Assessment of health status in elderly patients with cancer

BackgroundHealth status assessment of senior adults is one of the most important aspects of a treatment decision making process. A group of elderly cancer patients is very heterogeneous according to the health status – some of them are fit enough for aggressive treatment, but others are frail and vulnerable. Treatment for the latter group has to be adapted and carefully monitored.AimTo review and analyze relevant literature on the usage and optimization of Comprehensive Geriatric Assessment (CGA).Materials and methodsMedline search of studies published between 2000 and 2011, containing key words: Comprehensive Geriatric Assessment, aging, cancer in senior adults, frailty.ResultsTo recognize and address individual needs of senior adults, a special holistic approach has been developed – comprehensive geriatric assessment (CGA). This tool is a gold standard in gerontooncology, recommended by International Society of Geriatric Oncology. CGA evaluates all important health domains, from physiology to social and economical problems, using sets of different tests. Assessment has to be performed by a trained team, including a physician, nurse and social worker. CGA has been clinically validated in many studies, but it is still not clear whether CGA improves the outcome of treatment of the elderly with cancer.ConclusionsComplexity and multidimensionality of CGA pose a logistic challenge for everyday clinical practice. Special senior programs, which could be developed inside comprehensive cancer center, focusing attention on seniors’ problems and needs seem to be a way forward for geriatric oncology

Do we protect or discriminate? Representation of senior adults in clinical trials

AimThe analysis of barriers responsible for low recruitment of older patients in clinical trials and presentation of possible solutions are the subject of this review.BackgroundEurope's population is ageing, and the group of people who more frequently develop neoplasms increases. Oncologists are confronted with a new challenge – how to treat cancer in this group of patients, especially considering the lack of Evidence Based Medicine (EBM) guidelines for treatment of cancer in the elderly population.Materials and methodsMedline search and analysis of studies published between 1999 and 2012, containing key words: senior adults, cancer, elderly in clinical trials.ResultsDetailed analysis of relevant studies demonstrated that senior adults are underrepresented in clinical trials. Moreover, there is a lack of trials exclusively designed for this heterogeneous group of patients. The analysis of reasons for low recruitment of older patients in clinical trials revealed barriers dependent on patient's and physician's attitudes as well as institutional and logistic problems.ConclusionsIt is necessary to widen the scale of trials of all phases in the group of seniors with appropriate assessment of toxicity. This will allow a proper stratification and obtaining representative groups for statistical analysis and credible trial results. Another priority is the design of trials dedicated exclusively to the elderly

Comparison of dose volume histograms for supine and prone position in patients irradiated for prostate cancer—A preliminary study

AbstractAimTo compare DVHs for OARs in two different positions – prone and supine – for prostate cancer patients irradiated with a Tomotherapy unit.BackgroundIn the era of dose escalation, the choice of optimal patient immobilization plays an essential role in radiotherapy of prostate cancer.Materials and methodsThe study included 24 patients who were allocated to 3 risk groups based on D’Amico criteria; 12 patients represented a low or intermediate and 12 a high risk group.For each patient two treatment plans were performed: one in the supine and one in the prone position. PTV included the prostate, seminal vesicles and lymph nodes for the high risk group and the prostate and seminal vesicles for the intermediate or low risk groups. DVHs for the two positions were compared according to parameters: Dmean, D70, D50 and D20 for the bladder and rectum and Dmean, D10 for the intestine. The position accuracy was verified using daily MVCT.ResultsProne position was associated with lower doses in OARs, especially in the rectum. Despite the fact that in the entire group the differences between tested parameters were not large, the Dmean and D10 for the intestine were statistically significant. In the case of irradiation only to the prostate and seminal vesicles, the prone position allowed for substantial reduction of all tested DVH parameters in the bladder and rectum, except D20 for bladder. Moreover, the Dmean and D50 parameter differences for the bladder were statistically significant.No significant differences between positions reproducibility were demonstrated.ConclusionIn patients irradiated to prostate and seminal vesicles, the prone position may support sparing of the rectum and bladder.The reproducibility of position arrangement in both positions is comparable

Significance of neutrophil to lymphocyte ratio as a predictor of outcome in head and neck cancer treated with definitive chemoradiation

Background: The role of host immune system in carcinogenesis and response to treatment is increasingly studied, including predictive potential of circulating neutrophils and lymphocytes. The objective of the study was to evaluate the prognostic value of pre- and post-treatment neutrophil-to-lymphocyte (NLR) for treatment outcome in patients diagnosed with squamous cell carcinoma of head and neck (HNSCC) treated with definitive chemoradiation. Materials and methods: Electronic medical records of patients were evaluated and NLR was calculated. Cox regression was used to assess the impact of selected variables on overall survival (OS), disease specific survival (DSS), progression free survival (PFS) and distant failure free survival (DFFS). Logistic regression was used to estimate odds ratios of complete response with NLR. Results: 317 patients' records were included in the study. Increases in both pre-and post-NLR were associated with decreased OS in univariable analysis [hazard ratio (HR): 2.26 (1.25–4.07), p = 0.0068 and HR: 1.57 (1.03–2.37), p = 0.035 respectively). Post-NLR remained significant for OS in multivariable analysis [HR: 1.93 (1.22–3.1), p = 0.005] as well as for unfavorable DSS [HR: 2.31 (1.22–4.4), p = 0.01]. Pre-treatment NLR and nodal status correlated with shorter DFFS in multivariable analysis [HR 4.1 (1.14–14), p = 0.03 and HR 5.3: (1.62–18), p = 0.0062, respectively]. Strong correlation of increased both pre- and post-NLR with probability of clinical tumor response (CR) was found [odds ratio (OR): 0.23 (0.08–0.6), p = 0.003, and OR: 0.39 (0.2–0.8), p = 0.01 respectively]. Conclusion: NLR evaluated before and post treatment was a strong predictor of unfavorable treatment outcome and can be used for risk evaluation and clinical decision about treatment and post-treatment surveillance

Kompetencje społeczne w edukacji, pracy socjalnej i relacjach zawodowych

W dzisiejszej dyskusji dotyczącej siły i słabości polskiego środowiska akademickiego – mając na względzie przyczyny i uwarunkowania jego wyraźnych zaniedbań, opóźnień i ograniczeń w porównaniu z univesitas Europy Zachodniej – coraz częściej pojawiają się pytania dotyczące umiejętności i kompetencji, jakie absolwenci naszych uczelni zdobywają w trakcie uniwersyteckiej edukacji. Wśród tych „umiejętności i kompetencji” wyróżniają się te, które sprzyjają konstruowaniu dobrych relacji interpersonalnych. Należą do nich: kompetencje i umiejętności komunikacyjne, umiejętności budowania bliskich relacji z innymi ludźmi, sfera tzw. roztropności emocjonalnej, czyli zdolność postrzegania, oceniania i wyrażania emocji, sprawność w rozumieniu i analizowania informacji emocjonalnej, a wreszcie – sztuka regulowania przestrzeni emocjonalności. Wszystkie wymienione umiejętności, nazywane „kompetencjami społecznymi” albo „społecznymi umiejętnościami miękkimi”, w praktyce akademickiej uznawane są coraz powszechniej za fundamentalny „budulec” wszelkich instytucji społecznych zarówno w skali „makro”, jak i „mikro”. Krucha struktura polskiej przestrzeni publicznej, niestabilność sektora prywatnej przedsiębiorczości czy też słabość instytucji rodziny przekonują jednak, że wiążąca siła kompetencji społecznych wciąż pozostaje nader wątpliwa. W przedstawianej pracy zbiorowej – będącej pokłosiem zorganizowanej wiosną 2012 roku konferencji naukowej Studenckiego Koła Umiejętności Społecznych, działającego przy Wydziale Pedagogiczno-Artystycznym UAM w Kaliszu – stawiamy pytania o jakość, charakter i specyfikę wspomnianego „budulca” życia społecznego, warunkują- cego sposoby funkcjonowania różnorodnych zawodów. Konferencyjne analizy i refleksje, dyskusje i płynące z nich wnioski odsłoniły zaskakujący fenomen. Z jednej strony wszyscy uczestnicy seminarium uznali, że podejmowane kwestie kompetencji społecznych są rzeczywiście ważne, lecz zarazem, niestety, najczęściej niedoceniane. Ale z drugiej strony okazało się, że dyskutanci operowali 6 często rozbieżną teoretycznie aparaturą pojęciową, istotnie utrudniającą naukowe porozumienie, wspólne wypracowanie odpowiedniej terminologii i badawczej perspektywy. Zagadnienie społecznych umiejętności miękkich obnażyło więc znaczące zróżnicowanie: prelegenci różnili się między sobą, bo w czym innym upatrywali istotę czy sedno problemu kompetencji społecznych. Taka sytuacja zintensyfikowała przede wszystkim kontrasty, utrudniając znacząco sformułowanie konstruktywnych wniosków. Prawdopodobną przyczyną zaistniałej sytuacji jest fakt niezmiennie niskiego stopnia zaawansowania badań nad problematyką kompetencji społecznych. Pomimo że literatura przedmiotu na przestrzeni ostatnich dwóch dekad wskazuje na rosnące zainteresowanie poruszanymi kwestiami, ciągle trudno mówić o stosowaniu spójnej i jednolitej aparatury pojęciowej, w której ta problematyka byłaby ujmowana, opisywana i badana. Inną przyczyną tego stanu rzeczy może być jednakże zróżnicowanie przygotowania oraz doświadczenie akademickie autorów zebranych w książce tekstów: dla wielu z nich była to bowiem pierwsza naukowa „próba”, nowatorskie doświadczenie owocujące naukową pracą. Przy okazji warto podkreślić, że autorzy, mimo towarzyszących im wątpliwości, co zrozumiałe w ich sytuacji, podjęli intelektualny wysiłek z ogromną wiarą we własne siły – ten naukowy optymizm wartościowany winien być pozytywnie. Zebrane artykuły i szkice zestawiliśmy w dwóch blokach tematycznych. Pierwszy z nich obejmuje artykuły podejmujące kwestię kompetencji społecznych przypisanych do zawodu i powołania nauczyciela. Problematyka ta wydaje się bardzo ważna, gdyż, jak wspomniano, różnice pomiędzy skutecznością kształcenia przez polskie szkoły wyż- sze i szkoły krajów Zachodu być może mają właśnie źródło w kompetencjach samych nauczycieli. Drugi blok tematyczny zawiera prace dotyczące problematyki sfery aktywności socjalnej, poziomu niesienia pomocy ludziom cierpiącym, wszystkim potrzebującym. W tej drugiej grupie artykułów stawiamy zatem pytania o wolontariat – jego psychologiczne, filozoficzne i społeczne uwarunkowania – pamiętając o jego wciąż kruchym (w polskich realiach) statusie. Czy udało się nam osiągnąć zasugerowane w tej przedmowie cele i zamierzenia? – niech oceni Czytelnik

Clinical results of the total skin electron irradiation of the mycosis fungoides in adults. Conventional fractionation and low dose schemes

BackgroundMycosis fungoides (MF) is a rare skin condition, effectively treated by irradiation. Since 1951, different methods of total skin irradiation have been developed. Although dose–response effect has been demonstrated in many publications, controversies about low dose treatment still exist.AimThe analysis of results of the total skin electron irradiation (TSEI), especially low dose TSEI in comparison with standard dose treatment is the subject of this review. Also, acute and late side effects of radiotherapy in MF are discussed.Materials and methodsMedline search and analysis of studies published between 1995 and 2012, containing key words: mycosis fungoides, standard dose TSEI, low dose TSEI, total skin electron beam therapy (TSEBT).ResultsDetailed analysis of relevant studies demonstrated that standard dose radiotherapy 30–36[[ce:hsp sp="0.25"/]]Gy is the most effective treatment used in clinical practice. Objective response rate (ORR) is high, especially for less advanced stages of disease. Complete response rate (CR), although slightly lower, is still relatively high.For more advanced MF, TSEI serves as a very good method of palliative treatment and relief of symptoms, like pruritus, pain or desquamation.There is no consensus regarding low dose TSEI; the method is widely accepted as a palliative treatment or in case of reirradiation.ConclusionsStandard dose TSEI is an effective method of MF treatment for radical and palliative treatment, producing high rate of ORR and reasonably long time to progression (TTP). Acute and late side effect of treatment are mostly mild and easy to manage. Low dose TSEI is still in the phase of clinical studies

Praca warsztatowa jako warunek sine qua non badań biograficznych

The aim of the paper is to share our reflections on the meaning, goals, and course of analytical workshops, which are treated by the authors not only in terms of methodological procedures, but also as a process of grounded theory building, where the phase of collective work is pivotal. We present the idea of workshops worked out within interpretative sociology and qualitative analysis and developed in different fields, yet we mainly focus on biographical research analysis. The knowledge and practice transfer between scholars in this respect is also one of the frames of our reasoning. The paper consists of several sections: firstly, we present a short overview of workshop practices in the field of biographical research referring mainly to students’ workshops; in the second part, we describe advantages of workshop practices for researchers and their possible outcomes; the third section describes examples of research and analysis of the same empirical material done by researchers representing different methodological approaches; finally, we finish with concluding remarks.Celem artykułu jest refleksja na temat wartości pracy warsztatowej w metodzie biograficznej. Wspólna praca nad tekstem jest nie tylko elementem pracy analitycznej, ale powinna być uznana za jeden z niezbędnych kroków procedury analitycznej prowadzącej do refleksji teoretycznej. Artykuł składa się z następujących części: krótkiej prezentacji historii idei warsztatów analitycznych w polu badań biograficznych zwłaszcza w odniesieniu do pracy ze studentami; opisu korzyści charakterze edukacyjnym, analitycznym i teoretycznym, jakie płynąć mogą z pracy zespołowej; charakterystyki konkretnych przykładów warsztatowej pracy badawczej i jej rezultatów w formie tekstów pokazujących różne podejścia analityczne i teoretyczne

Prospective study on dosimetric comparison of helical tomotherapy and 3DCRT for craniospinal irradiation – A single institution experience

AimThis prospective study aims to assess feasibility of helical tomotherapy (HT) for craniospinal irradiation (CSI) and perform dosimetric comparison of treatment plans for both HT and 3D conformal radiotherapy (3DCRT).BackgroundCSI is a challenging procedure. Large PTV size requires field matching due to technical limitations of standard linear accelerators, which cannot irradiate such volumes as a single field. HT could help to avoid these limitations as irradiation of long fields is possible without field matching.Materials and methodsThree adults were enrolled from 2009 to 2010. All patients received radiochemotherapy. Treatment plans in prone position for 3DCRT and in supine position for HT were generated. The superior plan was used for patients’ irradiation. Plans were compared with the application of DVH, Dx parameters – where x represents a percentage of the structure volume receiving a normalized dose and homogeneity index (HI).ResultsAll patients received HT irradiation. The treatment was well tolerated. The HT plans resulted in a better dose coverage and uniformity in the PTV: HI were 5.4, 7.8, 6.8 for HT vs. 10.3, 6.6, 10.4 for 3DCRT. For most organs at risk (OARs), the D(V80) was higher for HT than for 3DCRT, whereas D(V5) was lower for HT.ConclusionsHT is feasible for CSI, and in comparison with 3DCRT it improves PTV coverage. HT reduces high dose volumes of OARs, but larger volumes of normal tissue receive low radiation dose. HT requires further study to establish correlations between dosimetrical findings and clinical outcomes, especially with regard to late sequelae of treatment

Influence of Semiquantitative [¹⁸F]FDG PET and Hematological Parameters on Survival in HNSCC Patients Using Neural Network Analysis

The aim of this study is to assess the influence of semiquantitative PET-derived parameters as well as hematological parameters in overall survival in HNSCC patients using neural network analysis. Retrospective analysis was performed on 106 previously untreated HNSCC patients. Several PET-derived parameters (SUVmax, SUVmean, TotalSUV, MTV, TLG, TLRmax, TLRmean, TLRTLG, and HI) for primary tumor and lymph node with highest activity were assessed. Additionally, hematological parameters (LEU, LEU%, NEU, NEU%, MON, MON%, PLT, PLT%, NRL, and LMR) were also assessed. Patients were divided according to the diagnosis into the good and bad group. The data were evaluated using an artificial neural network (Neural Analyzer version 2.9.5) and conventional statistic. Statistically significant differences in PET-derived parameters in 5-year survival rate between group of patients with worse prognosis and good prognosis were shown in primary tumor SUVmax (10.0 vs. 7.7; p = 0.040), SUVmean (5.4 vs. 4.4; p = 0.047), MTV (23.2 vs. 14.5; p = 0.010), and TLG (155.0 vs. 87.5; p = 0.05), and mean liver TLG (27.8 vs. 30.4; p = 0.031), TLRmax (3.8 vs. 2.6; p = 0.019), TLRmean (2.8 vs. 1.9; p = 0.018), and in TLRTLG (5.6 vs. 2.3; p = 0.042). From hematological parameters, only LMR showed significant differences (2.5 vs. 3.2; p = 0.009). Final neural network showed that for ages above 60, primary tumors SUVmax, TotalSUV, MTV, TLG, TLRmax, and TLRmean over (9.7, 2255, 20.6, 145, 3.6, 2.6, respectively) are associated with worse survival. Our study shows that the neural network could serve as a supplement to PET-derived parameters and is helpful in finding prognostic parameters for overall survival in HNSCC