The Level of Hope in Patients Receiving Treatment for the Diagnosis of Lung Cancer

Lung cancer is the most common cause of cancer deaths worldwide. Hope is considered essential to life and has been positively associated with coping. The purpose of this study was to describe the level of hope in patients receiving medical treatment for lung cancer. The study was guided by Dufault and Martocchio\u27s multidimensional theoretical model of hope. A total of 167 patients were recruited for this cross sectional descriptive study from oncology clinics in the Southeast United States. Each participant completed a nine-item demographic self-survey questionnaire and a twelve-item, four point Likert-type Herth Hope Index (possible scores 12-48, higher score = higher hope) to measure the level of hope. Clinical information included lung cancer type, stage of lung cancer, and time since diagnosis. The overall total mean hope score was 41.48 (SD = 5.10). This finding suggests that although lung cancer patients may be at risk for lower hope scores, this study demonstrated that lung cancer patients continue to hope throughout their disease trajectory. The other major findings demonstrated that widow/widowers (n = 14, 8%), were more hopeful (M = 42.57) than divorced (n = 36, 22%), (M = 39.29) and Blacks/African Americans (n = 22, 13.2%) had higher levels of hope (M = 43.22) than Whites/Caucasians (n = 140, 83%) (M = 41.26). Participants undergoing second line of chemotherapy treatment n = 30 (18%), were more hopeful 43.63(4.99) compared to all others. Future studies may include measuring hope at the time of diagnosis and throughout the disease trajectory, as well as at multiple data points during different lines of chemotherapy treatment

Sustained Responses to Thrombopoetin Analogs in HIV Patients with Refractory ITP

Abstract Abstract 1165 Thrombocytopenia(TP) is common in patients with Human Immunodeficiency Virus (HIV) infection, reported in as many as 10–30% of patients and seen more often in IV drug users and advanced HIV infection even in post-HAART era. Both decreased production of platelets and increased destruction have been proposed as mechanisms of thrombocytopenia and at least 2 different clinical scenarios have been described: patients with very advanced AIDS, being thrombocytopenia another manifestation of bone marrow suppression; and patients without significant T-cell depletion in whom thrombocytopenia develops likely as an immune phenomenom, “ITP-like” HIV-related thrombocytopenia (HIV-TP). In HIV-TP, common treatments for classical ITP have been reported including corticosteroids, danazol, splenectomy, Intravenous Gammaglobulin, interferon, Anti-D, dapsone and splenic radiation with varying degrees of success with the highest responses seen with the use of HAART. Romiplostim (RMP) and Eltrombopag (ETP) are thrombopoeitin agonists (TA) approved in 2009 for refractory ITP and recently proposed to be used as first-line agents. No reports of the use of TA in patients with HIV-ITP are available to date. 5 patients with HIV-related ITP were treated with TP in our centers between 2009 to 2011. Mean age was 48 years (25–61), 4 males and 1 female. All of the patients had failed or relapsed after prednisone, 3 of the patients had also failed multiple treatments including splenectomy (1 patient), IVIG, Rho(D) immune globulin, Rituximab, danazole and vincristine. All but 1 of the patients were on HAART by the time of treatment and CD4 counts were <200 cells/μL in 2 patients (10–157 cells/ μL). All 5 patients were treated initially with RMP at the starting dose of 1 mcg/Kg and titrated as per guidelines. One patient requested to be switched to ETP and developed an acute lower extremity DVT and symptomatic PE 1 week after starting the medication. Responses to treatment are shown in graph 1. Mean baseline Platelet count was 27 × 103/μL (13–40 × 103/μL) and it increased to 66 × 103/μL (45–86 × 103/μL) within 1 week and 76 × 103/μL (45–107 × 103/μL) after 1 month of therapy, 2.8 times the baseline (2.1 – 3.4 × baseline value). 4 patients achieved a platelet count ≥50 × 103/μL within 1 month. 4 of the patients had durable responses for ≥ 12 months not requiring dose adjustments or modifications; the other patient had several compliance issues and missed several doses of RMP, his platelet count improved every time the medication was restarted. We present the first report of the successful and sustained use of TA in patient with HIV- ITP. Disclosures: Byrnes: Amgen: Honoraria, Speakers Bureau