Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients.

The overall purpose of this study was to evaluate the effectiveness of a psychosocial supportive intervention called the "Living with Hope Program" (LWHP) in increasing hope and quality of life for older adult, community-living, terminally ill cancer patients. Using a mixed method concurrent nested experimental design, 60 terminally ill cancer patients over the age of 60 years were randomly assigned to a treatment group and a control group. Baseline hope (Herth Hope Index [HHI]) and quality-of-life scores (McGill Quality of Life Questionnaire [MQOL]) were collected at the first visit in the patients' homes by trained research assistants. Those in the treatment group received the LWHP, which consisted of viewing an international award-winning video on hope and a choice of one of three hope activities to work on over a one-week period. The control group received standard care. Hope and quality-of-life data were collected one week later from both groups. Qualitative data using open-ended hope questions were collected from the treatment group. Patients receiving the LWHP had statistically significant higher hope (U=255, P=0.005) and quality-of-life scores at Visit 2 (U=294.5, P=0.027) than those in the control group. Qualitative data confirmed this finding, with the majority (61.5%) of patients in the treatment group reporting the LWHP increased their hope. This preliminary evaluation of the effectiveness of the LWHP suggests that it may increase hope and quality of life for older terminally ill cancer patients at home.

Extrapulmonary small cell cancer: a Canadian province's experience.

BACKGROUND: The objective of this study was to determine variables that correlate with the survival of patients with extrapulmonary small cell carcinoma (EPSCC). METHODS: Medical records of 101 eligible patients with EPSCC who were diagnosed in Saskatchewan from 1971 to 2002 were reviewed. Survival was calculated by using the Kaplan-Meier method. A logistic regression analysis with a backward elimination was carried out to determine prognostic variables that predicted mortality. RESULTS: The median patient age was 72 years (range, 24-100 years), and the male-to-female ratio was 1.4:1. The primary disease sites were as follows: breast, 9%; gastrointestinal, 20%; genitourinary, 18%; gynecologic, 11%; head and neck, 10%; thymus, 2%; and unknown primary site, 31%. Fifty-one patients had limited disease (LD), and 50 patients had extensive disease (ED). Patients with LD had a median overall survival of 34 months (range, 0.2-276 months) compared with 2 months (range, 0.1-108 months) in patients with ED (P < .0001). Among different primary sites, patients with gynecologic small cell cancer (SCC) had a median survival of 54.4 months, whereas patients with SCC of an unknown primary site had a survival of 2.5 months. Among various variables that were examined with respect to their prognostic importance, an abnormal white blood cell count (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 3.4-14.1), an Eastern Cooperative Oncology Group performance status >2 (OR, 4.5; 95% CI, 2.1-9.9), and ED (OR, 2.7; 95% CI, 1.4-5.0) were found to be correlated significantly with mortality. CONCLUSIONS: The gastrointestinal and genitourinary tracts were the 2 major sites involved by EPSCC in the current series. Survival varied according to the primary sites, and patients with gynecologic tumors had the best prognosis. An abnormal white blood cell count, a poor performance status, and disease extent were important factors in predicting survival.

Quality-of-life analysis in the management of endometrial cancer.

OBJECTIVE: The purpose of this study was to determine whether and how the quality of life (QL) of patients with stage I endometrial cancer was influenced by different surgical procedures with or without radiation therapy. STUDY DESIGN: We conducted a retrospective analysis of 200 women with stage I endometrial cancer at the University of Saskatchewan, Canada in 2001 through 2002. Modified QLQ-C30 Questionnaires were used in evaluating differences in the weighted QL of patients who underwent staged surgery and patients who had nonstaged surgery, the latter of which refers to total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) with or without radiation therapy. RESULTS: There was a significantly lower QL in patients who underwent staged surgery compared with nonstaged surgery. In addition, radiation therapy significantly worsened the QL of patients undergoing staged surgery, whereas it had little influence on the QL of patients who received nonstaged surgery. CONCLUSION: Our study suggests that nonstaged surgery with or without radiation therapy may be a preferred treatment for stage I endometrial cancer compared with staged surgery from the perspective of patients' QL.