much lower than that reported in other studies. Age was an independent factor predicting the occurrence of grade 4 neutropenia.

The behaviors of seeking a second opinion from other health-care professionals and the utilization of complementary and alternative medicine in gynecologic cancer patients.

GOALS OF WORK: The aim of the study is to determine the predictors for seeking a second opinion and the utilization of complementary and alternative medicine (CAM) among gynecologic cancer patients. PATIENTS AND METHODS: Patients attending a gynecologic cancer clinic of a tertiary referral center were recruited over a period of 1 year. A survey was conducted for all the participants in a one-on-one basis. MAIN RESULTS: One hundred ninety-one patients were recruited. Eighty patients (41.9%) had consulted other health-care professionals (HCP) for a second opinion after they were diagnosed to have cancer and 89 (46.6%) had utilized CAM. In multivariate analysis, late-stage disease (OR=2.65, 95% CI 1.26-5.58), treatment with radiotherapy (OR=2.27, 95% CI 1.19-4.33) and tertiary education (OR=11.28, 95% CI 3.06-41.54) were independent predictors for seeking a second opinion from other HCP and utilization of CAM. Patients who sought a second opinion from other HCP were more likely to utilize CAM (OR=6.12, 95% CI 3.24-11.54). Eighty percent of the patients did not inform their usual caregiver their utilization of CAM. CONCLUSIONS: Seeking a second opinion from other HCP is common in gynecologic cancer patients. Patients who seek a second opinion are more likely to utilize CAM.

Effect of individual psychological intervention in Chinese women with gynecologic malignancy: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of psychological intervention in the care of cancer patients and to determine whether routine use of individual psychological therapies is indicated. PATIENTS AND METHODS: Patients with newly diagnosed gynecologic malignancies from August 1999 to November 2000 were recruited and randomly assigned to either a control group receiving routine medical care or to an intervention group receiving individual psychotherapy. A set of fixed-choice, self-report questionnaires assessing the patients' psychological status, quality of life, and their perceptions related to the medical consultations was completed at recruitment and then every 3 months for 18 months. Data analysis was performed according to the intention-to-treat principle by fitting the data into a linear mixed-effects model. Multivariable analyses were performed to examine the effects of confounding factors. RESULTS: One hundred fifty-five patients participated in the trial. There were no statistically significant differences between the two groups at baseline. There was a trend toward better quality of life and functional status and also improvement of the symptoms over time for both groups. No differences were found between the groups in the scores measured by any of the instruments at baseline and at any time points after the cancer diagnosis. Psychological intervention had no significant effects on the psychosocial parameters. CONCLUSION: Routine use of psychological therapies as given in our format has no significant effect on the patients' quality of life and psychological status.