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1.
Pathology ; 54(1): 49-54, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34955242

ABSTRACT

Previous reports have shown that quantification of high tumour grade is of prognostic significance for patients with prostate cancer. In particular, percent Gleason pattern 4 (GP4) has been shown to predict outcome in several studies, although conflicting results have also been reported. A major issue with these studies is that they rely on surrogate markers of outcome rather than patient survival. We have investigated the prognostic predictive value of quantifying GP4 in a series of prostatic biopsies containing Gleason score 3+4=7 and 4+3=7 tumours. It was found that the length of GP4 tumour determined from the measurement of all biopsy cores from a single patient, percent GP4 present and absolute GP4 were all significantly associated with distant progression of tumour, all-cause mortality and cancer-specific mortality over a 10-year follow-up period. Assessment of the relative prognostic significance showed that these parameters outperformed division of cases according to Gleason score (3+4=7 versus 4+3=7). International Society of Urological Pathology (ISUP) Grade Groups currently divide these tumours, according to Gleason grading guidelines, into grade 2 (3+4=7) and grade 3 (4+3=7). Our results indicate that this simple classification results in the loss of important prognostic information. In view of this we would recommend that ISUP Grade Groups 2 and 3 be amalgamated as grade 2 tumour with the percentage of GP4 carcinoma being appended to the final grade, e.g., 3+4=7 carcinoma with 40% pattern 4 tumour would be classified as ISUP Grade Group 2 (40%).


Subject(s)
Adenocarcinoma/pathology , Prognosis , Prostatic Neoplasms/pathology , Biopsy, Large-Core Needle , Humans , Male , Neoplasm Grading/methods , Prostate/pathology , Prostatectomy , Retrospective Studies
2.
Article in English | MEDLINE | ID: mdl-28776784

ABSTRACT

The EORTC Quality of Life Group has just completed the final phase (field-testing and validation) of an international project to develop a stand-alone measure of spiritual well-being (SWB) for palliative cancer patients. Participants (n = 451)-from 14 countries on four continents; 54% female; 188 Christian; 50 Muslim; 156 with no religion-completed a provisional 36-item measure of SWB plus the EORTC QLQ-C15-PAL (PAL), then took part in a structured debriefing interview. All items showed good score distribution across response categories. We assessed scale structure using principal component analysis and Rasch analysis, and explored construct validity, and convergent/divergent validity with the PAL. Twenty-two items in four scoring scales (Relationship with Self, Relationships with Others, Relationship with Someone or Something Greater, and Existential) explained 53% of the variance. The measure also includes a global SWB item and nine other items. Scores on the PAL global quality-of-life item and Emotional Functioning scale weakly-moderately correlated with scores on the global SWB item and two of the four SWB scales. This new validated 32-item SWB measure addresses a distinct aspect of quality-of-life, and is now available for use in research and clinical practice, with a role as both a measurement and an intervention tool.


Subject(s)
Christianity , Islam , Neoplasms/therapy , Palliative Care , Religion and Medicine , Spirituality , Adolescent , Adult , Aged , Aged, 80 and over , Emotions , Female , Humans , Interpersonal Relations , Male , Middle Aged , Neoplasms/psychology , Quality of Life , Reproducibility of Results , Surveys and Questionnaires , Young Adult
3.
Article in English | MEDLINE | ID: mdl-27647712

ABSTRACT

Cancer patients with bone metastases have previously been excluded from participation in physical activity programmes due to concerns of skeletal fractures. Our aim was to provide initial information on the association between physical activity levels and physical and mental health outcomes in prostate cancer patients with bone metastases. Between 2012 and 2015, 55 prostate cancer patients (mean age 69.7 ± 8.3; BMI 28.6 ± 4.0) with bone metastases (58.2% >2 regions affected) undertook assessments for self-reported physical activity, physical and mental health outcomes (SF-36), objective physical performance measures and body composition by DXA. Sixteen men (29%) met the current aerobic exercise guidelines for cancer survivors, while 39 (71%) reported lower aerobic exercise levels. Men not meeting aerobic exercise guidelines had lower physical functioning (p = .004), role functioning (physical and emotional) (p < .05), general health scores (p = .014) as well all lower measures of physical performance (p < .05). Lower levels of aerobic exercise are associated with reduced physical and mental health outcomes in prostate cancer patients with bone metastases. While previous research has focused primarily in those with non-metastatic disease, our initial results suggest that higher levels of aerobic exercise may preserve physical and mental health outcomes in prostate cancer patients with bone metastases. Clinical Trial Registry: Trial Registration: ACTRN12611001158954.


Subject(s)
Bone Neoplasms/physiopathology , Exercise , Mental Health , Prostatic Neoplasms/physiopathology , Absorptiometry, Photon , Adipose Tissue , Aged , Body Composition , Bone Neoplasms/psychology , Bone Neoplasms/secondary , Cross-Sectional Studies , Health Status , Humans , Male , Middle Aged , Prostatic Neoplasms/pathology , Prostatic Neoplasms/psychology , Role , Self Report , Walk Test
4.
Pathology ; 47(6): 520-5, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26325671

ABSTRACT

In 2014 a consensus conference convened by the International Society of Urological Pathology (ISUP) adopted amendments to the criteria for Gleason grading and scoring (GS) for prostatic adenocarcinoma. The meeting defined a modified grading system based on 5 grading categories (grade 1, GS 3+3; grade 2, GS 3+4; grade 3, GS 4+3; grade 4, GS 8; grade 5, GS 9-10). In this study we have evaluated the prognostic significance of ISUP grading in 496 patients enrolled in the TROG 03.04 RADAR Trial. There were 19 grade 1, 118 grade 2, 193 grade 3, 88 grade 4 and 79 grade 5 tumours in the series, with follow-up for a minimum of 6.5 years. On follow-up 76 patients experienced distant progression of disease, 171 prostate specific antigen (PSA) progression and 39 prostate cancer deaths. In contrast to the 2005 modified Gleason system (MGS), the hazards of the distant and PSA progression endpoints, relative to grade 2, were significantly greater for grades 3, 4 and 5 of the 2014 ISUP grading scheme. Comparison of predictive ability utilising Harrell's concordance index, showed 2014 ISUP grading to significantly out-perform 2005 MGS grading for each of the three clinical endpoints.


Subject(s)
Adenocarcinoma/pathology , Neoplasm Grading , Prostatic Neoplasms/pathology , Adenocarcinoma/mortality , Adenocarcinoma/therapy , Adult , Aged , Androgen Antagonists/administration & dosage , Antineoplastic Agents/administration & dosage , Biopsy, Large-Core Needle , Chemoradiotherapy/methods , Consensus Development Conferences as Topic , Diphosphonates/administration & dosage , Humans , Imidazoles/administration & dosage , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Grading/methods , Neoplasm Grading/standards , Pathology, Surgical/standards , Proportional Hazards Models , Prostatic Neoplasms/mortality , Prostatic Neoplasms/therapy , Societies, Medical , Urology/standards , Zoledronic Acid
6.
Osteoporos Int ; 25(11): 2663-8, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24993816

ABSTRACT

UNLABELLED: The bone-specific physical activity questionnaire (BPAQ) accounts for activities that affect bone but has not been used in studies with older adults. Relationships exist between the BPAQ-derived physical activity and bone density in healthy middle-aged and older men but not men with prostate cancer. Disease-related treatments detrimental to bone should be considered when administering the BPAQ. INTRODUCTION: The bone-specific physical activity questionnaire (BPAQ) was developed to account for bone-specific loading. In this retrospective study, we examined the relationship between BPAQ-derived physical activity and bone mineral density (BMD) in middle-aged and older men with and without prostate cancer. METHODS: Two groups, 36 healthy men and 69 men with prostate cancer receiving androgen suppression therapy (AST), completed the BPAQ and had whole body, total hip, femoral (FN) and lumbar spine BMD assessed by dual-energy X-ray absorptiometry. RESULTS: Past (pBPAQ), current (cBPAQ) and total BPAQ (tBPAQ) scores for the healthy men were related to FN BMD (pBPAQ r = 0.36, p = 0.030; cBPAQ r s = 0.35, p = 0.034; tBPAQ r = 0.41, p = 0.014), and pBPAQ and tBPAQ were related to total hip (r s = 0.35, p = 0.035 and r s = 0.36, p = 0.029, respectively) and whole body BMD (r s = 0.44, p = 0.007 and r s = 0.45, p = 0.006, respectively). In men with prostate cancer, the BPAQ was not significantly associated with BMD. In stepwise regression analyses, body mass and tBPAQ predicted 30 % of the variance in total hip BMD (p = 0.003), cBPAQ predicted 14 % of the variance in FN BMD (p = 0.002), and body mass, age and tBPAQ predicted 47% of the variance in whole body BMD (p < 0.001) in healthy men. In men with prostate cancer, the BPAQ was not an independent predictor of BMD. CONCLUSIONS: Although BPAQ-derived estimates of physical activity are related to bone status in healthy middle-aged and older men, the adverse effect of AST on bone appears to obscure this relationship in men with prostate cancer.


Subject(s)
Bone Density/physiology , Motor Activity/physiology , Absorptiometry, Photon/methods , Aged , Aged, 80 and over , Aging/physiology , Antineoplastic Agents, Hormonal/pharmacology , Antineoplastic Agents, Hormonal/therapeutic use , Bone Density/drug effects , Femur Neck/physiology , Femur Neck/physiopathology , Hip Joint/physiology , Hip Joint/physiopathology , Humans , Lumbar Vertebrae/physiology , Lumbar Vertebrae/physiopathology , Male , Middle Aged , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/physiopathology , Retrospective Studies , Surveys and Questionnaires
7.
Prostate Cancer Prostatic Dis ; 16(4): 328-35, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23917308

ABSTRACT

BACKGROUND: Due to concerns of fragility fracture, exercise is a perceived contraindication for prostate cancer patients with bone metastases. These patients experience significant functional impairment and muscle atrophy, which may lead to an increased likelihood of skeletal complicaTIOns (i.e., pathological fracture, bone pain) and/or falls. Safe resistance exercise prescription may counteract this effect. The aim of this feasibility trial was to determine the safety and efficacy of resistance exercise by prostate cancer survivors with bone metastatic disease. METHODS: Twenty men with established bone metastases secondary to prostate cancer were randomly assigned to a 12-week resistance exercise program in which exercise prescription was based on the location of bone lesions (n=10) or usual care (n=10). Outcomes included safety and tolerance of the exercise program, physical function, physical activity level, body composition, fatigue, quality of life and psychological distress. Outcomes were compared between groups using analysis of covariance adjusted for baseline values. RESULTS: Participants had significant disease load with 65% of participants presenting with two or more regions affected by bone metastases and an average Gleason score of 8.2±0.9. Five participants (exercise=2; usual care=3) did not complete the intervention, three of which were due to advancing disease (exercise=2; usual care=1). No adverse events or skeletal complications occurred during the supervised exercise sessions. The exercise program was well tolerated as evidenced by high attendance (83%) and compliance rates (93%), and the ability of the participants to exercise at an intensity within the target range for cancer survivors (rating of perceived exertion =13.8±1.5). The change in physical function (muscle strength ∼11%; submaximal aerobic exercise capacity ∼5% and ambulation ∼12%), physical activity level (∼24%) and lean mass (∼3%) differed significantly between groups following the intervention, with favorable changes in the exercise group compared with the usual care group. No significant between-group differences were observed for fatigue, quality of life or psychological distress. CONCLUSIONS: This initial evidence involving a small sample size suggests that appropriately designed and supervised resistance exercise may be safe and well tolerated by prostate cancer patients with bone metastatic disease and can lead to improvements in physical function, physical activity levels and lean mass. Future trials involving larger sample sizes are required to expand these preliminary findings.


Subject(s)
Bone Neoplasms/secondary , Exercise Therapy , Exercise , Muscular Atrophy/etiology , Muscular Atrophy/rehabilitation , Prostatic Neoplasms/pathology , Aged , Aged, 80 and over , Body Composition , Bone Neoplasms/complications , Exercise Therapy/adverse effects , Fatigue , Humans , Male , Middle Aged , Muscular Atrophy/physiopathology , Pilot Projects , Prostatic Neoplasms/complications , Quality of Life , Risk Factors , Stress, Psychological , Treatment Outcome
8.
Support Care Cancer ; 21(6): 1725-33, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23381060

ABSTRACT

PURPOSE: Although patients receive information prior to commencing radiotherapy, they often experience anxiety and distress. We conducted a pilot randomised controlled trial to determine whether a radiation therapist led psycho-educational intervention for breast cancer patients prior to radiotherapy is likely to be effective in reducing radiotherapy-related concerns, patient anxiety and depression. METHODS: The intervention comprised two face-to-face consultations with a radiation therapist (one prior to radiation planning and the other prior to treatment). Patients completed surveys at baseline, prior to treatment planning and on the first day of treatment. Outcome measures included the Hospital Anxiety and Depression Scale, Radiation Therapy Related Patient Concerns and Radiation Therapy Knowledge Scales. RESULTS: One hundred and twenty two patients completed baseline measures. Fifty-eight patients received usual care, and 64 received the intervention. After the first consultation, patient anxiety was significantly lower in the intervention group (p = 0.048), as were concerns about radiotherapy (p = 0.001). There were no differences between groups for depression. Patient knowledge for the intervention group was higher after the first consultation (p < 0.001). CONCLUSION: This intervention is likely to be effective in reducing patient anxiety and concerns and increasing knowledge. Future research is required to test this intervention with a larger population.


Subject(s)
Breast Neoplasms/psychology , Breast Neoplasms/radiotherapy , Patient Education as Topic/methods , Radiotherapy/psychology , Adult , Aged , Anxiety/prevention & control , Anxiety/psychology , Chemoradiotherapy/methods , Chemoradiotherapy/psychology , Depression/prevention & control , Depression/psychology , Female , Humans , Middle Aged , Pilot Projects , Radiotherapy/methods , Referral and Consultation
9.
Prostate Cancer Prostatic Dis ; 16(2): 170-5, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23318529

ABSTRACT

BACKGROUND: Previous research has shown exercise to be an effective method to mitigate many adverse treatment-related effects of androgen suppression therapy (AST) but the potential impact of exercise on sexual activity remains unknown. The purpose of this investigation was to report the effect of a 12-week exercise program on sexual activity in prostate cancer patients undergoing AST. METHODS: Fifty-seven prostate cancer patients undergoing AST were randomly assigned to an exercise program (resistance and aerobic modes; n=29) or usual care control (n=28). Sexual activity was assessed by the European Organization for Research and Treatment of Cancer prostate cancer-specific quality of life questionnaire (QLQ-PR25). RESULTS: QLQ-PR25 data were log transformed and analysis of covariance was used to compare sexual activity between groups following the intervention adjusted for baseline activity. No differences in sexual activity were observed between the exercise and control groups before the intervention. There was a significant (P=0.045) adjusted group difference in sexual activity following the 12-week intervention. Patients undergoing usual care decreased sexual activity while patients in the exercise program maintained their level of sexual activity. At baseline, 20.6 and 22.2% of participants in the exercise and control groups reported a major interest in sex (that is, high libido). Following the intervention, the exercise group had a significantly higher percentage of participants reporting a major interest in sex (exercise=17.2% vs control=0%; P=0.024). CONCLUSIONS: Participation in a short-term exercise program resulted in the maintenance of sexual activity in prostate cancer patients undergoing AST.


Subject(s)
Exercise Therapy , Prostatic Neoplasms/therapy , Sexual Behavior , Aged , Aged, 80 and over , Humans , Kallikreins/blood , Male , Middle Aged , Neoplasms, Hormone-Dependent/blood , Neoplasms, Hormone-Dependent/therapy , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Quality of Life , Surveys and Questionnaires , Testosterone/blood , Treatment Outcome
10.
Prostate Cancer Prostatic Dis ; 16(1): 67-72, 2013 Mar.
Article in English | MEDLINE | ID: mdl-22907511

ABSTRACT

BACKGROUND: To examine changes to whole body and regional lean mass (LM) and fat mass (FM) over 33 months of intermittent androgen suppression therapy (IAST). METHODS: Phase II cohort study of 72 prostate cancer patients without metastatic bone disease. Patients received flutamide 250 mg tid and leuprolide 22.5 mg three monthly depot for the 9-month initial treatment phase (iTREAT), at which point patients ceased therapy providing PSA <4 ng ml(-1) with continued monitoring for further 2 years (POST). AST was recommenced when PSA exceeded pretreatment level or ≥ 20 ng ml(-1). Body composition was assessed using dual energy X-ray absorptiometry at baseline, completion of treatment phase, and 1 and 2 years post treatment phase (months 21 and 33). RESULTS: LM decreased by 1.3 kg and FM increased by 2.3 kg (P<0.001) following iTREAT. During the POST period, there were no further adverse effects on LM or FM, but also no recovery to pretreatment levels. Patients who failed to recover testosterone by month 33 experienced a significant increase in FM compared with those who recovered eugonadal levels of testosterone (10 nmol ml(-1); P = 0.019). Change in testosterone was moderately correlated to changes in % FM (r = -0.314, P<0.028) and LM (r = 0.300, P<0.036) during POST phase. Waist circumference progressively increased over time and by 2 years, POST had not recovered to baseline levels. CONCLUSIONS: Loss of LM and gain in FM during the 9-month iTREAT was not reversed during 2-year POST, although further deterioration was not observed. Subgroup analysis identified those recovering testosterone showed some body composition improvements. These findings suggest potential benefits of IAST, where testosterone levels are able to recover, to reduce the ongoing adverse effects on body composition, such as the acceleration of sarcopenia and risks associated with metabolic disease.


Subject(s)
Androgen Antagonists/administration & dosage , Body Composition/drug effects , Flutamide/administration & dosage , Leuprolide/administration & dosage , Prostatic Neoplasms/drug therapy , Absorptiometry, Photon , Adipose Tissue , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Time
11.
Prostate Cancer Prostatic Dis ; 15(4): 329-38, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22733158

ABSTRACT

Androgen suppression treatment (AST) for men with prostate cancer is associated with a number of treatment-related side effects including an accelerated rate of bone loss. This loss of bone is greatest within the first year of AST and increases the risk for fracture. Pharmaceutical treatment in the form of bisphosphonates is currently used to counter the effects of hormone suppression on bone but is costly and associated with potential adverse effects. Recently, exercise has been shown to be an important adjuvant therapy to manage a range of treatment-related toxicities and enhance aspects of quality of life for men receiving AST. We propose that physical exercise may also have an important role in not only attenuating the bone loss associated with AST but in improving bone health and reducing fracture risk. In this review, the rationale underlying exercise as a countermeasure to AST-induced bone loss is provided.


Subject(s)
Androgen Antagonists , Bone Diseases, Metabolic/therapy , Exercise Therapy , Osteoporosis , Prostatic Neoplasms/drug therapy , Androgen Antagonists/adverse effects , Androgen Antagonists/therapeutic use , Androgens/metabolism , Androgens/physiology , Humans , Male , Osteoporosis/chemically induced , Osteoporosis/therapy , Prostatic Neoplasms/physiopathology
12.
Br J Cancer ; 106(1): 61-9, 2012 Jan 03.
Article in English | MEDLINE | ID: mdl-22134511

ABSTRACT

BACKGROUND: Locally advanced inoperable pancreatic cancer (LAPC) has a poor prognosis. By increasing intensity of systemic therapy combined with an established safe chemoradiation technique, our intention was to enhance the outcomes of LAPC. In preparation for phase III evaluation, the feasibility and efficacy of our candidate regimen gemcitabine-oxaliplatin chemotherapy with sandwich 5-fluorouracil (5FU) and three-dimensional conformal radiotherapy (3DCRT) needs to be established. METHODS: A total of 48 patients with inoperable LAPC without metastases were given gemcitabine (1000 mg m(-2) d1 + d15 q28) and oxaliplatin (100 mg m(-2) d2 + d16 q28) in induction (one cycle) and consolidation (three cycles), and 5FU 200 mg m(-2) per day over 6 weeks during 3DCRT 54 Gy. RESULTS: Median duration of sustained local control (LC) was 15.8 months, progression-free survival (PFS) was 11.0 months, and overall survival was 15.7 months. Survival rates for 1, 2, and 3 years were 70.2%, 21.3%, and 12.8%, respectively. Global quality of life did not significantly decline from baseline during treatment, which was associated with modest treatment-related toxicity. CONCLUSION: Fixed-dose gemcitabine and oxaliplatin, combined with an effective and safe regimen of 5FU and 3DCRT radiotherapy, was feasible and reasonably tolerated. The observed improved duration of LC and PFS with more intensive therapy over previous trials may be due to patient selection, but suggest that further evaluation in phase III trials is warranted.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Pancreatic Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Biomarkers, Tumor/blood , CA-19-9 Antigen/blood , Combined Modality Therapy , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Female , Fluorouracil/administration & dosage , Humans , Male , Middle Aged , Organoplatinum Compounds/administration & dosage , Oxaliplatin , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/radiotherapy , Quality of Life , Treatment Outcome , Gemcitabine
13.
Eur J Cancer Care (Engl) ; 21(2): 259-65, 2012 Mar.
Article in English | MEDLINE | ID: mdl-22146103

ABSTRACT

The aim of this study was to assess general practitioner (GP) consultations with standardised patients presenting with cancer-related problems that might benefit from radiotherapy. Standardised patient scenarios were constructed with indications for radiotherapy or with side effects of radiotherapy. Six GPs consulted six standardised patients. All consultations were video recorded. Two GPs independently rated the consultation performance using the Leicester Assessment Package (LAP). Each consultation was also assessed by two radiation oncologists to assess specific decisions taken or advice offered to 'patients' in each case. The mean duration of consultations was 13 min and 55 s. Three GPs differed significantly (P < 0.025) in competencies measured by the LAP, but not as assessed by radiation oncologists. There was no significant difference in LAP scores when reviewed by scenario. However, there was significant differences in the management of the case with prostate cancer (P= 0.005) and data suggest that GPs management of different problems presented varied widely. These data are consistent with the published literature which suggests that in practice not all patients are appropriately advised or referred. There is a need for innovations to support GPs to manage patients who would benefit from radiotherapy.


Subject(s)
Case Management/standards , Clinical Competence/standards , Family Practice/standards , Neoplasms/radiotherapy , Referral and Consultation/standards , Adult , Aged , Attitude of Health Personnel , Female , Humans , Male , Middle Aged , Patient Simulation , Radiation Oncology/standards , Videotape Recording
14.
Phys Med Biol ; 55(11): N337-46, 2010 Jun 07.
Article in English | MEDLINE | ID: mdl-20463378

ABSTRACT

This study examined the variation of dose-volume histogram (DVH) data sourced from multiple radiotherapy treatment planning systems (TPSs). Treatment plan exports were obtained from 33 Australian and New Zealand centres during a dosimetry study. Plan information, including DVH data, was exported from the TPS at each centre and reviewed in a digital review system (SWAN). The review system was then used to produce an independent calculation of DVH information for each delineated structure. The relationships between DVHs extracted from each TPS and independently calculated were examined, particularly in terms of the influence of CT scan slice and pixel widths, the resolution of dose calculation grids and the TPS manufacturer. Calculation of total volume and DVH data was consistent between SWAN and each TPS, with the small discrepancies found tending to increase with decreasing structure size. This was significantly influenced by the TPS model used to derive the data. For target structures covered with relatively uniform dose distributions, there was a significant difference between the minimum dose in each TPS-exported DVH and that calculated independently.


Subject(s)
Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy/methods , Radiotherapy/standards , Australia , Humans , Models, Statistical , New Zealand , Radiometry/methods , Radiotherapy Dosage , Regression Analysis , Reproducibility of Results , Tomography, X-Ray Computed/methods
15.
Eur J Cancer Care (Engl) ; 19(4): 538-47, 2010 Jul.
Article in English | MEDLINE | ID: mdl-19708930

ABSTRACT

Previous research has reported that patients require specific information relating to radiotherapy; however, these studies fail to describe patients' specific information needs over time. The aims of this study were to determine the specific information needs of breast cancer patients who are receiving radiotherapy and identify when patients prefer to receive specific information. Semi-structured interviews were conducted with 34 early breast cancer patients and 14 health professionals. Seventeen patients were interviewed after treatment completion, and 17 patients were interviewed on at least two occasions during their radiotherapy. Grounded theory and the constant comparative method were used to analyse the data. Three main categories emerged from the data: 'repertoire of information', 'amount of information relating specifically to radiotherapy' and'tailoring information to match patients' radiotherapy journeys'. Patients' information needs were identified, and key messages and strategies to inform patients were described. This paper identifies breast cancer patient's specific information needs during radiotherapy and shows that patients' information needs are highest during their first appointment with their radiation oncologist and at the time of their planning appointment. The findings presented will enable health professionals to develop and refine their approaches to patient education in radiotherapy.


Subject(s)
Breast Neoplasms/radiotherapy , Communication , Patient Education as Topic/organization & administration , Patient Preference/psychology , Adolescent , Adult , Aged , Breast Neoplasms/psychology , Female , Health Personnel , Health Services Needs and Demand , Humans , Interviews as Topic , Middle Aged , Patient Education as Topic/standards , Young Adult
16.
Prostate Cancer Prostatic Dis ; 12(3): 233-40, 2009.
Article in English | MEDLINE | ID: mdl-19488067

ABSTRACT

Apart from the well-established adverse musculoskeletal and sexual health effects of androgen deprivation therapy (ADT), evidence is accumulating of substantial ADT-related cardiovascular and metabolic complications, which may impact quality of life and overall survival. In this brief review we discuss (1) the incidence of cardiovascular and metabolic complications during/following ADT from large cohort studies, (2) the increased risk factors for cardiovascular and metabolic disease from cross-sectional and prospective studies and (3) the use of physical exercise as a countermeasure in this new era of ADT-related toxicity. It is clear that exercise has the potential to provide a myriad of benefits to men undergoing ADT that may result in reduced morbidity and mortality, and subsequently improve quality of life.


Subject(s)
Androgen Antagonists/adverse effects , Exercise , Prostatic Neoplasms/drug therapy , Cardiovascular Diseases/etiology , Humans , Male , Metabolic Diseases/etiology , Risk Factors
17.
Prostate Cancer Prostatic Dis ; 12(2): 198-203, 2009.
Article in English | MEDLINE | ID: mdl-18852703

ABSTRACT

This study examined the effects of androgen suppression therapy (AST) on upper and lower body muscle strength and a range of direct measures of physical performance using a cross-sectional design with 118 men (48 men undertaking AST for prostate cancer and 70 healthy aged-matched controls) from a single tertiary center. Primary end points included muscle strength for the upper- and lower-body; functional performance--repeated chair rise, usual and fast 6-m walk, 6-m backwards walk and 400-m walk time; and dual-energy X-ray absorptiometry assessment--whole body, regional soft tissue composition and bone mineral density (BMD). Men on AST had significantly reduced muscle strength for the upper- and lower-body and impaired functional performance compared to controls (P<0.05). As expected, AST patients had significantly lower whole-body and hip BMD and higher percent of body fat than controls (P<0.05), and tended to have lower whole-body lean mass (-2.3 kg, P=0.077). Appendicular skeletal muscle was positively associated with upper-body (r=0.400-0.606, P<0.001) and lower-body (r=0.549-0.588, P<0.001) muscle strength, and strength was related to functional performance. Men undertaking AST were consistently impaired across a broad range of physical and functional musculoskeletal performance assessments compared with their age-matched normal controls. These findings are relevant for those patients considering AST for subclinical disease management, but whose physical reserve is marginal. Strategies to counter these adverse effects of AST need to be initiated so that independent living and quality of life can be maintained.


Subject(s)
Androgen Antagonists/adverse effects , Muscle Strength/drug effects , Muscle Weakness/chemically induced , Muscle, Skeletal/drug effects , Prostatic Neoplasms/drug therapy , Absorptiometry, Photon , Aged , Bone Density , Cross-Sectional Studies , Exercise Therapy , Gonadotropin-Releasing Hormone/agonists , Humans , Male , Physical Endurance/drug effects
18.
J Med Imaging Radiat Oncol ; 52(6): 598-604, 2008 Dec.
Article in English | MEDLINE | ID: mdl-19178636

ABSTRACT

Before a multicentre trial of 3-D conformal radiotherapy to treat cancer of the pancreas, participating clinicians were asked to complete an accreditation exercise. This involved planning two test cases according to the study protocol, then returning hard copies of the plans and dosimetric data for review. Any radiation technique that achieved the specified constraints was allowed. Eighteen treatment plans were assessed. Seven plans were prescribed incorrect doses and two of the planning target volumes did not comply with protocol guidelines. All plans met predefined normal tissue dose constraints. The identified errors were attributable to unforeseen ambiguities in protocol documentation. They were addressed by feedback and corresponding amendments to protocol documentation. Summary radiobiological measures including total weighted normal tissue equivalent uniform dose varied significantly between centres. This accreditation exercise successfully identified significant potential sources of protocol violations, which were then easily corrected. We believe that this process should be applied to all clinical trials involving radiotherapy. Due to the limitations of data analysis with hard-copy information only, it is recommended that complete planning datasets from treatment-planning systems be collected through a digital submission process.


Subject(s)
Accreditation/standards , Antineoplastic Agents/therapeutic use , Guideline Adherence/statistics & numerical data , Pancreatic Neoplasms/therapy , Practice Guidelines as Topic , Quality Assurance, Health Care/standards , Radiotherapy, Conformal/standards , Australia , Humans , Radiotherapy, Conformal/statistics & numerical data
19.
Prostate Cancer Prostatic Dis ; 11(2): 160-5, 2008.
Article in English | MEDLINE | ID: mdl-17637762

ABSTRACT

This study examined the effect of 20 weeks resistance training on a range of serum hormones and inflammatory markers at rest, and following acute bouts of exercise in prostate cancer patients undergoing androgen deprivation. Ten patients exercised twice weekly at high intensity for several upper and lower-body muscle groups. Neither testosterone nor prostate-specific antigen changed at rest or following an acute bout of exercise. However, serum growth hormone (GH), dehydroepiandrosterone (DHEA), interleukin-6, tumor necrosis factor-alpha and differential blood leukocyte counts increased (P < 0.05) following acute exercise. Resistance exercise does not appear to compromise testosterone suppression, and acute elevations in serum GH and DHEA may partly underlie improvements observed in physical function.


Subject(s)
Adenocarcinoma/physiopathology , Cytokines/blood , Exercise Therapy , Hormones/blood , Inflammation Mediators/blood , Prostatic Neoplasms/physiopathology , Weight Lifting/physiology , Adenocarcinoma/blood , Adenocarcinoma/drug therapy , Adenocarcinoma/immunology , Androgen Antagonists/adverse effects , Androgen Antagonists/therapeutic use , Antineoplastic Agents, Hormonal/adverse effects , Antineoplastic Agents, Hormonal/therapeutic use , Biomarkers , Bone Remodeling , Dehydroepiandrosterone/blood , Exercise Therapy/adverse effects , Follow-Up Studies , Human Growth Hormone/blood , Humans , Interleukin-6/blood , Leukocyte Count , Male , Muscle Contraction , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/immunology , Tumor Necrosis Factor-alpha/blood
20.
Br J Cancer ; 97(4): 464-71, 2007 Aug 20.
Article in English | MEDLINE | ID: mdl-17653074

ABSTRACT

The aim of this phase II study was to assess the feasibility and efficacy of a specific three-dimensional conformal radiotherapy technique with concurrent continuous infusion of 5-fluorouracil (CI 5FU) sandwiched between gemcitabine chemotherapy in patients with locally advanced pancreatic cancer. Patients with inoperable cancer in the pancreatic head or body without metastases were given gemcitabine at 1000 mg m(-2) weekly for 3 weeks followed by a 1-week rest and a 6-week period of radiotherapy and concurrent CI 5FU (200 mg m(-2) day(-1)). The defined target volume was treated to 54 Gy in 30 daily fractions of 1.8 Gy. After 4 weeks' rest, gemcitabine treatment was re-initiated for three cycles (days 1, 8, 15, q28). Forty-one patients were enrolled. At the end of radiotherapy, one patient (2.4%) had a complete response and four patients (9.6%) had a partial response; at the end of treatment, three patients (7.3%) had a complete response and two patients (4.9%) had a partial response. Median survival time was 11.7 months, median time to progression was 7.1 months, and median time to failure of local control was 11.9 months. The 1- and 2-year survival rates were 46.3 and 9.8%, respectively. Treatment-related grade 3 and 4 toxicities were reported by 16 (39.0%) and four (9.8%) patients, respectively. Sixteen out of 41 patients did not complete the planned treatment and nine due to disease progression. This approach to treatment of locally advanced pancreatic cancer is safe and promising, with good local control for a substantial proportion of patients, and merits testing in a randomised trial.


Subject(s)
Adenocarcinoma/drug therapy , Adenocarcinoma/radiotherapy , Deoxycytidine/analogs & derivatives , Fluorouracil/therapeutic use , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/radiotherapy , Radiotherapy, Conformal , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Aged , Chemotherapy, Adjuvant/adverse effects , Combined Modality Therapy/adverse effects , Deoxycytidine/adverse effects , Deoxycytidine/therapeutic use , Disease Progression , Dose-Response Relationship, Drug , Feasibility Studies , Female , Fluorouracil/adverse effects , Humans , Imaging, Three-Dimensional , Male , Middle Aged , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Radiotherapy, Computer-Assisted/adverse effects , Radiotherapy, Conformal/adverse effects , Survival Analysis , Treatment Outcome , Gemcitabine
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