Current whole-body MRI applications in the neurofibromatoses

ObjectivesThe Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration Whole-Body MRI (WB-MRI) Working Group reviewed the existing literature on WB-MRI, an emerging technology for assessing disease in patients with neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN), to recommend optimal image acquisition and analysis methods to enable WB-MRI as an endpoint in NF clinical trials.MethodsA systematic process was used to review all published data about WB-MRI in NF syndromes to assess diagnostic accuracy, feasibility and reproducibility, and data about specific techniques for assessment of tumor burden, characterization of neoplasms, and response to therapy.ResultsWB-MRI at 1.5T or 3.0T is feasible for image acquisition. Short tau inversion recovery (STIR) sequence is used in all investigations to date, suggesting consensus about the utility of this sequence for detection of WB tumor burden in people with NF. There are insufficient data to support a consensus statement about the optimal imaging planes (axial vs coronal) or 2D vs 3D approaches. Functional imaging, although used in some NF studies, has not been systematically applied or evaluated. There are no comparative studies between regional vs WB-MRI or evaluations of WB-MRI reproducibility.ConclusionsWB-MRI is feasible for identifying tumors using both 1.5T and 3.0T systems. The STIR sequence is a core sequence. Additional investigation is needed to define the optimal approach for volumetric analysis, the reproducibility of WB-MRI in NF, and the diagnostic performance of WB-MRI vs regional MRI

Sleep–wake disturbances in cancer patients: narrative review of literature focusing on improving quality of life outcomes

Suzanne S Dickerson, Laurie M Connors, Ameera Fayad, Grace E Dean School of Nursing, State University of New York, University at Buffalo, NY, USA Purpose: Evidence suggests a high prevalence of sleep–wake disturbances in patients with cancer, occurring at diagnosis, during treatment, and continuing to survivorship. Yet associations between sleep–wake disturbances and the impact on quality of life outcomes is less clear. The purpose of this narrative review of the literature is to evaluate sleep–wake disturbances in patients with cancer, to describe the influence of poor sleep on quality of life as an outcome, and to evaluate the evidence to recommend future interventions. Framework and methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Four databases (CINAHL, MEDLINE, PsycINFO, and Embase) were searched using terms "cancer OR neoplasm", "sleep, sleep disturbance, sleep disorders or insomnia", and "quality of life"; the search included all years, English language, and peer-reviewed articles on research studies. Studies included measurements of sleep and quality of life in cancer patients at a minimum of two time points and demonstrated relationships between sleep and quality of life. Data were collected on date, patient demographics, cancer type and treatment, timeframe, design, measurement, variables, and results. Results: This narrative review demonstrates that sleep–wake disturbance is a major problem/symptom in patients with cancer. Of the 18 studies included, measurement of sleep-related variables included objective and subjective measures; however, direct measurement of the associations between sleep and quality of life was not common. Cognitive behavioral therapy for insomnia and mind–body interventions demonstrated feasibility when implemented into cancer care settings. In addition, the majority of interventions exhibited moderate effectiveness in improving sleep–wake disturbance and quality of life outcomes. Conclusion: The studies predominantly reported that poor sleep negatively impacts quality of life. The intervention studies included nonpharmacologic interventions such as cognitive behavioral treatment and mind–body and exercise interventions with moderate-to-high levels of evidence for improvement in sleep measures and quality of life. Keywords: sleep–wake disturbance, quality of life, cancer, cognitive behavioral therapy, mind-body interventions, insomni