Postdiagnostic use of ß-blockers and other antihypertensive drugs and the risk of recurrence and mortality in head and neck cancer patients: an observational study of 10,414 person-years of follow-up.

INTRODUCTION: Growing evidence indicates that norepinephrine promotes cancer growth and metastasis whereas ß-blockers decrease these risks. This study aimed to examine the clinical impact of ß-blockers and other hypertensive drugs on disease recurrence and survival in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: This study analyzed a cohort of 1274 consecutive patients who received definitive treatments for previously untreated HNSCC at our tertiary referral center between January 2001 and December 2012. Antihypertensive use was considered positive if patients were on medication from HNSCC diagnosis to at least 1 year after treatment initiation. Cox proportional hazard models were utilized to determine associations between antihypertensive drugs and recurrence, survival, and second primary cancer (SPC) occurrence. RESULTS: Hypertension itself was not a significant variable of recurrence and survival and no antihypertensive drug use affected SPC occurrence (all P > 0.1). After controlling for clinical factors, calcium-channel blocker use remained an independent variable for index cancer recurrence, and ß-blocker use was significantly associated with poor cancer-specific mortality, competing mortality, and all-cause mortality (all P < 0.05). ß-blocker use significantly affected competing and all-cause mortalities in normotensive patients, and calcium-channel blocker use affected index cancer recurrence in normotensive patients (all P < 0.05). CONCLUSIONS: Our data show that ß-blocker use is associated with decreased survival and calcium-channel blockers is associated with increased cancer recurrence in patients of HNSCC.

Psychology/Counseling: a universal competency in athletic training.

OBJECTIVE: To present the rationale that certified athletic trainers (ATCs) may require structured educational training in the psychological aspects of athletic injury. DATA SOURCES: We searched MEDLINE, Psych Lit, Psyc- INFO, First Search, and SPORT Discus databases for the years 1990 through 1999 under the search terms "psychological distress," "depression," "athletic injury," and "rehabilitation adherence." DATA SYNTHESIS: Psychological factors are significant predictors of athletic injury. Athletic injury is accompanied by significant psychological distress, which has been shown to impair rehabilitation compliance and possibly physical recovery. Although "counseling" and knowledge of psychological aspects of injury are required National Athletic Trainers' Association competencies, extant data suggest that athletic trainers may lack training in this competency. CONCLUSIONS: Evidence suggests that (1) psychological distress is prospectively associated with the incidence of athletic injury, and prolonged psychological distress, specifically depression, may occur after athletic injury; (2) psychological factors may also either hinder or facilitate rehabilitation adherence, compliance, and recovery; (3) psychological distress may persist even after physical recovery has been completed; (4) psychosocial factors related to injury occurrence and injury recovery may be overlooked by ATCs, but knowledge of these factors and appropriate use of referral sources may enhance the effectiveness of ATCs; and (5) ATCs may benefit from structured educational experiences specific to the National Athletic Trainers' Association psychology/counseling competency. RECOMMENDATIONS: With 75% of a national survey of ATCs indicating that they do not have access to a sport psychologist, it would be advantageous for ATCs to gain adequate training in the recognition, evaluation, and treatment of psychological factors associated with athletic injury. The literature also suggests that structured educational training with respect to psychological aspects of athletic injury would be well received by ATCs.