Follow-up care for cancer survivors: views of the younger adult

BACKGROUND: Since the launch of the National Cancer Survivorship Initiative, there has been a surge of interest surrounding the value and organisation of long-term follow-up care after cancer treatment. We report the views of 309 adult cancer survivors (aged 18-45 years) on provision of follow-up and preferences for care. METHODS: A total of 207 survivors completed questionnaires before and after routine consultant-led follow-up appointments and 102 were recruited by post. Measures of health status (including late effects, perceived vulnerability to late effects and quality of life), reasons for attending follow-up (clinical and supportive), issues to be discussed at follow-up and preferences for different models of care were assessed. RESULTS: In all, 59% of the survivors reported experiencing one or more cancer-related health problems. Survivors rated clinical reasons for attending follow-up more highly than supportive reasons (P < 0.001), although nutritional advice and counselling were considered useful (60 and 47%, respectively). Those still receiving scheduled follow-up appointments did not discuss the range of issues intended with 'late effects' and 'fertility', which were particularly under-discussed. Hospital rather than GP follow-up was more highly rated. CONCLUSION: Survivors value the clinical reassurance currently provided by consultant-led care. However, supportive needs are not systematically addressed. Multi-disciplinary services are recommended to meet supportive needs in addition to clinical care

High-spatial resolution matrix-assisted laser desorption ionization imaging analysis of glucosylceramide in spleen sections from a mouse model of Gaucher Disease

MALDI mass spectrometric imaging (MSI) enables spatially resolved mass and intensity information to be obtained directly from tissue sections, thereby illustrating how analytes are distributed within these sections. Here we have used an oversampling technique on a commercially available MALDI orthogonal acceleration TOF mass spectrometer with ion mobility separation capability to produce high spatial resolution images of the glycosphingolipid, glucosylceramide (GC). To exemplify the biological application of our approach, GC was imaged in spleen sections from a conditional knockout mouse model of type 1 Gaucher disease in which the catabolism of this glycosphingolipid is impaired. The laser was continually fired at one position until no more ions were observed and then the sample was moved by 15 μm (laser diameter ~150 μm). Ions were generated from only the unirradiated surface at each of these positions achieving an effective spacing of 15 μm. At 15 μm laser step-size, it was possible to visualize macrophages enriched in GC, which could be distinguished from other cell types in the spleen. Current MALDI MSI spatial resolution is typically limited by the diameter of the laser spot-size, which is usually between 50 and 100 μm, covering an area equivalent to tens of mammalian cells.Marten F. Snel and Maria Fulle

Primary care for young adult cancer survivors: an international perspective.

Contains fulltext : 89604.pdf (publisher's version ) (Closed access)PURPOSE: Internationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement. METHODS: Comparative descriptions and literature review. RESULTS: Cancer among YAs is rare and usually not the first thing that comes into the FP's mind. Youth is sometimes mistakenly regarded as a protective factor. Across the countries, almost all YACs are treated in tertiary health care facilities with specialists providing the majority of care. Health care services are covered by the universal health insurance in Denmark, The Netherlands, and Canada but not in the US. Once the YAC has completed acute treatment and follow-up care, they often return to the care of the FPs who may potentially be expected to deal with and take action upon any possible medical, mental health, and psychosocial issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited. CONCLUSIONS: YACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care of this group of cancer patients. Primary care features such as patient-centered, integrated, and comprehensive care over extended periods of time bring the FP into the unique position to provide follow-up for YAC. However, this will require integrating patient's perspectives on their care, professional continuing medical education (CME) initiatives, and an enhanced cooperative effort between those delivering and coordinating cancer care.1 oktober 201