ABSTRACT
OBJECTIVE: To determine whether there is an association between duration of voriconazole therapy and number of nonmelanoma skin cancers (NMSC) after lung transplantation. DESIGN: A telephone-based survey and chart review were performed for all living patients who received a lung transplant at Emory University from 1993 to 2009. SETTING: Academic medical center. PARTICIPANTS: Lung transplant recipients. MAIN OUTCOME MEASURED: Number of NMSC after lung transplantation. RESULTS: Sixty of 91 (65.9%) subjects were exposed to voriconazole for at least 3 months (11.2 ± 8.7 months, range 3-58 months) after lung transplantation, of whom 16 developed NMSC, with a mean of 38 months to first NMSC. Of 31 patients not exposed to voriconazole, 12 developed NMSC, with a mean of 52 months to first NMSC . By univariate analysis, time since transplant (correlation coefficient (r) = 0.514), age (r = 0.101), and high lifetime sun exposure (r = 0.211) were correlated with number of skin cancers after transplantation. Skin types V and VI were protective (r = -0.353). In multivariate regression, time since transplantation (0.061 per month), age (0.151 per year), skin type I or II (4.939), and months of exposure to voriconazole (0.149) were found to be independent risk factors for number of skin cancers after lung transplantation. CONCLUSION: Duration of voriconazole exposure correlates with number of NMSC after lung transplantation. All patients exposed to voriconazole should be educated about their increased risk of skin cancer and should have regular dermatologic follow-up for skin cancer screening. Physicians caring for lung-transplant recipients should consider alternatives to voriconazole in patients at risk for skin cancer.
Subject(s)
Antifungal Agents/adverse effects , Lung Transplantation , Pyrimidines/adverse effects , Skin Neoplasms/chemically induced , Triazoles/adverse effects , Antifungal Agents/therapeutic use , Female , Humans , Immunocompromised Host , Male , Middle Aged , Mycoses/immunology , Mycoses/prevention & control , Pyrimidines/therapeutic use , Risk Factors , Skin Neoplasms/etiology , Triazoles/therapeutic use , VoriconazoleABSTRACT
BACKGROUND: Perceptual Control Theory (PCT) suggests that psychological distress can be conceptualized as the by-product of conflicted control systems. METHOD: Using a program of psychotherapy based on the principles of PCT called the Method of Levels (MOL), a 12-month study was conducted with 120 patient participants and 4 clinicians. In this study, analyses of statistical significance were conducted. Qualitative data were also analysed to understand psychotherapy from patients' perspectives. Data were collected on the attendance patterns of patients, their ages, referral problem, and socio-economic background. A standardized questionnaire measured pre and post treatment effects. The null hypothesis of no difference between pre and post treatment scores was examined by the derivation of p values and the construction of 95% confidence intervals. RESULTS: In all cases the null hypothesis was rejected. CONCLUSIONS: Results suggest that MOL is a useful form of psychotherapy that warrants further investigation.
