Differences in coping strategies among young adults and the elderly with cancer.

BACKGROUND: Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer. METHODS: Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions). RESULTS: Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment. CONCLUSION: Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.

Survey of neonatal resuscitation practices showed post-training improvements but need to reinforce preterm management, monitoring and adrenaline use.

AIM: Neonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres. METHODS: A 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions. RESULTS: The following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was <7% and endotracheal administration of adrenaline was >90%. CONCLUSION: Neonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.

Changes in perinatal management and outcomes in infants born at 23 weeks of gestational age during the last decade in Spain.

INTRODUCTION: The 2021-updated guidelines of the Spanish Society of Neonatology Guidelines have moved the zone of parental discretion to 23 + 0-23 + 6 weeks. The objective of this study was to describe the changes in perinatal management at this gestational age along the last decade and to determine if a more active perinatal management has contributed to improved outcomes. METHODS: Retrospective analysis of prospectively collected data from the 23-week infants included in the Spanish SEN 1500 neonatal network during the period 2010-2019. The main study outcomes were survival at discharge and survival without major morbidity of actively managed infants. Two periods were compared: 2010-2014 (Period 1) and 2015-2019 (Period 2). NICUs were classified into low activity NICUs (less than 50 admissions of very low birth weight infants per year) and high activity NICUs (50 or more admissions). RESULTS: A total of 381 infants were included, 182 in Period 1 and 199 in Period 2. In Period 2 an increase in the use of intrapartum magnesium sulfate (21.5% vs 39.9%, p .002), antenatal steroids (56.6% vs 69.3%, p .011) and active neonatal approach in delivery room (76.9% vs 86.9%, p .011) were observed.The clinical outcomes of the actively managed 313 infants were similar in both periods, except for less arterial hypotension in Period 2. Survival was 27.1% in Period 1 and 25% in Period 2 (p .068) and survival without major morbidity was 2.1% and 2.3% respectively (p .914). No difference was found between low and high activity NICUs. CONCLUSION: A change to a more active intention to treat infants born at 23 weeks is taking place in Spain. But the survival rate of the actively-managed infants has remained stable around 25-30% during the study period. A multidisciplinary effort is needed to improve outcomes in this population.

Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants.

OBJECTIVE: Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation. METHOD: Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009-2011), patients who failed medical treatment underwent surgical closure; in second period (2012-2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival-without-morbidity were compared. RESULTS: This study included 188 patients (27±2 weeks, 973±272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p<0.001) and surgical closure (34.5% P1 versus 16.1% P2, p<0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p=0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p=0.403), necrotizing enterocolitis (15.5% versus 6.9%, p=0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p=0.264), mortality (17.5% versus 15.2%, p=0.690) or survival-without-morbidity adjusted OR=1.10 (95% CI: 0.55-2.22); p=0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n=82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p=0.019) and more survival-without-morbidity (20% versus 45.6%, p=0.028) were found. CONCLUSION: A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival-without-morbidity. However, two-thirds of preterm infants under 26 weeks are still treated.

Quality of life, coping, and psychological and physical symptoms after surgery for non-metastatic digestive tract cancer.

OBJECTIVE: The aim of this study was to investigate the impact of curative surgery for non-metastatic digestive tract cancers on quality of life (QoL), psychological status, and coping strategies. METHODS: A prospective, transversal, multicenter study was conducted in 404 patients: 361 with colorectal, 44 with gastroesophageal, and 35 with pancreaticobiliary cancer six months after surgery. Participants completed questionnaires evaluating QoL, including functioning (EORTC-QLC-C30), coping strategies (Mini-MAC), and psychological distress (BSI-18). RESULTS: The effects of surgery had a strong impact on functional domains, global QoL, and symptoms, especially in pancreaticobiliary and gastroesophageal cancer. Patients with pancreaticobiliary and gastroesophageal cancer had lower functional scale scores than those with colorectal cancer. Fatigue, appetite loss, diarrhea, depression, and psychological distress were the most common symptoms after surgery. Subjects with pancreaticobiliary cancer reported more fatigue, pain, insomnia, depression, somatization and psychological distress, whereas individuals with gastroesophageal cancer exhibited more fatigue, nausea/vomiting, diarrhea, depression, psychological distress, and helplessness than those with colorectal cancer. Only participants with colorectal cancer displayed improved QoL six months post-surgery, albeit their psychological state had worsened. CONCLUSION: Surgeons should discuss expectations regarding symptoms and QoL with patients prior to surgery to minimize physical and psychological impact.

Changes in Parenteral Nutrition During the First Week of Life Influence Early but Not Late Postnatal Growth in Very Low-Birth-Weight Infants.

BACKGROUND AND AIMS: Postnatal growth restriction remains a serious problem in very low-birth-weight infants. Enhanced parenteral supply of nutrients as soon as possible after birth is one of the strategies addressed to avoid extrauterine growth restriction. We aimed to analyze changes in growth patterns and in clinical outcomes in our unit after a change in our parenteral nutrition (PN) protocol. METHODS: We collected data from 2 time periods, comprising the 2 years before (period I) and the 2 years after (period II) the change of protocol. We included 142 very low-birth-weight infants ≤32 weeks of gestation with a birth weight ≤1500 g. Data regarding nutrition intakes (parenteral and enteral) in the first week of life, growth during admission, and clinical outcomes were retrieved from clinical charts. RESULTS: Babies in period II received a higher nutrition supply during the first week of life, but no further differences were found after this period. Weight at 14 days of life was significantly higher in period II but not at day 28 of life or discharge. CONCLUSIONS: In our population, an enhanced PN regimen for very low-birth-weight infants led to a better growth at 14 days of life. However, this positive effect had disappeared at day 28 of life. Strategies to improve nutrient supply once the preterm baby is stable and on full enteral feeds should be implemented and analyzed.

Survival and Neurodevelopmental Outcomes of Preterms Resuscitated With Different Oxygen Fractions.

BACKGROUND AND OBJECTIVES: Stabilization of preterm infants after birth frequently requires oxygen supplementation. At present the optimal initial oxygen inspiratory fraction (Fio2) for preterm stabilization after birth is still under debate. We aimed to compare neurodevelopmental outcomes of extremely preterm infants at 24 months corrected age randomly assigned to be stabilized after birth with an initial Fio2 of 0.3 versus 0.6 to 0.65 in 3 academic centers from Spain and the Netherlands. METHODS: Randomized, controlled, double-blinded, multicenter, international clinical trial enrolling preterm infants <32 weeks' gestation assigned to an initial Fio2 of 0.3 (Lowox group) or 0.6 to 0.65 (Hiox group). During stabilization, arterial pulse oxygen saturation and heart rate were continuously monitored and Fio2 was individually titrated to keep infants within recommended ranges. At 24 months, blinded researchers used the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) to assess visual acuity, neurosensory deafness, and language skills. RESULTS: A total of 253 infants were recruited and 206 (81.4%) completed follow-up. No differences in perinatal characteristics, oxidative stress, or morbidities during the neonatal period were assessed. Mortality at hospital discharge or when follow-up was completed didn't show differences between the groups. No differences regarding Bayley-III scale scores (motor, cognitive, and language composites), neurosensorial handicaps, cerebral palsy, or language skills between groups were found. CONCLUSIONS: The use of an initial lower (0.3) or higher (0.6-0.65) Fio2 during stabilization of extremely preterm infants in the delivery room does not influence survival or neurodevelopmental outcomes at 24 months.

Clinical outcomes after more conservative management of patent ductus arteriosus in preterm infants / Desfechos clínicos após tratamento mais conservador da persistência do canal arterial em prematuros

Abstract Objective: Management of patent ductus arteriosus is still controversial. This study aimed to describe the impact of a more conservative approach on treatment rates and on main outcomes of prematurity, especially in preterm infants with <26 weeks of gestation. Method: Clinical charts review of infants ≤30 weeks with patent ductus arteriosus between 2009 and 2016 at two centers. In 2011, the authors changed patent ductus arteriosus management: in first period (2009-2011), patients who failed medical treatment underwent surgical closure; in second period (2012-2016), only those with cardiopulmonary compromise underwent surgical ligation. Medical treatment, surgical closure, mortality, and survival-without-morbidity were compared. Results: This study included 188 patients (27 ± 2 weeks, 973 ± 272 grams); 63 in P1 and 125 in P2. In P2, significantly lower rates of medical treatment (85.7% P1 versus 56% P2, p < 0.001) and surgical closure (34.5% P1 versus 16.1% P2, p < 0.001) were observed. No differences were found in chronic lung disease (28.8% versus 13.9%, p = 0.056), severe retinopathy of prematurity (7.5% versus 11.8%, p = 0.403), necrotizing enterocolitis (15.5% versus 6.9%, p = 0.071), severe intraventricular hemorrhage (25.4% versus 18.4%, p = 0.264), mortality (17.5% versus 15.2%, p = 0.690) or survival-without-morbidity adjusted OR = 1.10 (95% CI: 0.55-2.22); p = 0.783. In P2, 24.5% patients were discharged with patent ductus arteriosus. The subgroup born between 23 and 26 weeks (n = 82) showed significant differences: lower incidence of chronic lung disease (50% versus 19.6%, p = 0.019) and more survival-without-morbidity (20% versus 45.6%, p = 0.028) were found. Conclusion: A conservative approach in preterm infants with patent ductus arteriosus can avoid medical and surgical treatments, without a significant impact in survival-without-morbidity. However, two-thirds of preterm infants under 26 weeks are still treated.

Resumo Objetivo O tratamento da persistência do canal arterial ainda é controverso. Nosso objetivo foi descrever o impacto de uma abordagem mais conservadora em nossas taxas de tratamento e nos principais desfechos da prematuridade, especialmente em prematuros com < 26 semanas de gestação. Método Revisão de prontuários de lactentes com ≤ 30 semanas e persistência do canal arterial entre 2009-2016 em dois centros. Em 2011, mudamos o manejo da persistência do canal arterial: no primeiro período (2009-2011), os pacientes que não apresentaram sucesso com o tratamento clínico foram submetidos a fechamento cirúrgico; no segundo período (2012-2016), apenas aqueles com comprometimento cardiopulmonar foram submetidos ao fechamento cirúrgico. Comparamos o tratamento clínico, fechamento cirúrgico, mortalidade e sobrevida sem morbidade. Resultados Foram incluídos 188 pacientes (27 ± 2 semanas, 973 ± 272 gramas); 63 em P1 e 125 em P2. Em P2, foram observadas taxas significativamente mais baixas de tratamento clínico (85,7% no P1 versus 56% no P2, p < 0,001) e fechamento cirúrgico (34,5% no P1 versus 16,1% no P2, p < 0,001). Não foram encontradas diferenças em relação à doença pulmonar crônica (28,8% versus 13,9%, p = 0,056), retinopatia grave da prematuridade (7,5% versus 11,8%, p = 0,403), enterocolite necrosante (15,5% versus 6,9%, p = 0,071), hemorragia intraventricular grave (25,4% versus 18,4%, p = 0,264), mortalidade (17,5% versus 15,2%, p = 0,690) ou OR ajustado pela sobrevida sem morbidade = 1,10 (IC95%: 0,55-2,22); p = 0,783. Em P2, 24,5% dos pacientes receberam alta com persistência do canal arterial. O subgrupo nascido entre 23 a 26 semanas (n = 82) apresentou diferenças significativas, foram encontradas menor incidência de doença pulmonar crônica (50% versus 19,6%, p = 0,019) e maior sobrevida sem morbidade (20% versus 45,6%, p = 0,028). Conclusão Uma abordagem conservadora em prematuros com persistência do canal arterial pode evitar tratamentos clínicos e cirúrgicos, sem um impacto significativo na sobrevida sem morbidade. No entanto, dois terços dos prematuros com menos de 26 semanas ainda são tratados.

Psychometric properties of Liverpool Stoicism Scale (LSS) in a cohort of patients with resected cancer in adjuvant treatment / Propiedades psicométricas de la Liverpool Stoicism Scale (LSS) en una cohorte de pacientes con cáncer resecado en tratamiento adyuvante

Stoicism has been used to describe a wide range of behaviors in the face of disease that go from silence, resistance to the adversity, or ‘to make the best of a bad disease’. This study pursued two objectives: 1) analyze the psychometric properties of the Spanish version of the LSS; 2) assess the relation between stoicism and gender, age, and the five-factor personality model. NEOcoping is a prospective, multicenter, observational, non-interventionist study. Patients were recruited consecutively at thirteen Spanish teaching hospitals. The following scales were administered: Liverpool Stoicism Scale (LSS) and Big Five Inventory (BFI-10). A total of 443 patients (250 females) with a mean age of 59.8 years (SD =12.3) were enrolled. Colon cancer was the most common, followed by breast cancer. At the total-scale level, mean LSS was lower than the originally reported British sample. The four-factor structure fitted the data well, had a clear interpretation, and the derived scales showed acceptable reliabilities. The personality trait of introversion predicted 4.1% of the variance of stoicism (p<001). Even though it needs to be improved, the LSS scale demonstrates acceptable psychometric properties to appraise stoicism in the Spanish population with resected cancer (AU)

El estoicismo se ha utilizado para describir una amplia gama de comportamientos frente a la enfermedad que van desde el silencio a la resistencia a la adversidad. Este estudio tiene dos objetivos: 1) analizar las propiedades psicométricas de la versión española del LSS; 2) evaluar la relación entre estoicismo, género, edad y el modelo de los cinco grandes factores de personalidad. NEOcoping es un estudio prospectivo, multicéntrico, observacional, no-intervencionista. Los pacientes fueron reclutados consecutivamente en 13 hospitales universitarios de España. Se aplicó la Liverpool Stoicism Scale (LSS) y el Big Five Inventory (BFI-10). Participaron 443 pacientes (250 mujeres) con una edad media de 59,8 años (SD =12,3). El cáncer de colon y mama fueron los más frecuentes. A nivel de escala total, la puntuación media de la LSS fue inferior a la muestra Británica. La estructura propuesta en cuatro factores proporciona un buen ajuste a los datos, y las puntuaciones en las escalas derivadas presentan fiabilidades aceptables. El rasgo de personalidad de introversión fue capaz de predecir el 4,1% de la variancia de estoicismo (p<001). Aunque debe ser mejorada, la LSS presenta globalmente unas propiedades psicométricas aceptables para evaluar el estoicismo en pacientes españoles con cáncer resecado (AU)