Health-related quality of life and physical fitness in breast cancer patients: the impact of a supervised physical exercise program in women with no exercise experience.

After breast cancer diagnosis (BCD), localized breast cancer (BC) patients are treated with curative intent by several therapeutic modalities. Despite the benefit of those therapies, the induction of side effects is acommon consequence affecting psychosocial and physiological outcomes. This quasi-experimental study compared physical fitness in recent-term (14-30 months; n= 11) and later-term (74-92 months; n= 8) BCD patients. After inclusion, recent-term BCD patients were engaged in asupervised exercise program and was explored its impact on physical fitness, health-related quality of life (HR-QOL) and fatigue. At baseline (M1) and after 8 (M2) and 16 weeks (M3) of this period, HR-QOL and fatigue were evaluated by the EORTC QLQ-C30 questionnaire and physical fitness through the estimation of maximum oxygen consumption (VO2max,ml.kg.min-1), handgrip force (kg) and sit-stand test. At baseline, women with later-term BCD have revealed better VO2max (p < 0.05) than recent-term BCD patients. There was asignificant time*group interaction for physical fitness outcomes and only the patients who have participated in the exercise program reported significant changes between baseline and at 16 weeks. The observed results demonstrated that performing regular exercise is associated with effective psychosocial and physiological recovery after BCD.

Information perception, wishes, and satisfaction in ambulatory cancer patients under active treatment: patient-reported outcomes with QLQ-INFO25.

BACKGROUND: Information is vital to cancer patients. Physician-patient communication in oncology presents specific challenges. The aim of this study was to evaluate self-reported information of cancer patients in ambulatory care at a comprehensive cancer centre and examine its possible association with patients' demographic and clinical characteristics. PATIENTS AND METHODS: This study included adult patients with solid tumours undergoing chemotherapy at the Institute Jules Bordet's Day Hospital over a ten-day period. EORTC QLQ-C30 and QLQ-INFO25 questionnaires were administered. Demographic and clinical data were collected. Descriptive and inferential statistics were used. RESULTS: 101 (99%) fully completed the questionnaires. They were mostly Belgian (74.3%), female (78.2%), with a mean age of 56.9 ± 12.8 years. The most frequent tumour was breast cancer (58.4%). Patients were well-informed about the disease and treatments, but presented unmet information domains. The Jules Bordet patients desired more information on treatment side effects, long-term outcome, nutrition, and recurrence symptoms. Patients on clinical trials reported having received less information about their disease and less written information than patients outside clinical trials. Higher information levels were associated with higher quality of life (QoL) scores and higher patient satisfaction. CONCLUSION: Patients were satisfied with the information they received and this correlated with higher QoL, but they still expressed unmet information wishes. Additional studies are required to investigate the quality of the information received by patients enrolled in clinical trials.

Bacillary prostatitis after intravesical immunotherapy: a rare adverse effect.

Nowadays, the most efficient form of intravesical immunotherapy for superficial transitional cell carcinoma of the urinary bladder is the instillation of bacillus Calmette-Guérin (BCG), proceeding from an attenuated strain of Mycobacterium bovis. In up to 40% of cases, its instillation is associated with significantly elevated prostate-specific antigen (PSA) levels. In these cases, prostate biopsy should be withheld for 3 months and PSA should be monitored. Bacillary prostatitis is a rare occurrence in patients treated with intravesical BCG immunotherapy. Although symptomatic bacillary prostatitis is even rarer, it is the worst type of this condition. The aims of this study are to report a case of bacillary prostatitis as a rare adverse effect of intravesical BCG immunotherapy and to make a theoretical review about how to manage this complication. A 58-year-old man, former smoker, underwent a transurethral resection of the bladder in February 2004 because of a papillary transitional cell carcinoma of the bladder (pT1G2N0M0). After surgery, BCG instillation therapy was given in a total of 15 instillations, the last one in March 2007. In the last 3 months of therapy, until May 2007, a progressive increase in his PSA level was registered, and he underwent a prostate biopsy revealing granulomatous prostatitis of bacillary etiology. The semen culture was positive for M. bovis. After 3 months of a two-drug (isoniazid and rifampin) antituberculous regimen, the semen culture became negative and the PSA level decreased. The early identification of intravesical BCG immunotherapy complications allows their effective treatment. However, when a histological diagnosis of asymptomatic granulomatous prostatitis is made, the execution and type of treatment are controversial.

[Head and neck cancer: health related quality of life assessment considering clinical and epidemiological perspectives]. / Oncologia de Cabeça e Pescoço: enquadramento epidemiológico e clínico na avaliação da Qualidade de Vida Relacionada com a Saúde.

The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

Oncologia de Cabeça e Pescoço: enquadramento epidemiológico e clínico na avaliação da Qualidade de Vida Relacionada com a Saúde / Head and Neck Cancer: Health Related Quality of Life Assessment considering clinical and epidemiological perspectives

A importância das doenças oncológicas como causa de morbilidade e mortalidade está em crescimento, sendo reconhecido o seu impacto social e peso global pelos custos económicos e sociais envolvidos na sua prevenção, tratamento e reabilitação. As patologias oncológicas de cabeça e pescoço representam um dos seis tumores malignos mais prevalentes em todo o mundo, com um valor estimado de 900.000 novos casos diagnosticados anualmente em escala mundial. Estes doentes oncológicos apresentam deterioração de funções básicas que, quando percepcionadas, têm impacto negativo na sua Qualidade de Vida. Um registo oncológico adequado permite uma análise mais rigorosa dos resultados obtidos na avaliação da Qualidade de Vida Relacionada com a Saúde. Este estudo incluiu 380 doentes oncológicos de cabeça e pescoço e demonstra que as mulheres apresentam resultados de Qualidade de Vida globalmente inferiores. Salienta-se ainda a importância do diagnóstico precoce em oncologia, que se relaciona frequentemente com melhores scores e conclui-se que a localização do tumor tem impacto sobre a autopercepção de Qualidade de Vida. Os valores de Qualidade de Vida Relacionada com a Saúde devem ser interpretados à luz das variáveis sociodemográficas e clínicas, para melhor se avaliar a Patologia Oncológica de Cabeça e Pescoço numa perspectiva epidemiológica no sentido de melhor compreender o processo saúde - doença.

The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.

Serum homocysteine concentrations in Portuguese young adults reference interval.

INTRODUCTION AND OBJECTIVES: Hyperhomocysteinemia has been shown to be an independent risk factor for cardiovascular disease. Assessing the reference intervals for homocysteine among young adults is a critical step in the process of preventing cardiovascular diseases later in life. This study aimed to identify reference intervals for total serum homocysteine concentration in young adults. METHODS: The sample was composed of 469 (74.4% female) young adults (mean age 20.4 ± 2.1) who participated in an ongoing longitudinal study of apparently healthy undergraduate students registered in different academic years and different scientific areas in a Portuguese University, and coming from all regions of the country. Total homocysteine concentrations were determined and the data were analyzed employing the Hoffmann approach. This approach method has been widely used to evaluate reference intervals for various analytical parameters. Reference intervals (5th and 95th percentiles) for the total homocysteine concentration were first estimated by gender and since male and female reference intervals were similar, one reference interval for total homocysteine was estimated irrespective of gender. RESULTS: Reference intervals showed to be similar for both genders. The reference range, for homocysteine in young Portuguese adults, was 6.2-11.6 µmol/l, regardless of gender. Above 11.6 µmol/l surveillance should be considered in young adults. CONCLUSIONS: This is the first known study providing reference intervals for total homocysteine in young adults, based on a sample of Portuguese university students. The identification of a reference interval for total serum homocysteine concentration at these ages may help to identify those with a higher cardiovascular disease risk. Values above 11.6 µmol/L should lead physician concern and surveillance in adulthood.

Impact of academic exposure on health status of university students / Impacto da exposição académica no estado de saúde de estudantes universitários / Impacto de la exposición académica en el estado de salud de estudiantes universitarios

OBJETIVO: Avaliar a influência da vida académica na saúde de estudantes universitários. MÉTODOS: Estudo longitudinal envolvendo 154 estudantes de graduação da Universidade de Aveiro, Portugal, por pelo menos dois anos de acompanhamento. Características sociodemográficas e comportamentais foram recordados, por meio de questionários. Foram medidos peso, altura, pressão arterial, glicemia, perfil lipídico e os níveis séricos de homocisteína dos alunos. Foi realizada análise de regressão com modelos lineares mistos considerando as medidas repetidas de cada sujeito. RESULTADOS: Estudantes expostos à vida académica, quando comparados àqueles de ingresso recente à universidade apresentaram proporção mais elevada de dislipidemia (44,0 por cento versus 28,6 por cento), sobrepeso (16,3 por cento versus 12,5 por cento) e tabagismo (19,3 por cento versus 0,0 por cento). No geral, foi observada alta proporção de sedentarismo (cerca de 80 por cento). O colesterol total, lipoproteína de alta densidade, triglicérides, pressão arterial sistólica e níveis de atividade física apresentaram associação significativa com o género (p < 0,001). A exposição académica apresentou-se associada com o aumento dos níveis das lipoproteínas de baixa densidade (cerca de 1,12 vezes), e marginalmente com os níveis de colesterol total (p = 0,041). CONCLUSÕES: Nem o alto nível de instrução parece ter papel protetor na adoção de estilo de vida saudável, tampouco o envolvimento com áreas de saúde muda o comportamento dos estudantes. Altas proporções de fatores de risco para doenças não-transmissíveis em jovens universitários podem afetar seu bem-estar. Os resultados podem servir de apoio às universidades no desenvolvimento de programas de prevenção e promoção da saúde.

OBJECTIVE: To assess the impact of academic life on health status of university students.METHODS: Longitudinal study including 154 undergraduate students from the Universidade de Aveiro, Portugal, with at least two years of follow-up observations. Sociodemographic and behavioral characteristics were collected using questionnaires. Students' weight, height, blood pressure, serum glucose, serum lipids and serum homocysteine levels were measured. Regression analysis was performed using linear mixed-effect models, allowing for random effects at the participant level.RESULTS: A higher rate of dyslipidemia (44.0% vs. 28.6%), overweight (16.3% vs. 12.5%) and smoking (19.3% vs. 0.0%) was found among students exposed to the academic life when compared to freshmen. Physical inactivity was about 80%. Total cholesterol, high density lipoprotein-cholesterol (HDL-C), triglycerides, systolic blood pressure, and physical activity levels were significantly associated with gender (p<0.001). Academic exposure was associated with increased low density lipoprotein-cholesterol (LDL-C) levels (about 1.12 times), and marginally with total cholesterol levels (p=0.041).CONCLUSIONS: High education level does not seem to have a protective effect favoring a healthier lifestyle and being enrolled in health-related areas does not seem either to positively affect students' behaviors. Increased risk factors for non-transmissible diseases in university students raise concerns about their well-being. These results should support the implementation of health promotion and prevention programs at universities.

OBJETIVO: Evaluar la influencia de la vida académica en la salud de estudiantes universitarios. MÉTODOS: Estudio longitudinal involucrando 154 estudiantes de pregrado de la Universidad de Aveiro, Portugal, por al menos dos años de acompañamiento. Características sociodemográficas y de comportamiento fueron recordados, por medio de cuestionarios. Se midieron peso, altura, presión arterial, glicemia, perfil lipídico y los niveles séricos de homocisteína de los alumnos. Se realizó análisis de regresión con modelos lineares mixtos considerando las medidas repetidas de cada sujeto.RESULTADOS: Estudiantes expuestos a la vida académica, al compararlos con aquellos de ingreso reciente a la universidad presentaron proporción más elevado de dislipidemia (44,0% versus 28,6%), sobrepeso (16,3% versus 12,5%) y tabaquismo (19,3% versus 0,0%). En general, se observó alta proporción de sedentarismo (cerca de 80%). El colesterol total, lipoproteína de alta densidad, triglicéridos, presión arterial sistólica y niveles de actividad física presentaron asociación significativa con el género (p<0,001). La exposición académica se presentó asociada con el aumento de los niveles de las lipoproteínas de baja densidad (cerca de 1,12 veces), y marginalmente con los niveles de colesterol total (p=0,041). CONCLUSIONES: Ni el alto nivel de instrucción parece tener un papel protector en la adopción de estilo de vida saludable, tampoco el involucrarse con áreas de salud cambia el comportamiento de los estudiantes. Altas proporciones de factores de riesgo para enfermedades no transmisibles en jóvenes universitarios pueden afectar su bienestar. Los resultados pueden servir de apoyo a las universidades en el desarrollo de programas de prevención y promoción de la salud.

Impact of academic exposure on health status of university students.

OBJECTIVE: To assess the impact of academic life on health status of university students. METHODS: Longitudinal study including 154 undergraduate students from the Universidade de Aveiro, Portugal, with at least two years of follow-up observations. Sociodemographic and behavioral characteristics were collected using questionnaires. Students' weight, height, blood pressure, serum glucose, serum lipids and serum homocysteine levels were measured. Regression analysis was performed using linear mixed-effect models, allowing for random effects at the participant level. RESULTS: A higher rate of dyslipidemia (44.0% vs. 28.6%), overweight (16.3% vs. 12.5%) and smoking (19.3% vs. 0.0%) was found among students exposed to the academic life when compared to freshmen. Physical inactivity was about 80%. Total cholesterol, high density lipoprotein-cholesterol (HDL-C), triglycerides, systolic blood pressure, and physical activity levels were significantly associated with gender (p<0.001). Academic exposure was associated with increased low density lipoprotein-cholesterol (LDL-C) levels (about 1.12 times), and marginally with total cholesterol levels (p = 0.041). CONCLUSIONS: High education level does not seem to have a protective effect favoring a healthier lifestyle and being enrolled in health-related areas does not seem either to positively affect students' behaviors. Increased risk factors for non-transmissible diseases in university students raise concerns about their well-being. These results should support the implementation of health promotion and prevention programs at universities.

[Computer-based quality-of-life monitoring in head and neck cancer patients: a validation model using the EORTC-QLQ C30 and EORTC- H&N35 Portuguese PC-software version]. / Avaliação da qualidade de vida em doentes com patologia oncológica da cabeça e pescoço: modelo de validação da versão electrónica Portuguesa do EORTC-QLQ C30 e EORTC- H&N35.

Quality of Life is a distinct and important emerging health focus, guiding practice and research. The routine Quality of Life evaluation in clinical, economic, and epidemiological studies and in medical practice promises a better Quality of Life and improved health resources optimization. The use of information technology and a Knowledge Management System related to Quality of Life assessment is essential to routine clinical evaluation and can define a clinical research methodology that is more efficient and better organized. In this paper, a Validation Model using the Quality of Life informatics platform is presented. Portuguese PC-software using European Organization for Research and Treatment of Cancer questionnaires (EORTC-QLQ C30 and EORTC-H&N35), is compared with the original paper-pen approach in the Quality of Life monitoring of head and neck cancer patients. The Quality of Life informatics platform was designed specifically for this study with a simple and intuitive interface that ensures confidentiality while providing Quality of Life evaluation for all cancer patients. For the Validation Model, the sample selection was random. Fifty-four head and neck cancer patients completed 216 questionnaires (108 using the informatics platform and 108 using the original paper-pen approach) with a one-hour interval in between. Patient preferences and computer experience were registered. Quality of Life informatics platform showed high usability as a user-friendly tool. This informatics platform allows data collection by auto-reply, database construction, and statistical data analysis and also facilitates the automatic listing of the questionnaires. When comparing the approaches (Wilcoxon test by item, percentile distribution and Cronbach's alpha), most of the responses were similar. Most of the patients (53.6%) reported a preference for the software version. The Quality of Life informatics platform has revealed to be a powerful and effective tool, allowing a real time analysis of Quality of Life data. Computer-based quality-of-life monitoring in head and neck cancer patients is essential to get clinically meaningful data that can support clinical decisions, identify potential needs, and support a stepped-care model. This represents a fundamental step for routine Quality of Life implementation in the Oncology Portuguese Institute (IPO-Porto), ORL and C&P department services clinical practice. Finally, we propose a diagram of diagnostic performance, considerating the generalized lack of mycological diagnosis in Portugal, which emphasizes the need for a careful history, focused on quantifying the latency period.

Safety and resource utilization by non-small cell lung cancer histology: results from the randomized phase III study of pemetrexed plus cisplatin versus gemcitabine plus cisplatin in chemonaïve patients with advanced non-small cell lung cancer.

INTRODUCTION: A prespecified analysis of the large, randomized, phase III study in advanced non-small cell lung cancer showed significant improvement in survival for nonsquamous patients treated with pemetrexed/cisplatin versus gemcitabine/cisplatin. Selected grade 3/4 toxicities and resource utilization favored pemetrexed in the overall population, but detailed safety results by histology have not been reported. METHODS: Treated patients were included in this analysis of safety by histology. At each cycle, adverse events were assessed, and concomitant medications, transfusions, and hospitalizations were recorded. Measures were summarized by histology and compared between arms with Fisher's exact test. RESULTS: When analyzed by squamous and nonsquamous histology, safety and resource utilization for each treatment arm paralleled those of the overall population. Selected toxicities did not vary by histology. Concomitant medication use and hospitalizations were also very similar to the patterns observed in the overall population. CONCLUSIONS: Although previous efficacy analyses showed a significant pemetrexed treatment advantage for nonsquamous patients, results of this analysis indicate that safety and resource utilization do not vary by histology and are consistent with the overall population. The safety and resource utilization of patients treated with pemetrexed/cisplatin are predictable, reproducible, and consistent with the established favorable safety profile of pemetrexed, regardless of histology.

[Characterization of oncological disease: racional, objectives and methodology - perfil study]. / Perfil da doença oncológica em Portugal racional, objectivos e metodologia - estudo perfil.

Oncologic disease is one of the main causes of death in Portugal, as well as a high morbidity rate. Over the past few years, these diseases have been targeted with several strategies which aims at optimizing the use of available therapeutic and diagnostic options. Nevertheless, the amount of quantitative information available regarding the disease, patient profile, and treatment and monitoring practices is very low. In order to optimise the implementation of health policies specifically directed at oncologic diseases reliable and up-to-date information is needed, permitting optimisation and balancing of costs and benefits. The PERFIL national epidemiologic study is a multi-centre, retrospective cohort study which aims at evaluating the clinical practice regarding treatment of 6 neoplasias -colorectal, gastric, breast, prostate, lung, and lymphoma, in Portugal, between 2003 and 2007. This study is based upon data collection from the clinical files of patients being followed in the participating centres from 2003 to 2007. Qualitative evaluation (diagnosis and stage) was collected from the clinical records of all patients seen in each participating centre on a given month in each year from 2003 to 2007. The characterization of both patient profile and treatment and monitoring patterns will be based on a far-reaching analysis of 10,000 of those files, selected in a random and stratified sampling. This article describes the PERFIL study rationale, its objectives, and methodology.

Risk factors for cardiovascular disease in a Portuguese university population.

OBJECTIVE: To characterize the distribution of risk factors for cardiovascular disease among university students, through calculating the prevalence of hypercholesterolemia, hyperhomocysteinemia, hyperglycemia, hypertension, overweight, and sedentarism, as well as nutrient intake. METHODS: Cross-sectional study in a random stratified sample of 378 students from Aveiro University in the 2005/2006 academic year. Lifestyle questionnaires were completed on dietary habits and physical activity. The following were assessed: anthropometric measures, blood pressure, lipids, glycemia and homocysteine. Homocysteine was measured in 32 (25.2%) males and 95 (74.8%) females. RESULTS: A high prevalence of sedentarism was found (0.55, 95% CI: 0.50 to 0.60). The prevalence of overweight was 12.2% (0.122, 95% CI: 0.09 to 0.16) and of obesity 3.2% (0.032, 95% CI: 0.02 to 0.06). Hypercholesterolemia was found in 17.7% (0.177, 95% CI, 0.14 to 0.2) of the students and hypertension in 13.7% of males and 3.5% of females (p<0.001). High levels of homocysteine were found in 15.6% of males. The prevalence of hypercholesterolemia among health sciences students was higher than in technical and natural sciences (20.2% vs. 13.7%). Human and social sciences was the area with the highest prevalence of risk factors for non-communicable diseases (NCDs) (38.1%). DISCUSSION AND CONCLUSIONS: The high prevalence of risk factors for NCDs in higher education highlights the need for nutritional and health promotion programs, emphasizing the harmful effects of sedentary behavior. Longitudinal study of this cohort will enable analysis of the impact of such behavior in early life on subsequent development of health problems.