Retrospective Analysis of Emotional Burden and the Need for Support of Patients and Their Informal Caregivers after Palliative Radiation Treatment for Brain Metastases

Cancer burdens not only the patients themselves but also their personal environment. A few studies have already focused on the mental health and personal needs of caregivers of patients. The purpose of this retrospective analysis was to further assess the emotional burden and unmet needs for support of caregivers in a population of brain metastasis patients. In the time period 2013-2020, we identified 42 informal caregivers of their respective patients after palliative radiation treatment for brain metastases. The caregivers completed two standardized questionnaires about different treatment aspects, their emotional burden, and unmet needs for support. Involvement of psycho-oncology and palliative care was examined in a chart review. The majority of the caregivers (71.4%, n = 30) suffered from high emotional burden during cancer treatment of their relatives and showed unmet needs for emotional and psychosocial support, mostly referring to information needs and the involvement in the patient's treatment decisions. Other unmet needs referred to handling personal needs and fears of dealing with the sick cancer patient in terms of practical care tasks and appropriate communication. Palliative care was involved in 30 cases and psycho-oncology in 12 cases. There is a high need for emotional and psychosocial support in informal caregivers of cancer patients. There might still be room for an improvement of psychosocial and psycho-oncological support. Care planning should cater to the emotional burden and unmet needs of informal caregivers as well. Further prospective studies in larger samples should be performed in order to confirm this analysis

Caffeine Impairs Myocardial Blood Flow Response to Physical Exercise in Patients with Coronary Artery Disease as well as in Age-Matched Controls

BACKGROUND: Caffeine is one of the most widely consumed pharmacologically active substances. Its acute effect on myocardial blood flow is widely unknown. Our aim was to assess the acute effect of caffeine in a dose corresponding to two cups of coffee on myocardial blood flow (MBF) in coronary artery disease (CAD). METHODOLOGY/PRINCIPAL FINDINGS: MBF was measured with (15)O-labelled H2O and Positron Emission Tomography (PET) at rest and after supine bicycle exercise in controls (n = 15, mean age 58+/-13 years) and in CAD patients (n = 15, mean age 61+/-9 years). In the latter, regional MBF was assessed in segments subtended by stenotic and remote coronary arteries. All measurements were repeated fifty minutes after oral caffeine ingestion (200 mg). Myocardial perfusion reserve (MPR) was calculated as ratio of MBF during bicycle stress divided by MBF at rest. Resting MBF was not affected by caffeine in both groups. Exercise-induced MBF response decreased significantly after caffeine in controls (2.26+/-0.56 vs. 2.02+/-0.56, P<0.005), remote (2.40+/-0.70 vs. 1.78+/-0.46, P<0.001) and in stenotic segments (1.90+/-0.41 vs. 1.38+/-0.30, P<0.001). Caffeine decreased MPR significantly by 14% in controls (P<0.05 vs. baseline). In CAD patients MPR decreased by 18% (P<0.05 vs. baseline) in remote and by 25% in stenotic segments (P<0.01 vs. baseline). CONCLUSIONS: We conclude that caffeine impairs exercise-induced hyperaemic MBF response in patients with CAD to a greater degree than age-matched controls

Hemodynamics.

<p>DBP = diastolic blood pressure (BP); HR = heart rate; MAP = mean BP; RPP = rate pressure product; SBP = systolic BP.</p><p>P-values are given for the comparison of baseline vs. caffeine.</p

Myocardial Blood Flow, Coronary Resistance and Flow Reserve.

<p>MBF, myocardial blood flow (ml/min/g). Cor Res, coronary resistance (mmHg/ml/min/g). MPR, myocardial perfusion reserve (relative values). Ex, exercise.</p>*<p>P<0.05 for the comparison with remote segments.</p>†<p>P<0.05 for the comparison with age-matched controls.</p

Coronary resistance during physical exercise.

<p>Coronary resistance at exercise increased in all groups. A massive increase in resistance was found in stenotic segments. ‡<i>P</i><0.05 for the comparison versus remote. *<i>P</i><0.05 for the comparison versus remote segments and age-matched controls.</p

Myocardial perfusion reserve: effects of caffeine.

<p>Caffeine decreases myocardial perfusion reserve. This effect was most pronounced in stenotic segments of CAD patients. *<i>P</i><0.05 for the comparison versus baseline.</p

Exercise-induced hyperemia: effects of caffeine.

<p>Caffeine decreases exercise-induced hyperaemic MBF. This effect was most prominent in stenotic segments of CAD patients. *<i>P</i><0.005 for the comparison versus baseline.</p