A cross-sectional study evaluating the exercise discussion with oncologist during cancer consultation: the CONNECT study.

BACKGROUND: Evidence demonstrates that physical exercise confers several psycho-physical benefits on patients with cancer. This study aims to investigate the role of oncologists in exercise promotion. PATIENTS AND METHODS: A multicenter, cross-sectional study was conducted by distributing an anonymous, self-administered questionnaire to patients with cancer. The questionnaire enclosed demographic, health, and exercise variables. The exercise-related questions included in the study used the Godin-Shephard Leisure-Time Physical Activity Questionnaire to measure the amount of physical exercise. In addition, the survey gathered information on whether exercise was discussed with patients, and whether oncologists followed the assess, advise, reinforce, and refer (AARR) process regarding exercise. The survey also asked if patients preferred that exercise be discussed during their consultations. Descriptive statistics and logistic regression were applied. RESULTS: With a response rate of 75%, a total of 549 patients completed the survey. Regarding the exercise discussion, 38% of patients stated that their oncologist initiated an exercise discussion, 14% started the discussion themselves, and 48% said that the issue was not considered. Overall, 35% of patients reported that the oncologist assessed their exercise level, 22% and 42% received advice or reinforcement to increase their exercise, respectively, and 10% were referred to a dedicated service. Regarding preferences, 72% of patients thought that the oncologists should initiate an exercise discussion, 2% that only patients should start the discussion, and 26% thought that the issue should not be discussed. Similarly, 74% of patients are willing to receive the exercise assessment, 59% and 75% the advice and reinforcement to increase their exercise, and 46% to be referred to an exercise service. CONCLUSIONS: Although exercise promotion rates are low, patients are willing to receive exercise information. Dedicated strategies should be developed to support oncologists in promoting exercise to their patients.

Multislice spiral computed tomography in diagnosis and staging of pancreatic carcinoma: preliminary experience.

BACKGROUND: Computed tomography has become the modality of choice for preoperative evaluation of patients with suspected pancreatic carcinoma, although some limitations are well known. AIMS: To evaluate use of multislice spiral computed tomography in preoperative assessment of patients with suspected pancreatic carcinoma using volume-rendering as image reconstruction algorithm. PATIENTS: A total of 27 patients with suspected pancreatic carcinoma underwent multislice spiral computed tomography examination. METHODS: All studies were performed on a multislice computed tomography scanner with the following parameters: slice collimation, 1 mm; slice thickness, 1.25 mm; reconstruction interval, 1 mm; scan time, 22-25 sec; mAs, 165. Scans were acquired with a biphasic technique with a 30-sec (pancreatic phase) and a 70-sec (portal venous phase) delay time after start of contrast material injection. Diagnostic confirmation was obtained with surgical exploration, percutaneous biopsy, or with a combination of follow-up imaging studies. RESULTS: Multislice spiral computed tomography yielded correct diagnosis of pancreatic carcinoma in 20 cases (sensitivity, 95%; specificity, 100%). Positive predictive values for resectability and unresectability were 80% and 93.3%, respectively. Three-dimensional volume-rendered images improved diagnostic confidence in the depiction of major vascular structures. Two cases of anomalous origin of hepatic artery were also identified with volume-rendered images. CONCLUSIONS: Multislice technology improves accuracy of spiral computed tomography for diagnosis and staging of pancreatic carcinoma.

Multiphase multislice spiral CT for liver assessment: optimization in cirrhotic patients.

PURPOSE: The aim of our study was to optimize a multiphase study protocol with double arterial phase acquisition in a patient population with cirrhosis using a multislice spiral CT scanner. MATERIAL AND METHODS: Thirteen patients (10 males, 3 females, mean age 58 years) with known cirrhosis were selected for the study. All examinations were performed with a multislice spiral CT scanner (Somatom Plus 4 Volume Zoom; Siemens, Erlangen, Germany). Images were acquired using the following parameters: slice collimation, 2.5 mm; slice thickness, 3.0 mm; table feed, 10.8 mm/sec; mAs, 165; kVp, 120. Four scans of the hepatic parenchyma were obtained after the administration of contrast material. The first pass (early arterial phase) was acquired in a cranio-caudal direction; the second pass (late arterial phase) was acquired in a caudo-cranial direction. Early and late arterial phases were obtained during a single breath-hold of 24 sec. The third pass (portal-venous phase) was acquired with a 60-sec delay time after contrast material injection. The fourth pass (equilibrium phase) was obtained with a 180-sec delay time. Optimal delay time to start CT acquisition was assessed by means of injecting a 20-ml minibolus of contrast material and by performing serial dynamic scans every two sec at the level of the hepatic hilum. The time of peak aortic enhancement was used as the start time for the early arterial phase. Attenuation values of aorta, portal vein, and liver parenchyma were calculated in all the acquisitions. CT data from the early arterial phase were used to produce three-dimensional angiographic images of the hepatic and mesenteric circulation. RESULTS: The enhancement of liver parenchyma progressively increased from pre-contrast phase to portal-venous and equilibrium phases. The highest difference in attenuation values between aorta and hepatic parenchyma was observed during the second acquisition (early arterial phase, 247.78+/-106.29 HU) rather than during the third acquisition (late arterial phase, 185.72+/-109.23 HU); this difference was statistically significant (p<0.01). DISCUSSION: Results from our study emphasize the potential of multiphase acquisition in the evaluation of cirrhotic patients; in particular, the use of an early arterial phase is useful for studying the hepatic and mesenteric vascular anatomy, whereas the late arterial and the portal-venous phases are of paramount importance for adequate evaluation of liver parenchyma and focal lesions. Further studies are needed to evaluate whether the benefits deriving from double arterial phase acquisition would justify the increase in cost and patient radiation exposure.