Quality of Life Domains in Breast Cancer Survivors: The Relationship Between Importance and Satisfaction Ratings

Objectives: Quality of life (QoL) has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two. Methods: A sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction (FLZ-M), which measures participants’ satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls. Results: Compared with the general population sample, the patients were less satisfied with their health andmore satisfied with all other QoL domains. The subjective importance of health was lower in the patients’ sample (Effect size: d = 0.38). Satisfaction with health and importance of health were slightly positively correlated (r between 0.05 and 0.08). The effect of QoL domain importance on general QoL was small (beta between −0.05 and 0.11), and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible. Conclusion: In addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers’ attention

Использование информационно-коммуникационных источников для усовершенствования знаний старшекласников

This article examines the impact of the globalization process on individual life courses and employment careers in modern societies from an international comparative perspective. Empirical results are summarized from the GLOBALIFE research project (Life Courses in the Globalization Process), which studied the effects of globalization on life courses for the first time. As the results demonstrate, the globalization process has had diverse effects on different phases of the life course. Qualified men in their mid-careers are broadly protected from the effects of globalization, while young adults are the losers of the globalization process. We also find that educational and class characteristics determine the extent to which an individual faces increasing labour market risks. Under globalization, these effects have intensified. The results of the GLOBALIFE project thus indicate that globalization triggers a strengthening of existing social inequality structures. Another central finding is that globalization has not led to the same outcome across various modern societies. Globalization appears to be distinctly filtered by deeply embedded national institutions. These institutional packages entail diverse strategies of labour market flexibilization which themselves differentially shape patterns of social inequality in modern societies

La comunicación entre el paciente oncológico y los profesionales. El cuestionario de comunicación de la EORTC

The aims of the present work are to introduce to the field of communication between the cancer patient and the professionals, to remark the positive influence communication may have on the patient, and to present the EORTC communication questionnaire. Communication between patient and professional is a key element in the support that is offered to cancer patients. It is important to consider different professionals communicate with cancer patients. There is a need of research in communication between patients and professionals. Two main models of patient care are presented: Paternalistic and Patient-Centered Cancer Care. Patient-Centered Care includes Patient- Centered Communication - PCC. The relation between communication and other PROs - Quality of Life, Information and Satisfaction with Care - is presented. There are cross-cultural differences in communication that could be related to the model of patient care. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group is developing a questionnaire to assess communication between cancer patient and the professionals. This Communication questionnaire mainly assesses professionals’ behaviors. Cultural aspects have a key role in the development of the EORTC questionnaire. This instrument is based on the Patient- Centered Communication – PCC model. The EORTC QLQ-COMU26 is presented. It includes six scales and four individual items. The three phases of the questionnaire development process are described. At the present moment the EORTC QLQ-COMU26 is being field-tested in a larger international study (phase IV), to ensure it is an appropriate and psychometrically valid instrument.Este trabajo pretende introducir el área de la comunicación entre el paciente oncológico y los profesionales, y destacar el impacto que tiene en el paciente. Además, se presenta el cuestionario de comunicación de la EORTC. La comunicación entre el paciente y los profesionales es uno de los elementos claves del soporte que se ofrece a dichos pacientes. En dicha comunicación participan un rango importante de profesionales. Hay una necesidad de realizar más investigación sobre la comunicación. Se presentan dos modelos principales de atención al paciente: el Paternalista y el de Atención Centrada en el Paciente con cáncer. Este último lleva asociada la Comunicación Centrada en el Paciente - CCP. Se revisa la relación entre comunicación y otros PRO: Calidad de Vida, información, y Satisfacción con los Cuidados. Existen diferencias culturales en comunicación que pueden estar relacionadas con el modelo de atención al paciente. El Grupo de Calidad de Vida de la Organización Europea para la Investigación y Tratamiento del Cáncer-EORTC está desarrollando una escala de comunicación entre el paciente oncológico y los profesionales. La mayoría del contenido de dicho cuestionario se centra en las conductas de los profesionales. Los aspectos culturales tienen un papel fundamental en el desarrollo del instrumento. El cuestionario se basa en el modelo de Comunicación Centrada en el Paciente – CCP. Se presenta el cuestionario EORTC QLQ-COMU26, que consta de seis escalas y cuatro ítems individuales. Se describen las tres primeras fases que se han dado en su creación. En la actualidad su funcionamiento psicométrico se está valorando en un estudio internacional

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Allgemeine Depressionsskala (ADS)

Die allgemeine Depressionsskala (ADS) ist ein Selbstbeurteilungsinstrument, mit dem die Beeinträchtigung durch depressive Symptome innerhalb der letzten Woche eingeschätzt werden kann. Dabei werden sowohl emotionale, motivationale, kognitive, somatische als auch motorisch/interaktionale Beschwerden erfragt

Assessment of sleep problems with the Insomnia Severity Index (ISI) and the sleep item of the Patient Health Questionnaire (PHQ-9) in cancer patients

The objectives of this study were to examine sleep problems in cancer patients, to test the psychometric properties of the Insomnia Sleep Index (ISI) in comparison with the sleep item of the Patient Health Questionnaire-9 (PHQ-9), and to analyze disrupting factors which might cause the sleep problems. A sample of 1026 mixed-site cancer patients in treatment at a German oncological rehabilitation clinic was examined.The reliability of the ISI was very good (Cronbach's alpha = 0.92), and the results of the confirmatory factor analysis were acceptable. Females reported worse sleep quality (ISI mean: 13.7 ± 6.6) than males (10.7 ± 6.4). Sleep problems as measured with the PHQ-9 sleep item were markedly higher than those in the general population (effect size d = 1.15). Patients reported that, of the factors that disrupted their sleep, psychological factors (brooding, worries) were more relevant than symptom factors (pain, nocturnal urination, or restless legs).The ISI is effective in detecting sleep problems in cancer patients. Normative studies with the ISI would be helpful for assessing ISI mean scores. Sex differences should be taken into account when groups of patients are compared. The sleep item of the PHQ-9 can be used in epidemiological studies

The social peer interactions of very low birth weight children at 4 years of age : a dissertation.

The aim of this study was to examine whether VLBW children had difficulties in peer interactions at 4 years of age. There were 5 VLBW children and 5 age matched controls with normal birth weight, all of whom attended preschool settings in a large town in New Zealand. The type and frequency of peer interactions was assessed using observation and parents and teachers completed questionnaires. VLBW children were observed as interacting less with peers and as having less positive interactions but not more negative interactions. Teachers rated the VLBW children as having more peer problems and parents rated them as engaging in less play interaction. There was also a tendency for the VLBW children to be engaged in more solitary types of play. Trends indicated parents as rating their VLBW children as having more peer difficulties and teachers rating the VLBW children as engaging in less peer disruptive play. These findings indicate that VLBW children manifest decreased peer interactions and deficits in social competence at 4 years of age

Converging Divergences? : An International Comparison of the Impact of Globalization on Industrial Relations and Employment Careers

Profound social and economic transformations have taken place over the last two decades in modern societies. These changes are often referred to as globalization. The aim of this article is to examine whether processes of globalization have produced increasing convergence of employment-related aspects of national-level welfare regimes, industrial relation systems and mid-career employment paths among a set of industrialized nations. Atheory of convergence is developed to explain the coercive-isomorphic and mimetic-imitation effects of globalization, followed by potential reasons for growing divergence. The study concludes that globalization has produced ‘converging divergences’ and not resulted in a simple convergence based on neoliberal and market employmentrelated policies that leads to a rise of patchwork careers for all employees. Rather, it has served to intensify existent differences between industrial relations in the welfare regime clusters of countries and accentuated within-country occupational class, educational and gender inequalities.