A feasibility study of dignity psychotherapy delivered via telemedicine.

OBJECTIVE: Dignity Psychotherapy has shown great promise as a value-affirming intervention for patients with advanced disease. We delivered the Dignity Psychotherapy intervention in a feasibility study of a series of eight cancer patients via videophone technology to deliver the therapy into their homes. METHODS: Once eligible patients were consented on this IRB-approved study, they completed baseline assessments and were scheduled to have the videophone placed in their homes. The Dignity Therapy sessions then encompassed a first session, which was transcribed and edited, followed by a second session to go over the edited transcript and allow the patient to make changes. Patients then filled out follow-up questionnaires and had the telemedicine equipment removed from their homes, and their legacy document delivered. RESULTS: Participants had a mean age of 56.32 years (range = 41-66, SD = 7.65) and were diagnosed with lung (n = 5, 62.5%), breast (n = 2, 25%), or colon cancer (n = 1, 12.5%). They reported overall benefit from the intervention along with a high level of satisfaction. We were able to deliver the intervention in a timely fashion, with minimal length between sessions and transcript delivery and few technical difficulties. SIGNIFICANCE OF RESULTS: Telemedicine can greatly extend the benefits of Dignity Psychotherapy by bringing it to patients who are dying at home. Our very preliminary work suggests that delivering the intervention to patients who are too ill to leave their homes or who are in rural locations may be a feasible way to help them.

Spontaneous hematogenous and lymphatic metastasis, but not primary tumor growth or angiogenesis, is diminished in fibrinogen-deficient mice.

Previous studies of tumor cell-associated procoagulants and fibrinolytic factors have strongly suggested that local thrombin and plasmin generation may be important in tumor growth and dissemination. Given that one central target of both of these serine proteases is fibrin(ogen), a logical extension of this hypothesis is that local fibrin deposition and dissolution may be key determinants of tumor progression. In this paper, the role of fibrin(ogen) and its degradation products in the growth and spontaneous metastasis of Lewis lung carcinoma was directly examined by comparative studies of control and fibrinogen-deficient mice. Fibrinogen deficiency was found to have no effect on the time required for the formation of palpable tumors, tumor angiogenesis, overall tumor architecture, or primary (s.c.) or secondary (pulmonary) tumor growth. However, fibrinogen deficiency markedly reduced the incidence of spontaneous macroscopic metastases in the lung and regional lymph nodes, a process that occurred relatively late in tumor development. Furthermore, a significant quantitative reduction in pulmonary micrometastases was observed in fibrinogen-deficient mice. Quantitative analyses of pulmonary micrometastases in primary tumor-bearing mice indicated that spontaneous showering of tumor cell emboli into the lung was robust, regardless of animal genotype. Hence, our results suggest fibrin(ogen) plays an important role in spontaneous metastasis, facilitating the stable adhesion and/or survival of metastatic emboli after tumor cell intravasation. These studies suggest that therapeutic strategies focusing on hemostatic factors may be effective in controlling solid tumor metastasis, particularly if used for the treatment of micrometastatic disease.