Personalized Medicine: Recent Progress in Cancer Therapy

Personalized medicine (PM) or precision medicine in oncology is an emerging approach for tumor treatment and prevention that takes into account inter- and intra-tumor variability in genes, tumor (immune) environment, and lifestyle and morbidities of each person diagnosed with cancer [...

Added Value of Early Consultation of an Inpatient Palliative Care Team in Hospitalized Older Patients With High Symptom Burden: A Prospective Comparative Study

Background:It is estimated that in 2050 one quarter of the population in Europe will be aged 65 years and older. Although the added value of a palliative care team is emphasized in the literature, the impact of the palliative care team on the symptom burden in older non-cancer patients is not yet well established.Objectives:To structurally measure symptoms and to investigate whether proactive consultation with a palliative care team results in improvement of symptoms.Design:This study has a prospective comparative design.Setting/Participants:Older patients, admitted to a Dutch University Medical Centre for who a health care professional had a negative response to the Surprise Question, were selected.Measurements, Results:In period one, 59 patients completed the Utrecht Symptom Diary (USD) at day one of admission and after 7 days. In period 2 (n = 60), the same procedure was followed; additionally, the palliative care team was consulted for patients with high USD-scores. Significant improvement on the USD Total Distress Score (TSDS) was observed in both groups without a difference between the 2 periods. This study showed an association between consultation of the palliative care team and improvement on USD TSDS (adjusted odds ratio: 4.9; 95% confidence interval: 1.816-13.198), despite low follow-up rate of advices (approximately 50%).Conclusions:This study emphasizes the importance of creating awareness for consulting the palliative care team. Further research should focus on assessing the reason behind the low follow-up rate of the advice given and understanding the specific advices contributing to symptom improvement

Added Value of Early Consultation of an Inpatient Palliative Care Team in Hospitalized Older Patients With High Symptom Burden: A Prospective Comparative Study

BACKGROUND: It is estimated that in 2050 one quarter of the population in Europe will be aged 65 years and older. Although the added value of a palliative care team is emphasized in the literature, the impact of the palliative care team on the symptom burden in older non-cancer patients is not yet well established. OBJECTIVES: To structurally measure symptoms and to investigate whether proactive consultation with a palliative care team results in improvement of symptoms. DESIGN: This study has a prospective comparative design. SETTING/PARTICIPANTS: Older patients, admitted to a Dutch University Medical Centre for who a health care professional had a negative response to the Surprise Question, were selected. MEASUREMENTS, RESULTS: In period one, 59 patients completed the Utrecht Symptom Diary (USD) at day one of admission and after 7 days. In period 2 (n = 60), the same procedure was followed; additionally, the palliative care team was consulted for patients with high USD-scores. Significant improvement on the USD Total Distress Score (TSDS) was observed in both groups without a difference between the 2 periods. This study showed an association between consultation of the palliative care team and improvement on USD TSDS (adjusted odds ratio: 4.9; 95% confidence interval: 1.816-13.198), despite low follow-up rate of advices (approximately 50%). CONCLUSIONS: This study emphasizes the importance of creating awareness for consulting the palliative care team. Further research should focus on assessing the reason behind the low follow-up rate of the advice given and understanding the specific advices contributing to symptom improvement

Vrees voor terugkeer van borstkanker. Validering van de Nederlandse versie van de Concerns About Recurrence Scale (CARS).

Fear of recurrence of breast cancer. Validation of the dutch version of the concerns about recurrence scale (cars)the concerns about recurrence scale (cars) is an instrument measuring fear of recurrence of cancer in former breast cancer patients. It assesses the general level of fear of recurrence, and fear of recurrence as related to four different domains: health, death, womanhood and role functioning. In the present study we evaluate the psychometric properties of the dutch version of the cars (cars-dlv) in a sample of 136 breast cancer patients who had undergone curative treatment. Explorative factor analysis on the cars-dlv indicated a slightly different factor structure than that previously found: the items related to concerns about health and death collapsed into one subscale, whereas the items related to concerns about role functioning loaded on two different factors. However, based on similarity in content and the small number of items we merged these factors to a single domain of concerns about role functioning. The overall concern subscale and the three domain specific concern subscales proved highly internally consistent and also had good test-retest stability. Construct validity of the cars-dlv appeared adequate, as indicated by the correlations with related questionnaires (general anxiety, pain catastrophizing and optimism). Moderate to high levels of overall fear of recurrence were found in 66% of the breast cancer survivors. Fear of the consequence of recurrence for health was most prominent. Pain was a strong predictor of overall fear and of fear on the three sub domains of the cars. The prevalence of fear decreased significantly with age. Fear of recurrence was negatively correlated with health-related quality of life, and fear of the consequence of recurrence for role functioning appeared to be the strongest predictor.the results indicate that the cars-dlv may be a valuable instrument to measure women’s fears for recurrence of breast cancer. However, the distinctness of the four domains of fear and their specific predictors and/or consequences should be substantiated further. Moreover, the large number of items especially on the health subscale and their high inter-correlations suggest that a shorter version may be recommendable