Understanding Patient Experience in Biliary Tract Cancer: A Qualitative Patient Interview Study

Cáncer del tracto biliar; Estudio de entrevista; Investigación cualitativaCàncer del tracte biliar; Estudi d'entrevista; Recerca qualitativaBiliary tract cancer; Interview study; Qualitative researchIntroduction Patients living with biliary tract cancer (BTC) experience a decline in health-related quality of life (HRQoL). This study aimed to obtain a comprehensive understanding of the patient experience of BTC-related signs/symptoms and the impacts of these on daily functioning and HRQoL. Methods Patients with BTC participated in qualitative semi-structured concept elicitation interviews. Signs/symptoms and impacts of BTC were initially explored by targeted literature searches and interviews with five clinicians. Patient interviews were transcribed and coded using qualitative research software. Concept saturation was assessed over five interview waves. A sign/symptom or impact was defined as “salient” if mentioned by ≥ 50% of patients, with a mean disturbance rating of ≥ 5 (0–10 scale). A conceptual model of the patient experience of BTC-related signs/symptoms and impacts was produced. Results Twenty-three patients from the USA (78% women; median age: 54 years), diagnosed as having early (n = 3), locally advanced (n = 11) or metastatic (n = 9) disease, were interviewed. Sixty-six signs/symptoms and 12 impacts were identified. Of these, 46 signs/symptoms and 8 impacts were not identified from the targeted literature or clinician interviews. Concept saturation was reached by the fourth of five interview waves. Fourteen disease-related signs/symptoms (including fatigue/lack of energy, abdominal pain, lack of appetite, insomnia and diarrhoea) and three impacts (physical, emotional and cognitive impacts) were deemed “salient”. The conceptual model included 50 signs/symptoms and 12 impacts. Conclusion Patients with BTC reported a range of signs/symptoms and impacts that negatively affect daily functioning and HRQoL.This project was funded by AstraZeneca, Gaithersburg, MD, USA. Research and publication fees are funded by the study sponsor

Primary Hepatic Leiomyosarcoma with Giant Cyst Formation : A Case Report

A 64-year-old male with right upper abdominal pain had been treated with an H2-blocker for three months as a gastric ulcer recurrence with no response. An abdominal US identified a large cystic tumor in the left lobe of the liver. Tumor markers were all normal ; hepatitis serology tests were all negative, although liver function tests were elevated slightly. A CT scan showed a well-defined cystic tumor with a thick, heterogeneously enhanced wall. Selective celiac artery angiograms showed displacement of the common hepatic artery, and an avascular area. As a malignant tumor was suspected, a left lobectomy of the liver was performed. The tumor measured 17×15×12cm and contained central cystic degeneration filled with 280 ml of dark red fluid. Microscopic findings revealed anaplastic spindle cell proliferation, and immunohistochemical examination was positive for α-smooth muscle actin. A thorough survey did not detect a primary tumor in any other organ. Therefore, primary hepatic leiomyosarcoma was diagnosed. Only 80 cases have been reported. We reviewed the available literature

True Local Recurrences or New Primary Tumors after Breast-Conserving Surgery and Radiation Therapy

Background& Aims: True local recurrences(TR)and new primary tumors(NP)in the conserved breast after breast-conserving surgery with radiation therapy are determined by the initial surgical margin, the location of recurrent tumors and the histological consistency between initial tumors and recurrent tumors. Methods: A total of 15 patients with breast recurrence out of a group of 389 women with breast cancer who underwent breast-conserving therapy between 1991 and 2003 were included in this study. The biological differences between TR and NP were examined. Results: Eight patients had TR, and seven had NP. The disease-free interval was 34.6 months in the TR group and 94.1 in the NP group. Breast-free survival was significantly better in the NP group than the TR group. The accumulated 10-year overall survival after salvage surgery in patients with TR or NP tumors was 85.1％. The accumulated overall survival after salvage surgery was better in the NP group than the TR group. Conclusions: Patients with NP tumors have a favorable prognosis compared to those with TR tumors. It is important to determine the type of breast recurrence in order to accurately predict the prognosis of patients with breast recurrence

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma : A Case Report

We present a rare case of a 26-year old woman with diffuse sclerosing variant of papillary thyroid carcinoma. The patient was referred to our hospital with diffuse enlargement of the thyroid accompanied with palpable bilateral cervical lymph nodes. Ultrasonography showed a heterogeneous pattern with ill-defined hypoechoic areas in both thyroid lobes. There were multiple small punctate echogenic foci. Fine-needle aspiration cytology revealed typical signs of papillary carcinoma. The patient underwent a total thyroidectomy using a bilateral modified neck dissection. Pathological findings demonstrated diffuse involvement and continuous infiltration of the tumors to both thyroid lobes, lymph nodes and cervical soft tissue. Postoperatively, 100 mCi of 131I was administrated to the small amount of residual thyroid tissue. The patient is free from recurrence one year after the operation

Understanding Patient Experience in Biliary Tract Cancer: A Qualitative Patient Interview Study

Introduction: Patients living with biliary tract cancer (BTC) experience a decline in health-related quality of life (HRQoL). This study aimed to obtain a comprehensive understanding of the patient experience of BTC-related signs/symptoms and the impacts of these on daily functioning and HRQoL. Methods: Patients with BTC participated in qualitative semi-structured concept elicitation interviews. Signs/symptoms and impacts of BTC were initially explored by targeted literature searches and interviews with five clinicians. Patient interviews were transcribed and coded using qualitative research software. Concept saturation was assessed over five interview waves. A sign/symptom or impact was defined as "salient" if mentioned by ≥ 50% of patients, with a mean disturbance rating of ≥ 5 (0-10 scale). A conceptual model of the patient experience of BTC-related signs/symptoms and impacts was produced. Results: Twenty-three patients from the USA (78% women; median age: 54 years), diagnosed as having early (n = 3), locally advanced (n = 11) or metastatic (n = 9) disease, were interviewed. Sixty-six signs/symptoms and 12 impacts were identified. Of these, 46 signs/symptoms and 8 impacts were not identified from the targeted literature or clinician interviews. Concept saturation was reached by the fourth of five interview waves. Fourteen disease-related signs/symptoms (including fatigue/lack of energy, abdominal pain, lack of appetite, insomnia and diarrhoea) and three impacts (physical, emotional and cognitive impacts) were deemed "salient". The conceptual model included 50 signs/symptoms and 12 impacts. Conclusion: Patients with BTC reported a range of signs/symptoms and impacts that negatively affect daily functioning and HRQoL