ABSTRACT
Cancer and the various medical treatments and tests are a major physical and psychological challenge for patients, their relatives and for the medical staff as well. Adherence and compliance become critical factors during prolonged oncological therapies. The mental health of people with malignant cancer, untreated psychological symptoms can affect survival by increasing distress and suffering, weakening quality of life and reducing adherence. Furthermore, they have a particularly high comorbidity with psychiatric disorders. The aim of this study is to introduce the tools of cognitive behavioural therapy and the therapeutic indications in the context of mental disorders associated with chronic somatic illness. Our study presents the case of a 66-year-old woman with breast cancer. She was diagnosed with mild depressive episodes and hypochondriasis based on psychodiagnostic assessment. Instead of interpreting the patient's symptoms as a serious organic illness, the goal of psychotherapy is to develop new, more adaptive attitudes and more comforting perspective of the symptoms, and to reduce secondary depression. The elements of the 16-session cognitive behavioural therapy included behavioural activation, analysis of symptomatic behaviour, diary management, development of new alternatives and behavioural experiments, conceptualisation, and summarising learned techniques and future planning. Orv Hetil. 2022; 163(23): 895-901.
Subject(s)
COVID-19 , Cognitive Behavioral Therapy , Neoplasms , Aged , COVID-19/therapy , Cognitive Behavioral Therapy/methods , Female , Humans , Psychotherapy/methods , Quality of LifeABSTRACT
Background and Objectives: Medical imaging is a key element in the clinical workup of patients with suspected oncological disease. In Hungary, due to the high number of patients, waiting lists for Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were created some years ago. The Municipality of Budapest and Semmelweis University signed a cooperation agreement with an extra budget in 2020 (HBP: Healthy Budapest Program) to reduce the waiting lists for these patients. The aim of our study was to analyze the impact of the first experiences with the HBP. Material and Methods: The study database included all the CT/MRI examinations conducted at Semmelweis University with a referral diagnosis of suspected oncological disease within the first 13 months of the HBP (6804 cases). In our retrospective, two-armed, comparative clinical study, different components of the waiting times in the oncology diagnostics pathway were analyzed. Using propensity score matching, we compared the data of the HBP-funded patients (n = 450) to those of the patients with regular care provided by the National Health Insurance Fund (NHIF) (n = 450). Results: In the HBP-funded vs. the NHIF-funded patients, the time interval from the first suspicion of oncological disease to the request for imaging examinations was on average 15.2 days shorter (16.1 vs. 31.3 days), and the mean waiting time for the CT/MRI examination was reduced by 13.0 days (4.2 vs. 17.2 days, respectively). In addition, the imaging medical records were prepared on average 1.7 days faster for the HBP-funded patients than for the NHIF-funded patients (3.4 vs. 5.1 days, respectively). No further shortening of the different time intervals during the subsequent oncology diagnostic pathway (histological investigation and multidisciplinary team decision) or in the starting of specific oncological therapy (surgery, irradiation, and chemotherapy) was observed in the HBP-funded vs. the NHIF-funded patients. We identified a moderately strong negative correlation (r = -0.5736, p = 0.0350) between the CT/MR scans requested and the active COVID-19 case rates during the pandemic waves. Conclusion: The waiting lists for diagnostic CT/MR imaging can be effectively shortened with a targeted project, but a more comprehensive intervention is needed to shorten the time from the radiological diagnosis, through the decisions of the oncoteam, to the start of the oncological treatment.
Subject(s)
COVID-19 , Waiting Lists , Humans , Retrospective Studies , Hungary , COVID-19/diagnostic imaging , Tomography, X-Ray Computed , Magnetic Resonance Imaging/methods , COVID-19 TestingABSTRACT
BACKGROUND: Nutrition is essential to life and can have an indisputable influence on health and prevention of disease development including cancer. Methyl-donors are macronutrients that are important in achieving a healthy balance of metabolic processes. Their deficiency can lead to several symptoms and diseases-even to severe SARS-CoV-2 infection. We aimed to explore the potential protective effect of methyl-donor intake in breast, colorectal and pancreatic cancer by patient follow up. METHODS: A food frequency questionnaire and a diet diary were used to evaluate methyl-donor intake and blood samples were taken to evaluate Il-6 and IL-8 cytokine levels as well as MTHFR (C677T) polymorphism in breast, colorectal and pancreatic cancer patients. RESULTS: We found that levels around the recommended daily intake of B6 and B9 were effective in supporting the overall survival of breast and colorectal, and a relatively higher level of pancreatic adenocarcinoma, patients. The total intake of methyl-donors significantly and negatively correlated with smoking in pancreatic cancer, while folate as well as betaine intake significantly and positively correlated with IL-8 in colorectal cancer patients. CONCLUSIONS: Our results suggest that the appropriate intake of methyl-donor can be an adjunct of conventional oncotherapy to improve quality of life. Whether methyl-donor intake supports cancer prevention and patient survival needs further confirmation in large patient cohorts.