Efectividad de una intervención psicoterapéutica grupal en la mejora del bienestar de personas cuidadoras de un familiar con enfermedad de Alzheimer: estudio CuiDem / Effectiveness of a psychotherapeutic intervention group program in the improvement of caregiver well-being in Alzheimer’s disease patients’ family caregivers: the CuiDem study

Introducción: Las personas cuidadoras de familiares con enfermedad de Alzheimer presentan agotamiento físico y emocional, que puede abordarse con intervención no farmacológica. Objetivo: Evaluar la efectividad de una intervención psicoterapéutica grupal cognitivo-conductual para mejorar la percepción de bienestar de personas cuidadoras, respecto a una intervención de acompañamiento, y su sostenibilidad tras un período de seguimiento activo de un año postintervención. Sujetos y métodos: Estudio multicéntrico, cuasi experimental, abierto y con grupo control. Se asignó de forma no aleatorizada a 221 personas cuidadoras de familiares con enfermedad de Alzheimer, con demencia leve a moderada-grave, a tres condiciones de intervención: grupo de intervención psicoterapéutica sin seguimiento activo (GI) (n = 80); grupo de intervención psicoterapéutica con seguimiento activo (GIS) (n = 78); y grupo control de acompañamiento con seguimiento activo (GC) (n = 63). La intervención psicoterapéutica grupal (GI y GIS) es un programa estructurado, cognitivo-conductual, de una sesión semanal durante cuatro meses. La del GC tenía la misma duración. Se evaluaron preintervención, postintervención y, al año, sobrecarga percibida, estado de ánimo, resiliencia, apoyo social funcional y calidad de vida. Resultados: Se observó una mejora significativa postintervención en el GI y el GIS respecto al GC en percepción de sobrecarga (p = 0,0216). Al año de seguimiento, se observaron mejoras significativas en el GIS respecto al GI en estado de ánimo (p = 0,0271), resiliencia (p = 0,0018), apoyo social percibido (p = 0,014), calidad de vida (p = 0,0001) y salud mental (p = 0,0002); y en el GC frente al GI en estado de ánimo y apoyo social (p < 0,05). Conclusiones: Los resultados respaldan la efectividad de esta intervención psicoterapéutica para mejorar la percepción de bienestar (sobrecarga) y el seguimiento de apoyo para incrementar su eficacia.(AU)

Introduction: Caregivers of patients with Alzheimer’s Disease experience physical and emotional burnout that can be treated with non-pharmacological interventions. Aim: Assess the efficacy of a group cognitive behavioural psychotherapeutic intervention, for improving well-being perception in caregivers, compared to a support group. Also, we assessed its efficacy after a follow-up period of 1-year post-intervention. Subjects and methods: A multicentre, open, quasi experimental study with control group was conducted. 221 caregivers of patients with Alzheimer’s Disease, with mild to moderate-severe dementia, were non-randomly assigned to either IG-intervention group: psychotherapeutic program without active follow-up period (n = 80); IGF-intervention group: psychotherapeutic program with active follow-up period (n = 78); or CG-control group: support program with active follow-up period (n = 63). The psychotherapeutic intervention (IG and IGF) is a structured cognitive behavioural group program, of one weekly session over four months. The CG had the same duration. Caregiver’s burden, mood disorders, resilience, perceived functional social support and quality of life were measured at baseline, post-intervention and after 1-year follow-up. Results: At post-intervention, statistically significant improvements were observed in the IG and IGF compared to CG in caregiver burden (p = 0,0216). After one year follow-up, significant improvements were found in IGF compared to IG in emotional state (p = 0,0271), resilience (p = 0,0018), perceived social support (p = 0,014); quality of life (p = 0,0001) and mental health (p = 0,0002); and in CG versus GI in emotional state and social support (p < 0,05). Conclusions: These results support the efficacy of this psychotherapeutic intervention for improving well-being (burden), and the supportive follow-up period for increasing its efficacy.(AU)

[Effectiveness of a psychotherapeutic intervention group program in the improvement of caregiver well-being in Alzheimer's disease patients' family caregivers: the CuiDem study]. / Efectividad de una intervención psicoterapéutica grupal en la mejora del bienestar de personas cuidadoras de un familiar con enfermedad de Alzheimer: estudio CuiDem.

INTRODUCTION: Caregivers of patients with Alzheimer's Disease experience physical and emotional burnout that can be treated with non-pharmacological interventions. AIM: Assess the efficacy of a group cognitive behavioural psychotherapeutic intervention, for improving well-being perception in caregivers, compared to a support group. Also, we assessed its efficacy after a follow-up period of 1-year post-intervention. SUBJECTS AND METHODS: A multicentre, open, quasi experimental study with control group was conducted. 221 caregivers of patients with Alzheimer's Disease, with mild to moderate-severe dementia, were non-randomly assigned to either IG-intervention group: psychotherapeutic program without active follow-up period (n = 80); IGF-intervention group: psychotherapeutic program with active follow-up period (n = 78); or CG-control group: support program with active follow-up period (n = 63). The psychotherapeutic intervention (IG and IGF) is a structured cognitive behavioural group program, of one weekly session over four months. The CG had the same duration. Caregiver's burden, mood disorders, resilience, perceived functional social support and quality of life were measured at baseline, post-intervention and after 1-year follow-up. RESULTS: At post-intervention, statistically significant improvements were observed in the IG and IGF compared to CG in caregiver burden (p = 0,0216). After one year follow-up, significant improvements were found in IGF compared to IG in emotional state (p = 0,0271), resilience (p = 0,0018), perceived social support (p = 0,014); quality of life (p = 0,0001) and mental health (p = 0,0002); and in CG versus GI in emotional state and social support (p < 0,05). CONCLUSIONS: These results support the efficacy of this psychotherapeutic intervention for improving well-being (burden), and the supportive follow-up period for increasing its efficacy.

TITLE: Efectividad de una intervención psicoterapéutica grupal en la mejora del bienestar de personas cuidadoras de un familiar con enfermedad de Alzheimer: estudio CuiDem.Introducción. Las personas cuidadoras de familiares con enfermedad de Alzheimer presentan agotamiento físico y emocional, que puede abordarse con intervención no farmacológica. Objetivo. Evaluar la efectividad de una intervención psicoterapéutica grupal cognitivo-conductual para mejorar la percepción de bienestar de personas cuidadoras, respecto a una intervención de acompañamiento, y su sostenibilidad tras un período de seguimiento activo de un año postintervención. Sujetos y métodos. Estudio multicéntrico, cuasi experimental, abierto y con grupo control. Se asignó de forma no aleatorizada a 221 personas cuidadoras de familiares con enfermedad de Alzheimer, con demencia leve a moderada-grave, a tres condiciones de intervención: grupo de intervención psicoterapéutica sin seguimiento activo (GI) (n = 80); grupo de intervención psicoterapéutica con seguimiento activo (GIS) (n = 78); y grupo control de acompañamiento con seguimiento activo (GC) (n = 63). La intervención psicoterapéutica grupal (GI y GIS) es un programa estructurado, cognitivo-conductual, de una sesión semanal durante cuatro meses. La del GC tenía la misma duración. Se evaluaron preintervención, postintervención y, al año, sobrecarga percibida, estado de ánimo, resiliencia, apoyo social funcional y calidad de vida. Resultados. Se observó una mejora significativa postintervención en el GI y el GIS respecto al GC en percepción de sobrecarga (p = 0,0216). Al año de seguimiento, se observaron mejoras significativas en el GIS respecto al GI en estado de ánimo (p = 0,0271), resiliencia (p = 0,0018), apoyo social percibido (p = 0,014), calidad de vida (p = 0,0001) y salud mental (p = 0,0002); y en el GC frente al GI en estado de ánimo y apoyo social (p menor de 0,05). Conclusiones. Los resultados respaldan la efectividad de esta intervención psicoterapéutica para mejorar la percepción de bienestar (sobrecarga) y el seguimiento de apoyo para incrementar su eficacia.

Sentinel node biopsy after primary chemotherapy in cT2 N0/1 breast cancer patients: Long-term results of a retrospective study.

BACKGROUND: It is controversial whether sentinel node biopsy (SNB) is adequate in breast cancer patients who become cN0 after primary chemotherapy. To address this we retrospectively compared outcomes in T2 cases given primary chemotherapy, comparing those given axillary dissection (AD) with those given SNB but no AD if sentinel nodes were clinically negative post-chemotherapy. METHODS: We examined overall survival (OS), disease-free survival (DFS), and axillary failure in 317 consecutive cT2 cN0/1 patients given primary chemotherapy followed by quadrantectomy/mastectomy, between January 2002 and December 2007. The approach to the axilla changed over time allowing division into three groups: 101 (31.9%) given upfront AD; 139 (43.8%) given SNB + AD; and 77 (24.3%) given SNB only because the SNs were negative. RESULTS: After median follow-ups of 92 (AD), 99 (SNB + AD) and 72 months (SNB-only), OS (p = 0.131) and DFS (p = 0.087) did not differ between the 3 groups, or between SNB-only and the ypN1 and ypN0 subgroups of SNB + AD, or between the cN0 and cN1 subgroups (before chemotherapy) of the SNB-only group. No SNB-only patient had axillary failure. OS (p = 0.004) and DFS (p = 0.002) were better in patients with complete response than those with partial response or stable/progressive disease. CONCLUSIONS: SNB is adequate in T2 patients who are cN0 after primary chemotherapy, irrespective of axillary status before. Better outcomes after complete pathological remission confirm the prognostic importance of response to primary chemotherapy, and suggest that all T2 patients should receive primary chemotherapy.

Intratumour amount of sex steroids in elderly breast cancer patients. An approach to the biological characterization of mammary tumours in the elderly.

Interest in breast cancer in elderly women is growing as a result of the high frequency of cancer in older age groups. We measured tumour concentrations and circulating levels of testosterone, dihydrotestosterone (DHT) and oestradiol in 50 postmenopausal patients: 26 younger than 70 yr (median, 61.5, range 50-69) and 24 older than 70 yr (median, 74.5, range 70-82). Hormones were measured by radioimmunoassay (RIA) after extraction and separation on celite column chromatography. Intratumour levels of the three steroids were lower in the older than in the younger patients, but the difference was statistically significant only for DHT (P= 0.0126). The decrease in the tumour concentrations of testosterone and DHT in the older group was associated with a slight increase in circulating levels, yielding as final result a statistically significant decrease of the tissue/plasma (T/P) ratio of these hormones. No significant difference was observed between groups for oestradiol levels. The blood levels of testosterone, DHT and oestradiol were significantly correlated in the older group, but not in the younger group. In contrast, the tumour amounts of testosterone and DHT were found to be significantly associated only in the < 70 yr group. We concluded that the hormonal environment in which breast cancer develops is different in younger and older postmenopausal patients, and that the difference mainly concerns the intratumour amounts of androgens, suggesting that the steroids concur in the growth regulation of mammary tumours.

The role of fine needle aspiration in the diagnosis of thyroid nodules: analysis of 795 consecutive cases.

The utility of fine needle aspiration (FNA) and physical examination for selecting patients with palpable thyroid nodules for surgery was evaluated in 795 consecutive cases. Surgery was performed in 216 patients based upon the cytological diagnosis and clinical criteria. Excluding 42 patients who were lost to follow-up, the remaining 537 were regularly followed up (range, 2-10 years). Cytological findings were classified as malignant, histologic control recommended (suspicious), follicular tumor, benign, and unsatisfactory. Thirty-six aspiration biopsies were positive for malignancy and the diagnosis was confirmed histologically in 34 of them. In 65 patients with final histological diagnosis of malignancy, cytology was positive in 34, suspicious in 20, benign in 3 cases, and unsatisfactory in 8. All patients with cytological diagnosis of follicular tumor had a benign lesion at histology. There were two false positive and three false negative cytological results among the 216 histologically confirmed cases. Excluding unsatisfactory specimen sensitivity, specificity and the predictive value for a positive and a negative result were respectively 95%, 97.5%, 94.5%, and 97%. We conclude that FNA is a very reliable diagnostic test in the evaluation of thyroid nodules and is the best guidance in addition to clinical criteria for selecting patients to be submitted to surgery.

Treatment of breast cancer in elderly women: retrospective analysis of 111 wide lumpectomies performed in a day hospital regimen between 1982 and 1988.

Between 1982 and 1988, 111 elderly women with breast cancer but without clinical involvement of the axillary lymph nodes underwent wide lumpectomy in a Day Hospital regimen at the National Cancer Institute of Milan. The patients ranged in age from 70 to 92 years (median, 79). An adjuvant treatment was carried out in all but 9 cases: tamoxifen only in 84 cases, tamoxifen plus radiotherapy in 6 cases, radiotherapy alone in 12 cases. The median duration of follow-up was 44 months (range, 30-109 months). Four patients (3.6%) were lost to follow-up. In the remaining 107 patients, 10 local-regional relapses (9.1%) and 7 distant metastases (6.5%) occurred. Six patients died from the disease, 14 from unrelated conditions. This retrospective study showed that selected elderly patients with breast cancers can be treated successfully under local anesthesia on an outpatient basis. The treatment guarantees local control of the disease, meets the favor of elderly women and consequently improves their quality of life.

Fine needle aspiration cytology in superficial lymph nodes: an analysis of 266 cases.

The results of fine needle aspiration cytology of superficial lymph nodes in 275 patients are discussed. Nine cases were lost to follow-up. Of the remaining 266 aspirates, 152 were classified as cytologically malignant, 79 as benign, three as suspicious for malignancy, and 32 as unsatisfactory owing to scanty cellularity. The sensitivity of cytology for metastatic cancer was 96.5%. The results of aspiration biopsy from lymphomas were less accurate (67.5% sensitivity). There were no false positives and nine (11.3%) false negatives. Open biopsy of three suspect lymph nodes proved them to be malignant. The aspiration procedure is easy, safe and reliable. The diagnosis of benignity cannot, however, be determined without an open biopsy, particularly for lymphomas.

Outpatient biopsy of breast cancer. Influence on survival.

From 1948 to 1975, at the Istituto Nazionale Tumori of Milan, 209 patients underwent extended radical mastectomy (ERM) for breast cancer classified as T1 NO-1 MO. In 57 patients (27.3%), the ERM was preceded by an excisional biopsy performed in the outpatient clinic (Group A), of which 75% were performed within 30 days of admission and 25% after 30 days (average, 25 days; range 5-99). The remaining 152 patients (Group B) underwent an extemporaneous frozen biopsy. There was no difference in the distribution of the histologic types in the two groups. The axillary lymph nodes (N) and the internal mammary chain (MI) were free of neoplastic invasion (N-, MI-) in 156 patients (74.6%), 44 in Group A (77.2%) and 112 in Group B (73.7%). Actuarial 10-year survival of the patients was 79.9% in Group A and 77.7% in Group B (p = NS). It was 90% in N- MI- patients of Group A and 81.9% in those of Group B (p = NS). Instead, for N+ patients, actuarial survival at 10 years was 50% in Group A and 67% in Group B (p = NS), and for MI+ patients it was 50% and 49.8%, respectively. These present data do not support the hypothesis that a delay between biopsy and radical surgery of breast cancer is an important prognostic factor.