Assessment of procedure related anxiety and depression in oncologic patients before F-18 FDG PET-CT imaging

Background: The aim of this study was to study objectively the level of anxiety and depression in patients undergoing positron emission tomography-computed tomography (PET-CT).One hundred and forty four oncologic out-patients (76 male, 68 female) were included in this study. Methods: All patients were referred to Nuclear Medicine Department for Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET-CT imaging for the assessment of their malignant or possibly malignant diseases. The Hospital Anxiety Depression Scale and the State and Trait Anxiety Inventory I and II were used to evaluate the anxiety and depression levels in these patients. Results: The mean anxiety and depression scores of The Hospital Anxiety Depression Scale prior to F-18 FDG PET-CT were 9.2 ( ± 3.8) and 6.6 ( ± 3.4), respectively. The mean state and trait anxiety scores of the State and Trait Anxiety Inventory I and II prior to F-18 FDG PET-CT were 40.4 (± 8.5) and 46.62 ± 7.8, respectively. The Hospital Anxiety Depression Scale and the State and Trait Anxiety Inventory I and II anxiety scores were found to be significantly higher in female patients, smokers and in patients with higher stage disease. Conclusion: Our results suggest that F-18 FDG PET-CT imaging may at least contribute to patient's baseline anxiety which is already generated by being an oncology patient, and thus nuclear medicine physicians should handle the patients with extra care to minimize this affect. © 2015, Umut Elboga, et al

Long-term survival with transarterial chemoembolization and radioembolization in a patient with cancers of unknown primary

Gokmen Aktas,1 Tulay Kus,2 Taylan Metin,3 Selim Kervancioglu,4 Umut Elboga5 1Department of Internal Medicine, Division of Medical Oncology, School of Medicine, University of Kahramanmaras Sutcu Imam, Kahramanmaraş, Turkey; 2Division of Medical Oncology, Adiyaman Training and Research Hospital, Adiyaman, Turkey; 3Department of Internal Medicine, School of Medicine, Gaziantep Oncology Hospital, University of Gaziantep, Gaziantep, Turkey; 4Department of Radiology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey; 5Department of Nuclear Medicine, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey Abstract: Cancers of unknown primary (CUP) are histologically proven metastatic malignant tumors without an identified primary site before treatment. The common characteristics are early dissemination, lower response to chemotherapy and poor prognosis with short life expectancy. Treatment was directed according to the presence of localized or disseminated disease. The most frequent site of metastasis is the liver, which is a suitable target organ for arterial-directed therapies. We report a case of 53-year-old woman who was diagnosed with CUP and suspected with intracellular cholangiocellular carcinoma (ICC), presented with a very large, unresectable, chemotherapy-refractory hepatic mass and treated with transarterial chemoembolization and transarterial radioembolization and surprisingly followed for 48 months with minimally progressive and stable disease. Arterial-directed therapies, an important therapeutic option in unresectable liver tumors, can provide survival benefit even for ICC and CUP which are very large in size. Keywords: cancers of unknown primary, TACE, TAR

Effect of short term thyroxin withdrawal on health related quality of life in differentiated thyroid carcinoma patients

Background: We aimed to study the HRQL in patients with differentiated thyroid carcinoma (DTC) during hypothyroidism due to thyroxin withdrawal, which is induced routinely for iodine-131 (I-131) whole body scan and ablative treatment. Methods: Between September 2011 and March 2012, eligible patients with DTC who were referred to our institution for diagnostic or therapeutic radioiodine administration under hypothyroid conditions due to thyroid hormone withdrawal were asked to complete the psychological instruments rating their HRQL and psychological status. HRQL was studied using the Short Form (SF-36), Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), the total mood disturbance (TMD) score, Beck Depression Inventory (BDI).One hundred and forty three hypothyroid patients with DTC (F=101, M=42, age=58.7 yrs) who were also on low-iodine diet were included in this study. Hypothyroidism was induced by withdrawal of thyroxin replacement in all patients. Results: The results of SF-36 showed that the HRQL was significantly impaired in hypothyroid patients during withdrawal of thyroxin (physical component scale: 44.3 ± 9.5, mental component scale: 40.8 ± 10.2, p ? 0.001). Depression scores were in the normal or non-clinically relevant range: 4.1 ± 3.8 on the HADS-Depression and 8.3 ± 6.6 on the Beck Depression Index. However, the mean score of 28.8 ± 25.2 on the POMS TMD was within normal range. Conclusion: HRQL is impaired in hypothyroid patients with DTC during thyroxine withdrawal before I-131 whole body scan and radioiodine therapy. © 2015 Elboga U, et al