The "Palliative Care Quality of Life Instrument (PQLI)" in terminal cancer patients

BACKGROUND: This paper describes the development of a new quality of life instrument in advanced cancer patients receiving palliative care. METHODS: The Palliative Care Quality of Life Instrument incorporates six multi-item and one single-item scale. The questionnaire was completed at baseline and one-week after. The final sample consisted of 120 patients. RESULTS: The average time required to complete the questionnaire, in both time points, was approximately 8 minutes. All multi-item scales met the minimal standards for reliability (Cronbach's alpha coefficient ≥.70) either before or during palliative treatment. Test-retest reliability in terms of Spearman-rho coefficient was also satisfactory (p < 0.05). Validity was demonstrated by inter-item correlations, comparisons with ECOG performance status, factor analysis, criterion-related validation, and correlations with the Assessment of Quality of Life in Palliative Care Instrument (AQEL), and the European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30, version 3.0). CONCLUSION: The PQLI is a reliable and valid measure for the assessment of quality of life in patients with advanced stage cancer

Oral transmucosal fentanyl citrate in cancer pain management: a practical application of nanotechnology

Pain is experienced by most cancer patients and represents an important issue in the clinical setting. Breakthrough pain is a transitory flare of pain that occurs in most cancer patients on a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (OTFC; Actiq (R), Cephalon, UK), a new opioid formulation with a unique delivery system, utilizing the advantages that nanotechnology offers, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), which makes it an effective treatment to cancer patients who are already receiving opioids and continue to experience such flares of pain. Oral transmueosal fentanyl citrate is specifically developed and approved for the management of breakthrough pain in cancer patients and it has the potential to be a useful tool for clinicians

Quantitative image analysis in sonograms of the thyroid gland

High-resolution, real-time ultrasound is a routine examination for assessing the disorders of the thyroid gland. However, the current diagnosis practice is based mainly on qualitative evaluation of the resulting sonograms, therefore depending on the physician’s experience. Computerized texture analysis is widely employed in sonographic images of various organs (liver, breast), and it has been proven to increase the sensitivity of diagnosis by providing a better tissue characterization. The present study attempts to characterize thyroid tissue by automatic texture analysis. The texture features that are calculated are based on co-occurrence matrices as they have been proposed by Haralick. The sample consists of 40 patients. For each patient two sonographic images (one for each lobe) are recorded in DICOM format. The lobe is manually delineated in each sonogram, and the co-occurrence matrices for 52 separation vectors are calculated. The texture features extracted from each one of these matrices are: contrast, correlation, energy and homogeneity. Primary component analysis is used to select the optimal set of features. The statistical analysis resulted in the extraction of 21 optimal descriptors. The optimal descriptors are all co-occurrence parameters as the first-order statistics did not prove to be representative of the images characteristics. The bigger number of components depends mainly on correlation for very close or very far distances. The results indicate that quantitative analysis of thyroid sonograms can provide an objective characterization of thyroid tissue. (c) 2006 Elsevier B.V. All rights reserved

Psychometric properties of the impact of event scale in Greek cancer patients

To develop the Greek version of the Impact of E vent Scale-Revised (IES-R-Gr), assess its Psychometric properties, and finally to examine the impact of cancer diagnosis to a palliative care patient sample, the IES-R was translated into Greek using the “forward-backward” procedure. It was administered twice, at one-week intervals, to 82 eligible patients with advanced cancer. Together with the IES-R-Gr scale, the patients also completed the Hospital Anxiety and Depression (HAD) Scale. Reliability was assessed in terms of internal consistency (Cronbach’s alpha coefficients) and test/retest (Spearman’s r value and Kendall’s tau-b). Construct validity was demonstrated through association with the HAD Scale, and convergence and discriminative validity and interscale correlations were also assessed. The Greek version of the IES-R had Cronbach’s alphas for the intrusion, avoidance, and hyperarousal scales of 0.72, 0.77, and 0.85, respectively. Overall test-retest reliability was satisfactory at P &lt; 0.0005. Satisfactory construct validity was supported by the correlation analysis between the IES-R-Gr subscales and anxiety and depression. Factor analysis yielded three factors, explaining 57.26% of the variance. Interscale and interitem correlations were found satisfactory at P &lt; 0.0005. These results demonstrate that the IES-R-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the impact of cancer diagnosis in advanced cancer patients

The families evaluation on management, care and disclosure for terminal stage cancer patients

Abstract Background Quality of life is an important concept which is subjective and personal; what is an acceptable quality of life to one may be 'worse than death' to another. The objective of this study was to develop and validate a questionnaire to assess relatives' perceptions and attitudes towards their terminal stage cancer patients' management (information disclosure, treatment choice, hospitalization and support-communication and care) including aspects regarding end-of-life and quality-of-life decisions. Methods The final study consisted of 146 relatives of advanced terminal stage cancer patients receiving palliation, attending a Pain Relief and Palliative Care Unit. The questionnaire incorporated 6 multi-item and 7 single-item scales, and was developed following a systematic review of measures appropriate for use in palliative care settings. Results Following analysis of the 25-item scale, the questionnaire has been validated as a shortened 21-item scale consisting of 5 multi-item and 5 single-item scales. Factor analysis was based upon information disclosure, hospitalization, and support-communication demonstrating Cronbach's alpha coefficients of 0.66, 0.5 and 0.70 respectively. Average item totals and inter-item scale correlations were between 0.62–0.70, with convergent validity correlations between 0.60–0.86. The questionnaire was well accepted by all subjects with an 8–10 minute completion time. Conclusion The shortened 21-item self-assessment questionnaire may provide acceptable and valid assessment of caregiver(s)/Greek cancer patients' relatives perceptions on palliative care.</p

Psychological distress of patients with advanced cancer - Influence and contribution of pain severity and pain interference

The growing interest in the psychological distress and the multidimensionality of pain in patients with cancer has been the major reason for the conduction of this study. The aims we; re to evaluate psychological distress and pain in patients with advanced cancer and the impact of pain severity and pain interference dimensions on the anxiety and depression. One hundred twenty patients with advanced cancer were surveyed at a palliative care unit in Athens, Greece. Greek versions of the Hospital Anxiety and Depression (G-HAD) scale and the Brief Pain Inventory were administered. Information concerning patients’ treatment received was acquired from the medical records, whereas physicians recorded their clinical condition. The analysis showed that significant associations were found between pain interference to “mood” and HAD-A (anxiety) (r = 0.252, P =.005) and between pain interference to “relations with other people” and HAD-A (r = 0.474, P &lt;.0005). Multiple regression analyses showed that “average pain” (P &lt;.05), pain interference’to “walking ability” (P &lt;.05), “normal work” (P &lt;.05, and “relations with other people” are significant predictors of HAD-anxiety (HAD-A) (P &lt;.0005), explaining 46.2% of total variance. For depression (HAD-D), the Greek version of the Brief Pain Inventory dimension that serve as predictor is “enjoyment of life,” as well as the demographic variables of “age,” and “gender” (P &lt;.05), explaining 22.2% of variance. Moreover, a further analysis of the pain severity and pain interference scales showed that they differentiate the anxiety of the patients with cancer. In this patient sample, pain interference and, to a lesser extent, pain severity was significantly associated with psychological distress (anxiety and pain), whereas pain interference to “walking ability,” “normal work,” and “relations with other people” was found to be more prominent and troublesome to patients’ anxiety than that to patients’ depression

Predictive implications of bone turnover markers after palliative treatment with Re-186-HEDP in hormone-refractory prostate cancer patients with painful osseous metastases

To prospectively evaluate the predictive value of various bone formation and resorption markers in patients with bone metastases from prostate cancer after palliative treatment with Re-186-1,1-hydroxyethylidene diphosphonate (Re-186-HEDP). Included in the study were 36 men with prostate cancer, suffering from painful osseous metastases and treated with Re-186-HEDP. None had received any treatment that would have interfered with bone metabolism before Re-186-HEDP treatment or throughout the follow-up period. For each patient, pretreatment and posttreatment serum levels of osteocalcin (OC), bone alkaline phosphatase (BALP), aminoterminal (PINP) and carboxyterminal (PICP) propeptides of type I collagen, amino-terminal (NTx) and carboxyterminal (CTx) telopeptides of type I collagen and their combinations were compared with the level and duration of pain response to radionuclide treatment. Pain response was correlated only with pretreatment IeIcurrency signx/PINP, PICP/PINP and NTx/CTx ratios and posttreatment decrease in baseline NTx and PICP values (p=0.0025-0.035). According to multivariate and ROC analyses, the best marker-derived predictors of better and longer duration of response to Re-186-HEDP treatment were a posttreatment decrease in NTx of a parts per thousand yen20% (RR=3.44, p=0.0005) and a pretreatment NTx/PINP ratio of a parts per thousand yen1.2 (RR=3.04, p=0.036) NTx, a potent collagenous marker of bone resorption, along with the novel NTx/PINP ratio provide useful cut-off values for identifying a group of patients suffering from painful osseous metastases from hormone-refractory prostatic carcinoma who do not respond to palliative treatment with Re-186-HEDP. This information could help avoid an inefficient and expensive radionuclide treatment. Also, in the cohort of patients who will eventually undergo such treatment, the medium-term posttreatment changes in NTx offer valuable predictive information regarding long-term palliative response

Oral versus intravenous ibandronic acid: a comparison of treatment options for metastatic bone disease

Purpose This trial is the first to compare directly the clinical response to and safety of oral and intravenous (IV) ibandronic acid for metastatic bone disease. Methods Patients &gt;= 18 years with breast, prostate, lung, urogenital or colon cancer received IV ibandronic acid 6 mg infused over 15 min every 28 days or oral ibandronic acid 50 mg/day. Clinical response was determined using bone scintigraphy, radiography and serum C-terminal telopeptide of type I collagen (S-CTX) at months 3-6. Adverse events and biochemical safety measures were recorded. Results A total of 84.6 and 88.5% of patients had a complete/partial response to IV and oral ibandronic acid, respectively. Median percentage decreases in S-CTX were -39 and -35%, respectively. Bone pain scores decreased and analgesic use increased from month 0-3 and were stable from months 3-6. Both formulations improved physical and functioning scores. Conclusion Oral and IV ibandronic acid for bone metastases have similar efficacy and tolerability