Does perceived social support, psychological problems, and fatigue impact quality of life of geriatric patients with cancer?

Background: Health-related comorbidities often increase due to cancer among the ageing population. However, the domains of psychological functioning of geriatric patients remain undetected especially in the Indian scenario. This study aimed to evaluate psychological problems, perceived social support, fatigue, and quality of life among geriatric patients with cancer. Methods: A cross sectional study was conducted in a tertiary cancer center. Geriatric patients with cancer (n = 130) having solid malignancies categorized as older patients (>65 years) and younger geriatric patients (60–65 years) were included in the study. Depression, anxiety, perceived social support, fatigue, and quality of life was assessed using the Geriatric Depression Screening Scale, Geriatric Anxiety Scale, Multidimensional Scale of Perceived Social Support, Symbolic Assessment of Fatigue Extent, and the Old People Quality of life Scale, respectively. Descriptive and inferential statistics such as cross tab analysis, correlation and regression analysis. Results: A majority of patients 80 (61.5%) had low perceived social support, moderate-severe depression 61 (47.7%) and mild-moderate anxiety 55 (43.1%). Half of the patients were found to have poor quality of life. Further, psychological problems were higher among older geriatric patients (p = 0.000). Very few patients had a higher impact of fatigue on their daily functioning 17 (13.3%). There was a positive correlation between perceived social support, depression, anxiety, extent of fatigue, and quality of life (r = 0.256, P = 0.003). Conclusion: Psychological problems are higher among older geriatric patients with cancer undergoing treatment. Clinical implications could aim at regular screening to identify specific psychological issues and provide appropriate interventions. Future research warrants the efficacy of such therapeutic interventions for better quality of life outcomes

Systemic therapy for melanoma.

Advanced melanoma is a disease with a poor prognosis. Most of the currently available chemotherapy agents are ineffective. In contrast to other cancers, immune-based and novel, targeted therapies appear to have some effect in melanoma. Exciting research in the past few years holds hope for the future. We provide an overview of the current management principles of this condition with special emphasis on the emerging options in the systemic therapy of advanced disease.

Improving care in ovarian cancer: the role of a clinico-pathological meeting.

BACKGROUND: We assessed the impact of clinico-pathological meetings on the diagnosis and management of patients with ovarian cancer. METHODS: Between January 2005 and December 2006, about 400 patients of suspected or confirmed ovarian cancer were evaluated in the 'Gynaecology Tumour Clinic'. Of these, 108 cases were referred for discussion in the weekly clinico-pathology meeting for various indications. These cases were retrospectively analysed regarding their initial clinical and pathological diagnosis, the indication for referring the case for discussion in the meeting and the impact this had on the overall management. Alterations in diagnosis, which impacted management, were classified as 'major changes' and those, which did not, were called 'minor changes'. RESULTS: Ninety-one of the 108 cases discussed were available for analysis; 75.8% of cases were initially diagnosed as epithelial ovarian cancers. In 48 of 91 cases (52%), there was an alteration in the diagnosis as a direct result of discussion in the meeting, mainly after clarifications regarding histological grading in 34 cases. Of the remaining 14 cases, 3 had a change in histopathological diagnosis; 2 cases, which were initially labelled as undifferentiated tumours, had their diagnosis clarified; and in the remaining 9 cases, in which the primary site was not known, a possible primary site could be assigned (with the help of clinical, radiological and pathological inputs). Among the 14 cases with alterations other than grading, the change was contributed by slide review alone in 7 cases and in the rest by a combination of slide review and clinical inputs. As a direct outcome of the meeting, 20 of 91 cases (22%) had their management plan modified (major change). CONCLUSION: The practice of conducting weekly clinicopathological meetings has a major impact on the management of cases of ovarian cancer.