RESUMEN
PURPOSE: The effects of thoracic radiation therapy (RT) on physical functioning and quality of life (QoL) are incompletely defined. We determined the associations between thoracic RT dose volume metrics, physical activity, and QoL in patients with cancer. METHODS AND MATERIALS: Participants with breast cancer, lung cancer, or mediastinal lymphoma treated with radiation with or without chemotherapy were enrolled in a prospective, longitudinal cohort study. Data were collected pre-RT, immediately post-RT, and 5 to 9 months post-RT. At each timepoint, self-reported physical activity was assessed via the Godin-Shephard Leisure-Time Physical Activity Questionnaire, and QoL metrics were assessed via Functional Assessment of Chronic Illness Therapy Fatigue and Dyspnea Scales. Multivariable adjusted linear regression models were stratified by breast cancer alone and lung cancer and lymphoma combined. RESULTS: One hundred thirty participants were included in the study. In breast cancer (n = 80), each 1-Gy increase in mean heart dose was associated with worse Functional Assessment of Chronic Illness Therapy Fatigue scores (-1.0; 95% confidence interval [CI], -1.9 to -0.2; P = .021); similar associations were observed between V5 and fatigue (-2.5; 95% CI, -4.4 to -0.6; P = .010 for each 10% increase in V5). In lung cancer and lymphoma (n = 50), each 10% increase in V5 was associated with decreased physical activity (Godin-Shephard Leisure-Time Physical Activity Questionnaire score -2.3; 95% CI, -4.3 to -0.4; P = .017). Although the associations between baseline levels of physical activity and fatigue and dyspnea were of borderline significance in breast cancer alone (P < .10), increased physical activity over time was associated with improvements in fatigue and dyspnea across all cancer types (P < .05 for all). CONCLUSIONS: Higher cardiac RT dose was associated with worse fatigue and physical activity across breast cancer, lung cancer, and mediastinal lymphoma. Longitudinal increases in physical activity were associated with concurrent improvements in QoL measures. Strategies to increase physical activity and decrease cardiac RT dose may improve physical functioning and QoL for patients with cancer.
Asunto(s)
Neoplasias de la Mama/radioterapia , Ejercicio Físico , Neoplasias Pulmonares/radioterapia , Linfoma/radioterapia , Neoplasias del Mediastino/radioterapia , Calidad de Vida , Tórax/efectos de la radiación , Adulto , Anciano , Neoplasias de la Mama/psicología , Femenino , Humanos , Estudios Longitudinales , Neoplasias Pulmonares/psicología , Linfoma/psicología , Masculino , Neoplasias del Mediastino/psicología , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Psychiatric disorders are rare clinical manifestations of hypercalcaemia in the pediatric population, are relatively more frequent during adolescence and are often overlooked in cases of severe hypercalcaemia. We described the case of a 17-year-old girl affected by anorexia nervosa, depression and self-harm with incidental detection of moderate hypercalcaemia. Clinical, laboratory and instrumental tests demonstrated that hypercalcaemia was secondary to primary hyperparathyroidism (PHPT) due to a mediastinal parathyroid adenoma in the thymic parenchyma. After parathyroidectomy with robot-assisted surgery, we observed the restoration of calcium and PTH levels in addition to an improvement in psychiatric symptoms. This case demonstrates that serum calcium concentration should be evaluated in adolescents with neurobehavioural symptoms and in cases of hypercalcaemia PHPT should be excluded. Surgery represents the cornerstone of the management of PHPT and may contribute to improving quality of life and psychological function in these patients. However, the complexity of neurological involvement in cases of hypercalcaemia due to PHPT requires further investigations to establish the real impact of this condition on the neurocognitive sphere.
Asunto(s)
Adenoma/patología , Hipercalcemia/patología , Hiperparatiroidismo Primario/patología , Neoplasias del Mediastino/patología , Trastornos Mentales/patología , Neoplasias de las Paratiroides/patología , Adenoma/complicaciones , Adenoma/psicología , Adenoma/cirugía , Adolescente , Femenino , Humanos , Hipercalcemia/complicaciones , Hipercalcemia/psicología , Hipercalcemia/cirugía , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario/psicología , Hiperparatiroidismo Primario/cirugía , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/psicología , Neoplasias del Mediastino/cirugía , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Trastornos Mentales/cirugía , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/psicología , Neoplasias de las Paratiroides/cirugía , PronósticoAsunto(s)
Actitud del Personal de Salud , Costo de Enfermedad , Satisfacción del Paciente , Relaciones Médico-Paciente , Terapia Combinada , Atención a la Salud/economía , Historia del Siglo XX , Hospitalización/economía , Humanos , Linfoma de Células B/economía , Linfoma de Células B/historia , Linfoma de Células B/psicología , Linfoma de Células B/terapia , Masculino , Neoplasias del Mediastino/economía , Neoplasias del Mediastino/historia , Neoplasias del Mediastino/psicología , Neoplasias del Mediastino/terapiaRESUMEN
Heterogeneity in psychiatric responses to disease specific diagnosis is demonstrated for two groups of cancer patients who are comparable in prognosis and treatment intensity. Implications of this heterogeneity are drawn for etiological study and for planning psychiatric interventions.
Asunto(s)
Disgerminoma/psicología , Enfermedad de Hodgkin/psicología , Neoplasias del Mediastino/psicología , Rol del Enfermo , Neoplasias Testiculares/psicología , Adaptación Psicológica , Adulto , Terapia Combinada , Disgerminoma/patología , Disgerminoma/terapia , Femenino , Identidad de Género , Hormonas Esteroides Gonadales/sangre , Enfermedad de Hodgkin/patología , Enfermedad de Hodgkin/terapia , Humanos , Metástasis Linfática , Masculino , Matrimonio/psicología , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/terapia , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Persona de Mediana Edad , Estadificación de Neoplasias , Orquiectomía/psicología , Pruebas de Personalidad , Conducta Sexual/fisiología , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapiaAsunto(s)
Imagen Corporal , Neoplasias de Cabeza y Cuello/psicología , Enfermedad de Hodgkin/psicología , Neoplasias del Mediastino/psicología , Adolescente , Antineoplásicos/efectos adversos , Actitud Frente a la Muerte , Cicatriz , Femenino , Neoplasias de Cabeza y Cuello/terapia , Enfermedad de Hodgkin/terapia , Humanos , Neoplasias del Mediastino/terapiaRESUMEN
Medical personnel often reach erroneous judgments on the reaction of cancer patients to death and dying. Patients with terminal cancer sometimes will say little or nothing to hospital staff members or other professionals about their fears or expectations. This silence is generally construed as indicative of the primitive defense mechanism of denial. Usually, however, such patients are not truly "denying" cancer and its consequences, but have merely decided, more or less voluntarily, to "suppress" these thoughts as a method of coping with their illness. The medical staff, through careful observation of cancer patients, and through discussions with patients' families, should be able to distinguish between denial and suppression. This distinction can be significant because it enables the staff to understand the patient's feelings correctly, and thereby to provide more effective care. The staff, and the patients themselves, are thus in a better position to orchestrate the patients' various physical, emotional and interpersonal needs and resources optimally.