Palliative care among elderly cancer patients: Own experience.

BACKGROUND: Annually, more than 27,000 persons die of cancer in the Czech Republic. It is known that in addition to the demographic aging of the Czech population, the cancer burden is increased. AIM: These data clearly demonstrate the need for affordable and good follow-up care for patients, especially for older patients and/or patients with no other cancer treatment due to irreversible progression of tumor. MATERIALS AND METHODS: We are talking about so-called palliative cancer care, which can be provided at different levels. One of the most common forms of palliative cancer care is hospice care. RESULTS: Our clinic in the years 2008-2010 received a total of 446 patients. 288 of them were women and 158 men. The average age of women was 61 years (age range 20-81 years). The average age of men was 56 years (age range 18-96 years). The performance status was in the fitness category PS-0 (8%), PS-1 (54%), PS-2 (33%) and PS-3 (5%). CONCLUSION: Currently the outpatient palliative cancer care are coming more into the forefront. This type of care allows patients to stay as long as possible at home among their close relatives. Prerequisite for a well working outpatient palliative care is cooperation with general practitioners and home health care agencies.

Artery balloon angioplasty and depression symptoms.

Peripheral arterial occlusive disease (PAOD) as a chronic disease is associated with physical, psychological and social distress for elderly patients and their families. The study has three main aims: 1. to evaluate the occurrence and the relevance of depression symptoms in patients with PAOD, 2. to evaluate the effect of age and Fontaine stage of PAOD on relevance of depression in patients with PAOD, and 3. to evaluate the effect of artery balloon angioplasty (ABA) on occurence and relevance of depression symptoms. The study was prospective and longitudinal. Dates were obtained during year 2006. The total number of subjects with PAOD was 42 (28 males, 14 females). Thirty subjects with PAOD (20 male, 10 female) treated by ABA filled in Zung's scale 3-6 months after ABA (61%). The mean age of all subjects was 65.4 years (aged 45-79). The evaluation of occurrence and relevance of depression was performed with Czech version of Zung self-rating depression scale (ZSRS). The mean Zung self-rating depression score (ZSRDS) certifies the presence of signs of minimum or mildly depression in patients with PAOD. The results proved statistically significant dependence of depression on age and on Fontaine stage of PAOD. Also, the results proved that artery balloon angioplasty has a highly positive effect on occurrence and relevance of depression symptoms. The results had shown the existence of the association between PAOD, depression and ABA.

Nivolumab induced encephalopathy in a man with metastatic renal cell cancer: a case report.

BACKGROUND: Great progress has recently been made in the treatment of metastatic renal cell carcinoma, including the introduction of nivolumab, an immune checkpoint inhibitor. Despite promising results, this treatment brings a completely new spectrum of adverse events, distinct from those experienced with small-molecule kinase inhibitors. Neurologic immune-related adverse events may be serious and potentially life-threatening complications requiring immediate immunosuppressive therapy. Only a few cases of immune-related encephalitis induced by checkpoint inhibitors have been described and the data regarding the management of this serious adverse event are limited. CASE PRESENTATION: We report the case of a 63-year-old white man with metastatic renal cancer who developed severe chorea-like dyskinesia during nivolumab therapy. The findings on brain magnetic resonance imaging and flow cytometry of cerebrospinal fluid, and the positivity of anti-paraneoplastic antigen Ma2 immunoglobuline G class autoantibodies were consistent with a diagnosis of immune-related encephalitis. High-dose intravenous corticosteroid therapy was started immediately, with no signs of improvement, even when infliximab was added. Our patient refused further hospitalization and was discharged. Three weeks later, he presented with signs of severe urosepsis. Despite intensive treatment, he died 4 days after admission. CONCLUSIONS: The management of less frequent immune-related adverse events has not been fully established and more information is required to provide uniform recommendations. Immune-related encephalitis is a severe and potentially fatal complication requiring immediate hospital admission and extensive immunosuppressive therapy. The examination of cerebrospinal fluid for paraneoplastic antibodies, such as anti-N-methyl-D-aspartate receptor and anti-Ma2 antibodies, in order to distinguish autoimmune etiology from other possible causes is essential and highly recommended.

The effect of femoral and popliteal percutaneous transluminal balloon angioplasty on patients' quality of life.

CONTEXT AND OBJECTIVE: Peripheral arterial occlusive disease (PAOD) is a prevalent atherosclerotic disorder characterized by limb pain on exertion, limb loss and a high mortality rate. Because of its chronic nature, it often has a negative impact on patients' quality of life (QOL). This study aimed to assess QOL among patients with PAOD that was treated by endovascular intervention using femoral and popliteal percutaneous transluminal balloon angioplasty (PTBA). DESIGN AND SETTING: This study was local, prospective and longitudinal. It was carried at the Second Department of Internal Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. METHODS: Thirty PAOD patients (20 male and 10 female) were treated by endovascular intervention using femoral and popliteal PTBA. The Czech version of the international generic European Quality of Life Questionnaire (EQ-5D) was applied. RESULTS: The statistical evaluation demonstrated that QOL presented highly significant statistical dependence on femoral and popliteal PTBA (p < 0.0001). CONCLUSION: The results showed that femoral and popliteal PTBA had a highly positive effect on the QOL of patients with PAOD.

Psychosocial, health and demographic characteristics of quality of life among patients with acute myeloid leukemia and malignant lymphoma who underwent autologous hematopoietic stem cell transplantation.

CONTEXT AND OBJECTIVE: This study evaluated the effect of selected psychosocial, health and demographic characteristics of quality of life (QOL) among patients treated with autologous hematopoietic stem cell transplantation (HSCT). DESIGN AND SETTING: This was a retrospective study at Charles University Hospital, Hradec Kralove. METHODS: The Czech version of the international generic European Quality-of-Life questionnaire (EQ-5D) was applied to evaluate QOL among patients with acute myeloid leukemia (AML) and malignant Hodgkins and non-Hodgkins lymphoma (ML). The total number of respondents was 36: 12 with AML (seven males and five females) and 24 with ML (11 males and 13 females). The mean age of AML respondents was 46 years and the mean age of ML respondents was 44.5 years. RESULTS: Age, smoking status and education level had statistically significant effects on QOL among AML respondents (p < 0.05), and age had a statistically significant effect on QOL among ML respondents (p < 0.05). The overall QOL among AML and ML respondents was generally good: the mean EQ-5D score among AML respondents was 71.5% and among ML respondents it was 82.7%. CONCLUSION: The QOL among AML and ML respondents treated with autologous HSCT was good. However, patients more than 50 years old, smokers and patients with lower education levels presented worse QOL. These findings need to be better evaluated in longitudinal studies, using large samples.

Quality of life in adult patients treated with peripheral blood progenitor cell transplantation: the effect of selected psychosocial, demographics and health aspects on quality of life: a retrospective analysis.

AIM: this retrospective study analyses the effect of selected psychosocial, demographics and health aspects on quality of life (QoL) in adult patients treated with peripheral blood progenitor cell transplantation (PBPCT). PATIENTS AND METHODS: The total number of respondents treated with PBPCT between the years 2001-2003 was 95. The return rate of QoL questionnaires was 72.1 % (71 respondents). There were 100 % ratable QoL questionnaire. The average age of all respondents was 55.5 years old. The Czech version of an international generic European Quality of Life Questionnaire - Version EQ-5D was used. The effect of selected aspects on QoL of patients was determined by analysis of variance. The QoL questionnaires were evaluated with descriptive analysis. RESULTS: The above-mentioned aspects proved statistically significant dependence of QoL (EQ-5D score - QoL dimensions, EQ-5D VAS - subjective health condition) on age, increasing number of associated diseases, religion and type of disease. The effect of other aspects on QoL was not proven statistically significant. The QoL in adult patients treated with PBPCT declines with increasing age and with the increasing number of associated diseases. People of faith have a higher level of QoL than non-believers. Patients with multiple myeloma treated with PBPCT have the most low QoL. CONCLUSION: The global QoL in an adult patients treated with PBPCT is on a good level.

Effect of Depressive Mood on NK Cells in Patients with Pancreatic Tumor – Pilot Study.

Aims: In up to 50% of cases is pancreatic cancer accompanied with depressive symptoms or already developed depression. There is well described connection between pancreatic cancer and qualitative changes in immune system. The purpose of this pilot study was to observe the quantitative changes in levels of NK cells and the state of expression of activation and inhibitory receptors on the surface of NK cells in the peripheral blood of patients with pancreatic tumor. Study Design: This is prospective analytical study. Place and Duration of Study: The study was carried out between December 2010 and April 2011 at the University Hospital Hradec Králové, Czech Republic. Methodology: Twenty-one patients with locally advanced or metastatic adenocarcinoma of the pancreas were divided into two groups based on the presence of depressive symptoms. The control group consisted of healthy volunteers. The presence of depressive symptoms was assessed by the Zung self-rating depression and psychiatric examination. Measurement and analysis of peripheral venous blood was performed by flow cytometry to estimate quantitative changes in NK cells. The statistical significance was considered as p < .05. Results: There was reduced number of CD56brightCD16- subset (P = .01), decreased levels of NKp46 positive NK cells in patients with pancreatic cancer and depressive symptoms (P = .03), but without statistical significant for patient without depression (P = .054). We found decreased number of NKG2A-positive circulating NK cells in patients without depressive symptoms in comparison to control group (P = .05). No differences in NK cells, its subsets and receptors were observed when comparing each group of patients with each other. Conclusion: The main immunomodulating factor in the case of NK cells in pancreatic cancer is the tumor itself. This is valid particularly for reduced levels of NK cell activation receptors. The presence of chronic stress or depression plays its role in affecting the number and distribution of NK cells and might play an important role in tumor escape mechanism.

Quality of life and depression among metastatic breast cancer patients.

Depression is seen in many cancer patients. It is common in the general population and in adults and children with cancer and frequently coexists with anxiety and pain. The pilot study evaluated the level of the global quality of life (QoL) and the incidence and the relevance of the depression among metastatic breast cancer patients in a programme of palliative cancer care. The study is prospective and cross-sectional. Dates were obtained during year 2008 among 41 patients. The mean age of all 41 subjects was 58 years old (aged 41-80 years old). The Czech version of Zung self-rating depression scale was performed for the evaluation of the depression. The Czech version of generic European Quality of Life Questionnaire EQ-5D was performed for the evaluation of the level of global QoL. The statistical evaluation presents that mean ZSDS (Zung self-rating depression score) certifies the presence of the signs of the moderate depression among metastatic breast cancer patients (ZSDS range was 60-69). The incidence of the depression was 61% (25 of all 41 subjects). The relevance of the depression is characterized: the severe depression was proved in five of all 25 subjects, the moderate depression in 10 of all 25 subjects, and the mild depression in 10 of all 25 subjects. The global QoL among metastatic breast cancer patients is on very low level. The mean EQ-5D score (dimension of QoL) was 55%. The mean EQ-5D VAS (subjective health status) was 59.2%. The results showed that subsist association between metastatic breast cancer, depression, and the low level of the global QoL.

Moral judgement competence and moral attitudes of medical students.

A cross-sectional study explored the moral judgement competence and moral attitudes of 310 Czech and Slovak and 70 foreign national students at the Medical Faculty of Charles University in Hradec Králové, Czech Republic. Lind's Moral Judgement Test was used to evaluate moral judgement competence and moral attitudes depending on factors such as age, number of semesters of study, sex, nationality and religion. Moral judgement competence decreased significantly in the Czech and Slovak medical students as they grew older; in medical students from other countries it did not significantly increase. The influence of other factors (sex, nationality and religion) on moral judgement competence was not proven in either the Czech and Slovak or the foreign national medical students. Moral attitudes do not change; the Czech and Slovak as well as the foreign students preferred the post-conventional levels of moral judgement (Kohlberg's 5th and 6th stages). The fact that the Czech and Slovak students' moral judgement competence decreased with age and number of semesters of study completed is not an optimistic sign: medical students who had undergone a lower number of semesters of study were morally more competent.

The effect of femoral and popliteal percutaneous transluminal balloon angioplasty on patients' quality of life

CONTEXT AND OBJECTIVE: Peripheral arterial occlusive disease (PAOD) is a prevalent atherosclerotic disorder characterized by limb pain on exertion, limb loss and a high mortality rate. Because of its chronic nature, it often has a negative impact on patients' quality of life (QOL). This study aimed to assess QOL among patients with PAOD that was treated by endovascular intervention using femoral and popliteal percutaneous transluminal balloon angioplasty (PTBA). DESIGN AND SETTING: This study was local, prospective and longitudinal. It was carried at the Second Department of Internal Medicine of Charles University Hospital in Hradec Kralove, Czech Republic. METHODS: Thirty PAOD patients (20 male and 10 female) were treated by endovascular intervention using femoral and popliteal PTBA. The Czech version of the international generic European Quality of Life Questionnaire (EQ-5D) was applied. RESULTS: The statistical evaluation demonstrated that QOL presented highly significant statistical dependence on femoral and popliteal PTBA (p < 0.0001). CONCLUSION: The results showed that femoral and popliteal PTBA had a highly positive effect on the QOL of patients with PAOD.

CONTEXTO E OBJETIVO: Doença arterial oclusiva periférica (DAOP) é uma desordem aterosclerótica prevalente, caracterizada por dor esforço do membro, perda do membro e alta taxa de mortalidade. Devido à sua natureza crônica, freqüentemente tem impacto negativo na qualidade de vida (QV) dos pacientes. Este estudo objetivou avaliar a QV entre pacientes com DAOP tratada por intervenção endovascular usando angioplastia com balão transluminal femoral e poplítea (ABT). TIPO DE ESTUDO E LOCAL: Este estudo local, prospectivo e longitudinal foi realizado no Segundo Departamento de Medicina Interna do Charles University Hospital em Hradec Kralove, República Checa. MÉTODOS: 30 pacientes com DAOP (20 homens) foram tratados por intervenção endovascular usando ABT femoral e poplítea. A versão checa do Questionário Europeu de Qualidade de Vida (EQ-5D) foi aplicada. RESULTADOS: A avaliação estatística demonstrou que a QV apresentou dependência altamente significativa da ABT femoral e poplítea (p < 0,0001). CONCLUSÃO: Os resultados mostraram que a ABT femoral e poplítea teve efeito altamente positivo na QV dos pacientes com DAOP.

Psychosocial, health and demographic characteristics of quality of life among patients with acute myeloid leukemia and malignant lymphoma who underwent autologous hematopoietic stem cell transplantation

CONTEXT AND OBJECTIVE: This study evaluated the effect of selected psychosocial, health and demographic characteristics of quality of life (QOL) among patients treated with autologous hematopoietic stem cell transplantation (HSCT). DESIGN AND SETTING: This was a retrospective study at Charles University Hospital, Hradec Kralove. METHODS: The Czech version of the international generic European Quality-of-Life questionnaire (EQ-5D) was applied to evaluate QOL among patients with acute myeloid leukemia (AML) and malignant Hodgkin’s and non-Hodgkin’s lymphoma (ML). The total number of respondents was 36: 12 with AML (seven males and five females) and 24 with ML (11 males and 13 females). The mean age of AML respondents was 46 years and the mean age of ML respondents was 44.5 years. RESULTS: Age, smoking status and education level had statistically significant effects on QOL among AML respondents (p < 0.05), and age had a statistically significant effect on QOL among ML respondents (p < 0.05). The overall QOL among AML and ML respondents was generally good: the mean EQ-5D score among AML respondents was 71.5 percent and among ML respondents it was 82.7 percent. CONCLUSION: The QOL among AML and ML respondents treated with autologous HSCT was good. However, patients more than 50 years old, smokers and patients with lower education levels presented worse QOL. These findings need to be better evaluated in longitudinal studies, using large samples.

CONTEXTO E OBJETIVO: O transplante de células tronco hematopoiéticas (TCTH) é um método a ser utilizado na terapêutica das doenças hemato-oncológicas e tumores sólidos, assim como no tratamento de doenças não-malignas. O TCTH tem influência na evolução da doença e na qualidade de vida do doente, assim como outros métodos curativos. TIPO ESTUDO E LOCAL: Este estudo é retrospectivo. Foi desenvolvido no Departamento Clínico de Hematologia do 2º Departamento de Medicina Interna do Hospital da Universidade de Charles em Hradec Kralove, República Checa. MÉTODOS: Amostra de 36 adultos sujeitos ao tratamento com transplante autólogo de células tronco do progenitor, sendo 12 com leucemia mielóide aguda: sete homens e cinco mulheres, e 24 com linfoma maligno: 11 homens e 13 mulheres. Foi utilizada a versão checa do questionário internacional de qualidade de vida européia versão EQ - 5D. RESULTADOS: Houve associação estastiticamente significante entre qualidade de vida e idade, fumantes, pacientes com baixo nível educacional em ambos os sujeitos com leucemia mielóide aguda (p < 0.05). Houve associacão estatisticamente significante entre qualidade de vida e idade em ambos os sujeitos com linfoma maligno (p < 0.05). CONCLUSÃO: A qualidade de vida dos pacientes com linfoma maligno e leucemia mielóide aguda, submetidos a transplante autólogo do progenitor, mantém-se preservada na maioria dos pacientes. Pacientes com idade acima de 50 anos, baixo nível educacional e fumantes têm pior qualidade de vida. Estes fatores devem ser melhor avaliados em estudos longitudinais e com amostras maiores.